Renal transplant evaluation with MR angiography and MR imaging

Magnetic resonance (MR) angiography is a widely used, noninvasive tool for evaluating the aorta and its branches. It is particularly useful in renal transplant recipients because it provides anatomic detail of the transplant artery without nephrotoxic effects. Volume rendering is underutilized in MR angiography, but this technique affords high-quality three-dimensional MR angiograms, especially in cases of tortuous or complex vascular anatomy. An imaging protocol was developed that includes gadolinium-enhanced MR angiography of the transplant renal artery with volume rendering and multiplanar reformation postprocessing techniques. Axial T2-weighted and contrast material-enhanced T1-weighted MR images are also obtained to examine the renal parenchyma itself and to evaluate for hydronephrosis or peritransplant fluid collections. This imaging protocol allows rapid global assessment of the renal transplant arterial system, renal parenchyma, and peritransplant region. It can also help detect or exclude many of the various causes of renal transplant dysfunction (eg, stenosis or occlusion of a transplant vessel, peritransplant fluid collections, ureteral obstruction). Conventional angiography can thus be avoided in patients with normal findings and reserved for those with MR angiographic evidence of stenosis.