Prospective comparison of magnetic resonance angiography with selective renal angiography for living kidney donor assessment.
OBJECTIVE
For years, the reference standard in the evaluation of living donor vascular anatomy has been selective renal angiography (SRA). Because of the potential morbidity associated with SRA, we prospectively evaluated magnetic resonance angiography (MRA) in the assessment of renal donors.


METHODS
All patients had SRA and 53 renal units were prospectively evaluated by MRA. We used SRA supplemented by findings at donor nephrectomy (DN) as our standard. We defined a positive test as the detection of any abnormality in the number of renal arteries.


RESULTS
Selective renal angiography yielded a sensitivity of 86%, specificity of 95%, positive predictive value (PPV) of 75%, and negative predictive value (NPV) of 97% compared with findings at DN. MRA had a sensitivity of 64%, 88% specificity, 58% PPV, and 90% NPV. MRA correctly identified only 7 of 11 renal units with accessory arteries. MRA also incorrectly identified 5 accessory arteries not present on SRA or DN. Two patients diagnosed with fibromuscular dysplasia by SRA were missed using MRA.


CONCLUSIONS
We have shown that MRA is not capable of replacing SRA as the reference standard in renal donor imaging.
Neville
Christopher
C
Division of Urology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada.
House
Andrew A
AA
Nguan
Christopher Y
CY
Beasley
Kenneth A
KA
Peck
David
D
Thain
Lisa M F
LM
Rankin
Richard
R
McAlister
Vivian C
VC
Spouge
Alison R
AR
Luke
Patrick P W
PP
D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging*; D016030:Kidney Transplantation; D019520:Living Donors; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012077:Renal Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity