Zusammenfassung
Ziel: Evaluierung der kontrastverstärkten 3D-MR-Angiografie (CE-MRA) und der digitalen Subtraktionsangiografie (DSA) im Vergleich mit den intraoperativen Befunden bei Lebendnierenspendern. Material und Methoden: 156 Nieren von 78 potenziellen Nieren-Spendern wurden prospektiv mittels CE-MRA (0,2 mmol Gd/kg, Voxelgröße 1,3 × 0,8 × 2,0 mm) und DSA untersucht. Zwei erfahrene Radiologen beurteilten die Bilder im Konsensus bezüglich der renalen Gefäßanatomie und Varianten. Die Bilder der 67 von Urologen zur Explantation ausgewählten Nieren wurden mit dem intraoperativen Befund bezüglich der Gefäßanatomie verglichen, die MR- und DSA-Bilder der nicht explantierten übrigen Nieren wurden untereinander verglichen. Ergebnisse: Intraoperativ wurden 19 arterielle Varianten gefunden, von denen mit der CE-MRA 11 (58 %) und mit der DSA 10 (53 %) präoperativ ermittelt wurden, während von den 10 venösen Varianten mittels CE-MRA 8 (80 %) und mittels DSA 3 (30 %) detektiert wurden. Für sämtliche 156 evaluierte Nieren zeigte sich eine Übereinstimmung zwischen MRA und DSA bei den arteriellen Varianten von 0,7 (McNemar p = 0,12) und bei den venösen Varianten von 0,3 im Kappa-Test (McNemar p = 0,01). Die präoperative Wahl der Transplantatniere (rechts oder links) basierend auf der mittels CE-MRA oder DSA vorhergesagten renalen Gefäßanatomie differierte bei n = 17 (22 %) von 78 getesteten Patienten (McNemar p = 0,3). Schlussfolgerung: An unserem Patientenkollektiv konnte die Gleichwertigkeit der CE-MRA in der Detektion arterieller renaler Gefäßvarianten und die Überlegenheit in der Detektion venöser Gefäßvarianten gegenüber der DSA nachgewiesen werden. Die präoperative Wahl der Transplantatniere wurde durch die unterschiedlichen Befunde aus CE-MRA und DSA nicht signifikant beeinflusst.
Abstract
Purpose: To evaluate contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) in comparison with the intraoperative findings in living kidney donors. Materials and Methods: A total of 156 kidneys in 78 potential kidney donors were prospectively examined using CE-MRA (0.2 mmol Gd/kg, voxel size 1.3 × 0.8 × 2.0) and DSA. Two experienced radiologists assessed the images in consensus regarding the renal vascular anatomy and variants. The results for the 67 candidates accepted for donation were compared to the intraoperative findings. In the other kidneys not accepted for donor nephrectomy, MRA and DSA were compared with each other. Results: Nineteen arterial variants were identified intraoperatively, of which 11 (58 %) were also detected by preoperative CE-MRA and 10 (53 %) by preoperative DSA. Of the 10 venous variants found intraoperatively, CE-MRA detected 8 (80 %) and DSA 3 (30 %). The agreement (kappa test) between MRI and DSA for all 156 evaluated kidneys was 0.7 for arterial variants (McNemar p = 0.12) and 0.3 for venous variants (McNemar p = 0.01). The preoperative choice of kidney (right or left) made on the basis of the renal vascular anatomy seen on CE-MRA and DSA differed in 22 % of the 78 potential donors (McNemar p = 0.3). Conclusion: Our results in a large group of potential living kidney donors suggest that CE-MRA and DSA are comparable for detecting arterial renal variants while CE-MRA is superior for identifying venous variants. The preoperative choice of transplant kidney was not significantly influenced by the different results of CE-MRA and DSA.
Key words
renal arteries - renal veins - angiography - transplantation - MR angiography - living kidney donor
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Dr. Uta Lemke
Charité, Institut für Radiologie
Charitéplatz 1
10117 Berlin
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