Prospective study comparing three‐dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors

Bhatti, Aftab; Chugtai, A; Haslam, Philip; Talbot, David; Rix, D.; Soomro, Naeem

doi:10.1111/j.1464-410x.2005.05809.x

Cited by 54 publications

(32 citation statements)

References 15 publications

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“…As stated by Shih and Hagspiel, no direct comparison of MRA and CTA for mesenteric artery stenosis has been published [6], and as there is no comparison of all three noninvasive modalities versus DSA as the reference standard available in the literature, our study offers the first comprehensive comparative results for all modalities in the evaluation of mesenteric artery stenosis. Corresponding to Bhatti et al [12] who found CTA superior to MRA in renal arteries, our data indicate the superiority of CTA over MRA and duplex US in the two mesenteric arteries. Loewe et al refer to the outstanding role of CTA as a safe, robust and reproducible modality for diagnosing diseased abdominal arteries, and they rated the broad majority of their evaluated abdominal arteries as of good or excellent image quality [13].…”

Section: Image Qualitysupporting

confidence: 59%

Comparison of Noninvasive Imaging Modalities for Stenosis Grading in Mesenteric Arteries

Schaefer

Pfarr

Trentmann

et al. 2013

Fortschr Röntgenstr

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Bildqualität wurde beurteilt mit 1-unzureichend, 2-schlecht, 3-mäßig, 4-gut oder 5-exzellent. Stenosen wurden eingeteilt in die Grade 1 (< 25 %), 2 (25 -< 50 %), 3 (50 -< 75 %) oder 4 (> 75 %). Mittels zweiseitigen Chi-Quadrat-Tests wurde die Korrelation in der Stenosegradbeurteilung zwischen den Modalitäten bestimmt. Mittels gewichtetem Cohen's-kappa wurde das Korrelationsmaß berechnet. Für nicht-relevante versus relevante Stenosen (Schwellenwert 50 %) wurden Sensitivität, Spezifität, PPV, NPV und Genauigkeit ermittelt. Ergebnisse: Die durchschnittliche Bildqualität für DSA/Duplex-Sonografie/CTA/MRA lag bei 3,8 ± 0,7/3,1 ± 1,0/4,4 ± 0,7/3,8 ± 0,9. Alle nicht-invasiven Modalitäten erreichten eine signifikante Korrelation in der Stenosegradbeurteilung für TC und AMS im Vergleich mit der DSA mit jeweils p < 0,001. Der gewichtete Cohen's-kappa betrug für Duplex-Sonografie/CTA/MRA für TC 0,94/ 0,93/0,74 und für AMS 0,64/ 0,91/ 0,56. Die höchste Sensitivität/Spezifität/NPV/PPV/Genauigkeit erreichte die CTA mit 100 %/95 %/85 %/ 100 %/96 % für den TC und mit na/98 %/na/100 %/ 98 % für die AMS. Schlussfolgerung: Bei bester Bildqualität erreichte die CTA das höchste Maß an Korrelation in der Stenosegradbeurteilung und bot die größte diagnostische Genauigkeit. Abstract !Objective: To prospectively analyze duplex sonography, CTA, and MRA with respect to stenosis grading of the celiac trunk (TC) and the superior mesenteric artery (SMA), with DSA as the reference. Materials and Methods: 52 subjects were enrolled (mean age: 71). The image quality was graded: 1-insufficient, 2-bad, 3-moderate, 4-good or 5-excellent. Stenosis was graded: 1 (< 25 %), 2 (25 -< 50 %), 3 (50 -75 %) or 4 (75 %). Two-sided chi-square tests were used to check for correlation of stenosis grading between modalities. The weighted Cohen's kappa was calculated to assess the strength of correlation. With a threshold of 50 % for non-relevant stenosis vs. relevant stenosis, the sensitivity, specificity, PPV, NPV, and accuracy were calculated. Results: The mean image quality was 3.8 ± 0.7, 3.1 ± 1.0, 4.4 ± 0.7, and 3.8 ± 0.9 for DSA, duplex sonography, CTA, and MRA, respectively. For both TC and SMA, stenosis grading reached a significant level of correlation between each noninvasive modality with DSA (p < 0.001, each). The weighted Cohen's kappa for duplex sonography/ CTA/MRA was 0.94/0.93/0.74, respectively, for the TC and 0.64/0.91/0.56, respectively, for the SMA. Highest sensitivity/specificity/NPV/PPV/ accuracy were found for CTA with 100 %/95 %/ 85 %/100 %/96 % for the TC and with na/98 %/na/ 100 %/98 %, respectively, for the SMA. Conclusion: CTA provided the best image quality, reached the highest level of agreement and significance in correlation in stenosis grading, and offered the best diagnostic accuracy.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Section: Image Qualitysupporting

confidence: 59%

Comparison of Noninvasive Imaging Modalities for Stenosis Grading in Mesenteric Arteries

Schaefer

Pfarr

Trentmann

et al. 2013

Fortschr Röntgenstr

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“…Findings have shown CT to be more accurate than magnetic resonance angiography in detecting renal arterial and venous anomalies [8]. In our study, 16% of the donor organs had multiple arteries.…”

Section: Discussionmentioning

confidence: 75%

Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation

et al. 2009

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The presence of multiple arteries or the need to procure the right kidney does not affect the operative outcome of laparoscopic donor nephrectomy. Warm ischemia time may be greater for these groups, but this does not result in delayed allograft function. The laparoscopic approach should be the standard of care even when expansion of the donor pool includes organs with multiple arteries and procurement of the right kidney.

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“…There has been debate as to the most appropriate method for demonstrating the renal vascular anatomy in potential renal donors [5,7,[25][26][27], but there is increasing evidence to support the sole use of CE MRA as a suitable method [4,6,9,[28][29][30]. However, the use of any contrast medium carries a potential risk and, in the case of gadolinium-based media, nephrotoxicity and allergic reactions can result [31,32], although they are infrequent and usually mild.…”

Section: Discussionmentioning

confidence: 99%

Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study

Laurence

Ariff²,

Quest³

et al. 2012

The British Journal of Radiology

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Objective: Accurate pre-operative evaluation of renal vascular anatomy is essential for successful renal harvest in live donor transplantation. Non-contrast renal MR angiographic (MRA) techniques are potentially well suited to the screening of donors; however, their restricted imaging field of view (FOV) has previously been an important limitation. We sought to assess whether the addition of a large FOV balanced fast field echo (BFFE) steady-state free precession (SSFP) sequence to non-contrast SSFP MRA could overcome this problem. Comparison with contrast-enhanced MRA (CE MRA) and findings at surgery were performed. Methods: 22 potential renal donors each underwent SSFP and CE MRA. 11 out of 22 potential donors subsequently underwent a donor nephrectomy. Results: All images were diagnostic. Both SSFP MRA and CE MRA identified an equal number of arteries. Surgery confirmed two accessory renal arteries, both demonstrated with both imaging techniques. A third accessory vessel was identified with both techniques on a kidney contralateral to the donated organ. 6 out of 11 procured kidneys demonstrated early branch arteries at surgery, 5 out of 6 of which had been depicted on both SSFP and CE MRA. The median grading of image quality for main renal arteries was slightly better for CE MRA (p50.048), but for accessory vessels it was better for SSFP MRA. Conclusion: This pilot study indicates that by combining free-breathing SSFP MRA with large-FOV bFFE images, an accurate depiction of renal vascular anatomy without the need for intravenous contrast administration can be obtained, as compared with surgical findings and CE MRA. Living donor transplantation is becoming an increasingly important treatment option for end-stage renal failure (ESRF). The high prevalence of anatomical variants in renal vascular anatomy underscores the importance of accurate pre-operative evaluation of the vascular anatomy [1, 2], particularly in patients undergoing a laparoscopic approach, as the surgical field of view (FOV) is limited. Multiple renal arteries in the donor kidney result in a substantial increase in the risk of complications. Moreover, the presence of accessory arteries and early branches of the renal arteries, as well as variants in venous anatomy, can all affect the surgical decision for suitability for donor harvest [3,4].Although there has been some debate about the optimal imaging strategy for potential renal donors [5][6][7], with concerns raised over the ability of contrast-enhanced MR angiography (CE MRA) to detect all renal arteries [8], there is evidence to support the sole use of CE MRA for this purpose [9]. Non-contrast MRA techniques have been used for several years, but have been generally overshadowed by the more popular contrast-enhanced techniques [10]. CT angiography is a proven tool in this domain. It also has the ability to detect parenchymal abnormalities and calculi; however, its use of ionising radiation is a disadvantage that should be considered when evaluating a donor population [11,12].Balanced steady-...

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Prospective study comparing three‐dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors

Cited by 54 publications

References 15 publications

Comparison of Noninvasive Imaging Modalities for Stenosis Grading in Mesenteric Arteries

Comparison of Noninvasive Imaging Modalities for Stenosis Grading in Mesenteric Arteries

Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation

Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study

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