title: Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study.
abstract: 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 (p=0.048), but for accessory vessels it was better for SSFP MRA.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Radiology Department, Royal United Hospital, Bath, UK. isabellaurence@doctors.org.uk
authors.forename: I
authors.initials: I
authors.lastname: Laurence
authors.forename: B
authors.initials: B
authors.lastname: Ariff
authors.forename: R A
authors.initials: RA
authors.lastname: Quest
authors.forename: S
authors.initials: S
authors.lastname: Moser
authors.forename: A
authors.initials: A
authors.lastname: Glover
authors.forename: D
authors.initials: D
authors.lastname: Taube
authors.forename: P
authors.initials: P
authors.lastname: Gishen
authors.forename: V
authors.initials: V
authors.lastname: Papalois
authors.forename: C
authors.initials: C
authors.lastname: Juli
mesh_terms: D000328:Adult; D003097:Collateral Circulation / Q000502:physiology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012077:Renal Artery / Q000002:abnormalities*; D012119:Respiration
chemical_list: D003287:Contrast Media