title: New Dimensions in Renal Transplant Sonography: Applications of 3-Dimensional Ultrasound.
abstract: The aim of this study is to demonstrate the usefulness of adding 3-dimensional (3D) ultrasound in evaluation of renal transplant vasculature compared to 2-dimensional (2D) Duplex ultrasound.
  
  
  
  One hundred thirteen consecutive renal transplant 2D and 3D ultrasound examinations were performed and retrospectively reviewed by 2 board-certified radiologists and a radiology resident individually; each reviewed 2D and then 3D images, including color and spectral Doppler. They recorded ability to visualize the surgical anastomosis and rated visualization on a subjective scale. Interobserver agreement was evaluated. Variant anastomosis anatomy was recorded. Tortuosity or stenosis was evaluated if localized Doppler velocity elevation was present.
  
  
  
  The reviewers directly visualized the anastomosis more often with 3D ultrasound ((Equation is included in full-text article.)=97.5%) compared with 2D ((Equation is included in full-text article.)=54.5%) [difference in means (DM) = 43% (95% confidence interval (CI) = 36%-50%) (P < 0.001)]. The reviewers visualized the anastomosis more clearly with 3D ultrasound (P < 0.001) [difference in medians = 0.5, 1.0, and 1.0, (95% CI = 0.5-1.0, 0.5-1.0, and 1.0-1.5)]. Detection of variant anatomy improved with 3D ultrasound by 2 reviewers [DM = 7.1% and 8.9% (95% CI = 1%-13% and 4%-14%, respectively) (P < 0.05)]. There was high interobserver agreement [(Equation is included in full-text article.)= 95.3%, (95% CI = 91.9%-98.7%) regarding anastomosis visualization among reviewers with wide-ranging experience.
  
  
  
  Direct visualization of the entire anastomosis was improved with 3D ultrasound. Three-dimensional evaluation improved detection of anatomic variants and identified tortuosity as the likely cause of borderline localized elevation in Doppler velocity. The data added by 3D ultrasound may obviate confirmatory testing with magnetic resonance angiography or computed tomographic angiography after equivocal 2D ultrasound results.
authors.affiliation: 1 Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, Montefiore Medical Center, Bronx, NY. 2 NYU Langone Medical Center, New York, NY. 3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Frank
authors.forename: William R
authors.initials: WR
authors.lastname: Walter
authors.forename: Larry
authors.initials: L
authors.lastname: Latson
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.forename: Mordecai
authors.initials: M
authors.lastname: Koenigsberg
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012079:Renal Circulation; D012082:Renal Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*