Preoperative evaluation of living renal donors with gadolinium-enhanced magnetic resonance angiography.
BACKGROUND
Preoperative evaluation of living renal donors includes an intra-arterial digital subtraction angiography (DSA). Inasmuch as this technique is invasive, uses radiation and an iodine-containing contrast medium, an alternative technique would be preferable. The purpose of this study was to determine the accuracy of gadolinium-enhanced magnetic resonance (MR) angiography in the visualization of renovascular anatomy for the preoperative evaluation of renal donors.


METHODS
Twenty-four consecutive potential renal donors underwent gadolinium-enhanced MR angiography before the standard of reference, intra-arterial DSA. Both modalities were evaluated in a blinded manner. The results were correlated with the surgical findings.


RESULTS
Three MR angiograms were technically unacceptable because of inadequate breath-hold. The remaining 21 donors had 47 renal arteries, including 5 accessory renal arteries, which were all visualized by MR angiography. MR angiography failed to visualize one case of subtle fibromuscular dysplasia in the distal part of a renal artery. In one donor, a small accessory renal artery, which had not been visualized on DSA, was encountered during nephrectomy.


CONCLUSIONS
Gadolinium-enhanced MR angiography is an accurate minimally invasive method for the detection of accessory renal arteries in the preoperative evaluation of potential renal donors. The accuracy for excluding stenosis in general is high; however, the depiction of stenosis that are located far distally, or in the branch vessels, is less accurate. Advantages of gadolinium-enhanced MR angiography over the currently used method, intra-arterial DSA, are the minimal invasive nature, lower costs, and superiority in detecting venous anomalies, renal cysts, and tumors.
Bakker
J
J
Department of Radiology, University Hospital Utrecht, The Netherlands. jbakker@rrn.azu.nl
Ligtenberg
G
G
Beek
F J
FJ
van Reedt Dortland
R W
RW
Hené
R J
RJ
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D007674:Kidney Diseases / Q000175:diagnosis; D016030:Kidney Transplantation; D019520:Living Donors; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy
D005682:Gadolinium