Pre-donation Assessment of Kidneys by Magnetic Resonance Angiography and Venography: Accuracy and Impact on Outcomes

Abstract

Reports on the accuracy of magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) in evaluating living donor renovasculature employ few patients or omit the consequences of inaccurate scans. We retrospectively compared intraoperative findings to MRA/MRV scans in 146 donorrecipient pairs. For detecting accessory arteries and early branching, MRA sensitivity was 57.6%, specificity 96.5%, false positive rate 3.5%, false negative rate 42.4%, positive predictive value 82.6%, negative predictive value 88.6% and overall accuracy 87.7%. By excluding clinically inconsequential accessory arteries, MRA sensitivity rose to 73.1%, specificity to 96.7% and overall accuracy to 92.5%. For MRVs, sensitivity was 56.2%, specificity 99%, false positive rate 1%, false negative rate 43.8%, positive predictive value 90%, negative predictive value 94.8% and accuracy 94.5%. Inaccurate scans were associated with prolonged donor and recipient operations and more frequently reconstructed arteries, but did not affect clinical outcomes. Because most missed accessory arteries are inconsequential, MRA is a useful, less invasive method for defining donor renovascular anatomy.

Evaluation of the vascular anatomy in potential living kidney donors with gadolinium‐enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings

“…reported a series of 146 potential donors investigated with MRA. In their study, MRA detected only 19 of 33 accessory arteries found at transplantation (a sensitivity of 57.6%) and the false positive rate was 3.5% (11). Hodgson et al.…”

“…However, this technique misses small diameter vessels. Although most missed accessory arteries are inconsequential (11), the importance of preserving lower polar accessory arteries should be considered. MRA has the advantage of avoiding exposure to ionizing radiation therapy, potentially nephrotoxic contrast material and is non‐invasive.…”

Comparison of computed tomographic angiography and noncontrast magnetic resonance angiography in preoperative evaluation of living renal donors

“…[4589] As CTA is associated with significant amount of radiation, and intravenous contrast administration, several studies evaluated the role of MR in preoperative renal donor evaluation. [678] The NC MRA technique of ASL with 3D SSFP sequence has been evaluated in some recent studies to assess renal vascular anatomy and has produced promising results. [2122] In the current study, we compared Inhance Inflow IR Renal MRA, basically ASL with 3D SSFP sequence and CTA in preoperative renal donors evaluation.…”

“…The missed renal artery/early branch may increase procedure time and or additional back table procedure with more frequent reconstructed arteries rather than an unacceptable clinical outcome. [6]…”

“…Computed tomographic (CT) or magnetic resonance angiography (MRA) is the currently used for this purpose. [56789]…”