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Multidetector Computed Tomography Angiography for Preoperative Anatomical and Functional Assessment of Living Renal
Surya Kant1, Anurag Singh2, Poonam Verma3
1Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND.
Insights
Multidetector computed tomography angiography accurately assesses renal vascular anatomy and provides reliable differential renal function in living kidney donors. This imaging technique is a comprehensive tool for donor evaluation, ensuring transplant safety and improving outcomes.
Area of Science:
- Radiology
- Nephrology
- Surgical Assessment
Background:
- Living donor renal transplantation is a primary treatment for end-stage renal disease, necessitating precise donor evaluation for safety and efficacy.
- Multidetector computed tomography (MDCT) angiography offers detailed anatomical and functional insights in a single session for potential donors.
Purpose of the Study:
- To evaluate the accuracy of MDCT angiography in mapping renal vascular anatomy compared to surgical findings.
- To compare MDCT-derived differential renal function with technetium-99m DTPA (Tc-99m DTPA) scintigraphy.
Main Methods:
- Sixty-four living kidney donors underwent MDCT angiography with a triple-bolus contrast protocol and Tc-99m DTPA renal scintigraphy.
- MDCT assessed renal arteries, veins, vascular variants, and collecting system abnormalities; surgical findings served as the gold standard.
- Differential renal function from MDCT was compared to scintigraphy using Pearson correlation and Bland-Altman analysis.
Main Results:
- MDCT angiography achieved 98.44% accuracy for renal arteries and 100% for renal veins.
- Sensitivity and specificity for detecting arterial variants were 98% and 100%, respectively; venous variant detection was 100%.
- MDCT-derived differential renal function showed significant correlation with Tc-99m DTPA scintigraphy (r=0.59 for right, r=0.55 for left kidney).
Conclusions:
- MDCT angiography excels in providing detailed renal vascular anatomy for living donor evaluation.
- The modality demonstrates moderate agreement with scintigraphy for differential renal function assessment.
- MDCT angiography is a dependable and comprehensive imaging choice for selected living kidney donor candidates.
Abstract:
Background Living donor renal transplantation is the most common treatment for end-stage renal disease, and correct donor evaluation is mandatory to ensure safety and improve outcomes. Multidetector computed tomography angiography offers high-resolution anatomical assessment and potential functional evaluation within a single imaging session. Aims and objectives The aim and objectives of the study were to analyse multidetector computed tomography accuracy in delineating renal vascular anatomy against surgical findings and compare multidetector computed tomography-derived differential renal function with technetium-99m DTPA (Tc-99m DTPA) scintigraphy. Material and methods Sixty-four living renal donors underwent multidetector computed tomography angiography using a triple-bolus contrast protocol, followed by Tc-99m DTPA renal scintigraphy. Renal arterial and venous anatomy, vascular variants, and collecting system abnormalities were evaluated on multidetector computed tomography. Surgical findings were used as the reference standard for vascular anatomy. Differential renal function calculated from computed tomography was compared with scintigraphy using Pearson correlation and Bland-Altman analysis. Results Multidetector computed tomography angiography correctly identified renal arteries in 98.44% (63/64) of donors and renal veins in 100% (64) of donors. Sensitivity and specificity for arterial variants were 98% and 100%, respectively, and 100% for venous variants. Multidetector computed tomography-derived differential renal function correlated significantly with scintigraphy-derived differential renal function (right kidney: r=0.59, p<0.01; left kidney: r=0.55, p<0.01) with a mean difference of 0.10% and 95% limits of agreement within ±6% for both kidneys. Conclusion Multidetector computed tomography angiography provides the best anatomical detail and shows a moderate agreement with scintigraphy for differential renal function. It is a reliable, comprehensive modality for living donor evaluation in appropriately selected candidates.
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