title: Preoperative planning of renal transplantation: a comparison of non-contrast-enhanced ultrasonography, computed tomography, and magnetic resonance angiography with observations from surgery.
abstract: BACKGROUND
  Many candidates for kidney transplantation need to undergo vessel examination before the transplantation procedure.
  
  
  OBJECTIVE
  To identify the optimal preoperative modality for the examination of vessel status without the use of contrast agents in kidney transplant candidates.
  
  
  METHODS
  Fifty-three consecutive patients were examined and 31 patients were transplanted. Ultrasonography (US), non-contrast-enhanced computed tomography (NCCT), and non-contrast-enhanced magnetic resonance angiography (NCMRA) were compared using inspection during kidney transplantation (TX) as a reference standard. The sensitivity and specificity to severe arteriosclerotic changes and the accuracy were calculated. Kappa statistics were used to assess the agreement between TX and the different examination modalities, and McNemar's test was used to test for significant differences.
  
  
  RESULTS
  US had higher sensitivity (1.0) and better agreement with observations from surgery (k = 0.89) than both NCCT (sensitivity = 0.60; k = 0.72) and NCMRA (sensitivity = 0.20; k = 0.30). No significant difference was found between TX and US (P = 0.3173) or TX and NCCT (P = 0.1573), but there was a significant difference between TX and NCMRA (P = 0.0455). US was inconclusive in 20% of cases, and the internal iliac artery could not be visualized in 69% of cases.
  
  
  CONCLUSIONS
  Either US or NCCT can be used as the preferred preoperative imaging modality to examine vessel status before kidney transplantation, but a combination of the two is preferable. NCMRA should not be used as the sole imaging modality for preoperative imaging before kidney transplantation because of its low sensitivity in detecting severe arteriosclerotic disease without the presence of stenosis.
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark anneblan@rm.dk.
authors.forename: Anne Dorte
authors.initials: AD
authors.lastname: Blankholm
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bodil G
authors.initials: BG
authors.lastname: Pedersen
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Brian
authors.initials: B
authors.lastname: Stausbøl-Grøn
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Gratien
authors.initials: G
authors.lastname: Andersen
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Arne
authors.initials: A
authors.lastname: Hørlyck
authors.affiliation: Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Ernst Ø
authors.initials: EØ
authors.lastname: Østrat
authors.affiliation: Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Sussie
authors.initials: S
authors.lastname: Laustsen
authors.affiliation: Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark MR Research Centre, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Steffen
authors.initials: S
authors.lastname: Ringgaard
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology; D016030:Kidney Transplantation; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: Magnetic resonance angiography (MRA); computed tomography (CT); kidney transplantation; magnetic resonance imaging (MRI); ultrasonography