Gadofosveset-Enhanced MR Imaging for the Preoperative Evaluation of Potential Living Kidney Donors: Correlation with Intraoperative Findings

Zusammenfassung

Ziel: Das Ziel dieser Studie war die Evaluierung des Kontrastmittels Gadofosveset, welches in der Magnetresonanzangiografie (MRA) zur präoperativen Abklärung der renalen Gefäßanatomie bei potenziellen Lebendnierenspendern (LNS) eingesetzt wurde. Material und Methoden: Von 28 potenziellen LNS (13 Männer, 15 Frauen; Durchschnittsalter 55,14 Jahre ± 11,97), die initial in diese prospektive Studie eingeschlossen wurden, sind 20 operiert und weiterführend untersucht worden. Zur Beurteilung der Gefäßanatomie und des harnableitenden Systems sind bei 1,5 Tesla nach Applikation von Gadofosveset 7 Aufnahmeserien einer 3D T 1-gewichteten FLASH-Sequenz zu festgelegten Zeitpunkten durchgeführt worden. Alle MRT wurden prospektiv von 2 Radiologen im Konsensusmodus vor dem chirurgischen Eingriff analysiert. ROI-basierende relative Signalrauschverhältnisse in der Vena cava inferior und Aorta abdominalis wurden errechnet. Ergebnisse: Die MR-Datenakquisition wurde in allen potenziellen LNS vollständig durchgeführt. Bei 8 Nierenspendern waren zusätzliche CT-Untersuchungen vorliegend, die zur Evaluation der gegenüberliegenden, nicht gespendeten Niere dienten, wodurch sich eine Gesamtanzahl von 28 untersuchten Nieren ergab. Die MRA zeigte 36 Nierenarterien, bei 8 akzessorische Arterien, die in 8 Patienten gefunden worden sind. Eine akzessorische Arterie und ein Fall einer fibromuskulären Dysplasie wurden von der MRA übersehen. Die venöse Anatomie und die ableitenden Harnwege sind mit der MRT-Untersuchung korrekt identifiziert worden. Daneben wurden durch die MRT-Untersuchung zwei Nierenzellkarzinome diagnostiziert. Auf einer Pro-Nieren-Basis betragen in Zusammenschau die Sensitivität und der positive prädiktive Wert der gadofosveset-unterstützten MRT-Untersuchung 92,9 % bzw. 100 %. Schlussfolgerung: Gadofosveset ermöglicht eine präzise Evaluation von potenziellen LNS.

Abstract

Purpose: The purpose of this study was to evaluate the blood pool contrast agent gadofosveset for MR angiography (MRA) of the renal vasculature in living kidney donors (LKD). Materials and Methods: Of the 28 consecutive potential LKDs (13 men, 15 women; mean age 55.14 years ± 11.97) initially included in this prospective study, 20 patients underwent surgery and were considered for further evaluation. 7 acquisitions of a 3D T 1-weighted FLASH sequence were performed following administration of gadofosveset for the assessment of the vascular anatomy and collecting system at predefined time points at 1.5 T. All MR exams were prospectively analyzed by 2 radiologists in consensus mode prior to surgery. In addition, ROI-based relative SNR measurements were performed in the vena cava inferior and abdominal aorta. Results: MR image acquisition was completed in all 20 potential living donors. In 8 donors an additional CT scan was available for further comparison with the collateral anatomy, resulting in a total of 28 analyzed kidneys. MRA disclosed 36 renal arteries, since 8 accessory arteries were found in 8 subjects. One accessory artery and one case of fibromuscular dysplasia were missed by MRA. The venous anatomy and the collecting system were assessed correctly with MRI. In addition, MRI diagnosed two renal cell carcinomas. The overall sensitivity and positive predictive value of gadofosveset-enhanced MRI on a per kidney basis were 92.9 % and 100 %, respectively. Conclusion: Gadofosveset enables accurate evaluation of potential LKDs.

Key words

abdomen - renal arteries - renal veins - MR angiography - contrast agents

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