RSS-Feed abonnieren
DOI: 10.1055/s-2007-963698
© Georg Thieme Verlag KG Stuttgart · New York
Donor-Evaluation vor Lebendnierenspende: Vergleich von CE-MRA und DSA an 78 Patienten
Preoperative Imaging in 78 Living Kidney Donors using CE-MRA and DSAPublikationsverlauf
eingereicht: 14.6.2007
angenommen: 22.10.2007
Publikationsdatum:
18. Dezember 2007 (online)

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
Literatur
- 1
Giessing M, Deger S, Schonberger B. et al .
Laparoscopic living donor nephrectomy: from alternative to standard procedure.
Transplant Proc.
2003;
35
2093-2095
MissingFormLabel
- 2 Kadir S. Atlas of normal and variant angiographic anatomy. W. B. Saunders Company 1991
MissingFormLabel
- 3
Abreu S C, Goldfarb D A, Derweesh I. et al .
Factors related to delayed graft function after laparoscopic live donor nephrectomy.
J Urol.
2004;
171
52-57
MissingFormLabel
- 4
Oh H K, Hawasli A, Cousins G.
Management of renal allografts with multiple renal arteries resulting from laparoscopic
living donor nephrectomy.
Clin Transplant.
2003;
17
353-357
MissingFormLabel
- 5
Hawasli A, Boutt A, Cousins G. et al .
Laparoscopic versus conventional live donor nephrectomy: experience in a community
transplant program.
Am Surg.
2001;
67
342-345
MissingFormLabel
- 6
Thornton M J, Thornton F, O’Callaghan J. et al .
Evaluation of dynamic gadolinium-enhanced breath-hold MR angiography in the diagnosis
of renal artery stenosis.
AJR Am J Roentgenol.
1999;
173
1279-1283
MissingFormLabel
- 7
Thornton J, O’Callaghan J, Walshe J. et al .
Comparison of digital subtraction angiography with gadolinium-enhanced magnetic resonance
angiography in the diagnosis of renal artery stenosis.
Eur Radiol.
1999;
9
930-934
MissingFormLabel
- 8
Kim J C, Kim C D, Jang M H. et al .
Can magnetic resonance angiogram be a reliable alternative for donor evaluation for
laparoscopic nephrectomy?.
Clin Transplant.
2007;
21
126-135
MissingFormLabel
- 9
Buzzas G R, Shield C F, Pay N T. et al .
Use of gadolinium-enhanced, ultrafast, three-dimensional, spoiled gradient-echo magnetic
resonance angiography in the preoperative evaluation of living renal allograft donors.
Transplantation.
1997;
64
1734-1737
MissingFormLabel
- 10
Vallet C, Bettschart V, Meuli R. et al .
Preoperative assessment of laparoscopic live kidney donors by gadolinium-enhanced
magnetic resonance angiography.
Transplant Proc.
2002;
34
795-796
MissingFormLabel
- 11
Israel G M, Lee V S, Edye M. et al .
Comprehensive MR imaging in the preoperative evaluation of living donor candidates
for laparoscopic nephrectomy: initial experience.
Radiology.
2002;
225
427-432
MissingFormLabel
- 12
Jha R C, Korangy S J, Ascher S M. et al .
MR angiography and preoperative evaluation for laparoscopic donor nephrectomy.
AJR Am J Roentgenol.
2002;
178
1489-1495
MissingFormLabel
- 13
Mittal T K, Evans C, Perkins T. et al .
Renal arteriography using gadolinium enhanced 3D MR angiography - clinical experience
with the technique, its limitations and pitfalls.
Br J Radiol.
2001;
74
495-502
MissingFormLabel
- 14
Bakker J, Ligtenberg G, Beek F J. et al .
Preoperative evaluation of living renal donors with gadolinium-enhanced magnetic resonance
angiography.
Transplantation.
1999;
67
1167-1172
MissingFormLabel
- 15
Adamis M K, Goldszer R C, Pulde M F. et al .
Renal vasculature in potential renal transplant donors: comparison of MR imaging and
digital subtraction angiography.
Radiology.
1995;
197
467-472
MissingFormLabel
- 16
Heinrich M, Uder M.
Nephrogene systemische Fibrose nach Anwendung gadoliniumhaltiger Kontrastmittel -
ein Statuspapier zum aktuellen Stand des Wissens.
Fortschr Röntgenstr.
2007;
179
613-617
MissingFormLabel
- 17
Heinrich M, Uder M.
Hydrierung zur Prävention der Kontrastmittel-induzierten Nephropathie: Ein Update.
Fortschr Röntgenstr.
2006;
178
378-384
MissingFormLabel
- 18
Svetkey L P, Dunnick N R, Coffman T M. et al .
Comparison of intravenous digital subtraction angiography and conventional arteriography
in defining renal anatomy.
Transplantation.
1988;
45
56-58
MissingFormLabel
- 19
Turk I A, Deger S, Davis J W. et al .
Laparoscopic live donor right nephrectomy: a new technique with preservation of vascular
length.
J Urol.
2002;
167
630-633
MissingFormLabel
- 20
Debatin J F, Sostman H D, Knelson M. et al .
Renal magnetic resonance angiography in the preoperative detection of supernumerary
renal arteries in potential kidney donors.
Invest Radiol.
1993;
28
882-889
MissingFormLabel
- 21
Gourlay W A, Yucel E K, Hakaim A G. et al .
Magnetic resonance angiography in the evaluation of living-related renal donors.
Transplantation.
1995;
60
1363-1366
MissingFormLabel
- 22
Meyers S P, Talagala S L, Totterman S. et al .
Evaluation of the renal arteries in kidney donors: value of three-dimensional phase-contrast
MR angiography with maximum-intensity-projection or surface rendering.
AJR Am J Roentgenol.
1995;
164
117-121
MissingFormLabel
- 23
Prince M R, Yucel E K, Kaufman J A. et al .
Dynamic gadolinium-enhanced three-dimensional abdominal MR arteriography.
J Magn Reson Imaging.
1993;
3
877-881
MissingFormLabel
- 24
Prince M R, Narasimham D L, Stanley J C. et al .
Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major
branches.
Radiology.
1995;
197
785-792
MissingFormLabel
- 25
Low R N, Martinez A G, Steinberg S M. et al .
Potential renal transplant donors: evaluation with gadolinium-enhanced MR angiography
and MR urography.
Radiology.
1998;
207
165-172
MissingFormLabel
- 26
Diaz J M, Guirado L, Facundo C. et al .
Assessment of the arteries in living kidney donors: correlation of magnetic resonance
angiography with intraoperative findings.
Transplant Proc.
2006;
38
2376-2377
MissingFormLabel
- 27
Hodgson D J, Jan W, Rankin S. et al .
Magnetic resonance renal angiography and venography: an analysis of 111 consecutive
scans before donor nephrectomy.
BJU Int.
2006;
97
584-586
MissingFormLabel
- 28
Prosst R L, Fernandez E D, Neff W. et al .
Evaluation of MR-angiography for pre-operative assessment of living kidney donors.
Clin Transplant.
2005;
19
522-526
MissingFormLabel
- 29
Raman S S, Pojchamarnwiputh S, Muangsomboon K. et al .
Surgically relevant normal and variant renal parenchymal and vascular anatomy in preoperative
16-MDCT evaluation of potential laparoscopic renal donors.
AJR Am J Roentgenol.
2007;
188
105-114
MissingFormLabel
- 30
Tsuda K, Murakami T, Kim T. et al .
Helical CT angiography of living renal donors: comparison with 3D Fourier transformation
phase contrast MRA.
J Comput Assist Tomogr.
1998;
22
186-193
MissingFormLabel
- 31
Kim T, Murakami T, Takahashi S. et al .
Evaluation of renal arteries in living renal donors: comparison between MDCT angiography
and gadolinium-enhanced 3D MR angiography.
Radiat Med.
2006;
24
617-624
MissingFormLabel
- 32
Rastogi N, Sahani D V, Blake M A. et al .
Evaluation of living renal donors: accuracy of three-dimensional 16-section CT.
Radiology.
2006;
240
136-144
MissingFormLabel
- 33
Sahani D V, Kalva S P, Hahn P F. et al .
16-MDCT angiography in living kidney donors at various tube potentials: impact on
image quality and radiation dose.
AJR Am J Roentgenol.
2007;
188
115-120
MissingFormLabel
- 34
Vogt F M, Herborn C U, Parsons E C. et al .
Diagnostische Wertigkeit der kontrastverstärkten Magnetresonanzangiografie der Beckenstrombahn
mit dem intravaskulären Kontrastmittel Vasovist®: Erste klinische Erfahrungen im Vergleich
zur i. a. DSA.
Fortschr Röntgenstr.
2007;
179
412-420
MissingFormLabel
- 35
Leiner T, Schoenberg S O.
Current status of renal artery magnetic resonance imaging: theoretical and practical
considerations and the potential role of blood-pool contrast agents.
Eur Radiol.
2007;
17
B13-B17
MissingFormLabel
- 36
Goyen M, Shamsi K, Schoenberg S O.
Vasovist-enhanced MR angiography.
Eur Radiol.
2006;
16
B9-B14
MissingFormLabel
- 37
Henness S, Keating G M.
Gadofosveset.
Drugs.
2006;
66
851-857
MissingFormLabel
- 38
Klessen C, Hein P A, Huppertz A. et al .
First-Pass Whole-Body Magnetic Resonance Angiography (MRA) Using the Blood-Pool Contrast
Medium Gadofosveset Trisodium: Comparison to Gadopentetate Dimeglumine.
Invest Radiol.
2007;
42
659-664
MissingFormLabel
- 39
Michaely H J, Nael K, Schoenberg S O. et al .
Die Machbarkeit von räumlich hoch-aufgelöster Magnetresonanzangiographie (MRA) der
Nierenarterien bei 3.0 T.
Fortschr Röntgenstr.
2005;
177
800-804
MissingFormLabel
Dr. Uta Lemke
Charité, Institut für Radiologie
Charitéplatz 1
10117 Berlin
Telefon: ++ 49/30/4 50 62 73 47
Fax: ++ 49/30/4 50 52 79 11
eMail: uta.lemke@charite.de