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Helical CT evaluation of potential kidney donors: findings in 154 subjects
J F Platt1, J H Ellis, M Korobkin
1Department of Radiology, University of Michigan Hospital, Ann Arbor 48109-0030, USA.
Insights
Renal helical CT (RHCT) is effective for evaluating kidney donors, accurately identifying vascular and non-vascular findings. This technique reduces the need for multiple imaging procedures, lowering risks and costs for potential donors.
Area of Science:
- Radiology
- Nephrology
- Surgical Sciences
Background:
- Kidney transplantation is a vital treatment for end-stage renal disease.
- Accurate pre-transplant imaging of potential kidney donors is crucial for surgical success.
- Traditional imaging modalities may have limitations in fully characterizing renal anatomy.
Purpose of the Study:
- To evaluate the efficacy of renal helical CT (RHCT) as the primary imaging modality for potential kidney donors.
- To compare RHCT findings with established methods like renal arteriography and surgical outcomes.
Main Methods:
- 154 potential kidney donors underwent unenhanced and enhanced RHCT with 3-mm collimation.
- Contrast material (125-150 ml) was injected at 3-4 ml/sec with a pitch of 1.3-2.
- Scans were reconstructed at 1.5-mm intervals for 3D imaging and compared with renal arteriography (50 subjects) and surgery (117 subjects).
Main Results:
- RHCT demonstrated 95% agreement with surgical findings and 96% concordance with renal arteriography.
- RHCT identified 25 renal vein anomalies missed by other methods.
- Complementary axial and 3D CT images detected small accessory arteries, early arterial divisions, and renal artery stenosis. Non-vascular findings included calculi, cysts, and ureteral anomalies.
Conclusions:
- Renal helical CT serves as a reliable primary imaging technique for potential kidney donor assessment.
- RHCT can streamline the evaluation process, reducing the number of imaging examinations.
- Utilizing RHCT can decrease the overall risk and cost associated with donor screening.
Objective:
The purpose of our study was to assess renal helical CT (RHCT) as the primary imaging technique in the evaluation of potential kidney donors.
Subjects And Methods:
Unenhanced and enhanced (3-mm collimation) RHCT was performed in 154 kidney donors using 125-150 ml of i.v. contrast material at an injection rate of 3 or 4 ml/sec and a pitch of 1.3-2. Scans were reconstructed at 1.5-mm intervals for a three-dimensional image. RHCT images were compared with the results of renal arteriography (RA) (50 subjects) and surgery (117 subjects).
Results:
CT and surgical findings agreed in 95% of patients (111/117), with five cases of missed accessory arteries (all < 2 mm in diameter) and one case of a missed early division of the main artery. In the 50 subjects who underwent CT and RA, imaging revealed concordance in 96% of 100 kidneys. One small accessory artery was not detected by CT (origin from the common iliac artery). RA did not detect accessory arteries in three subjects. All 22 kidneys with early dividing main arteries (< 1.5 cm from the aortic origin) were identified by both RHCT and RA. Axial and three-dimensional CT images were complementary: five small accessory arteries were seen well only on the axial sections, whereas four early dividing arteries and two cases of renal artery stenosis were prospectively identified only on the three-dimensional images. Twenty-five renal vein anomalies were detected only by CT. In the full series of 154 subjects, nonvascular renal findings included renal calculi (n = 11), cysts (n = 12), duplicated ureters (n = 6), horseshoe kidney (n = 1), and pelvic kidney (n = 1).
Conclusion:
RHCT can be the primary imaging technique in the assessment of potential kidney donors, reducing the number of examinations as well as the risk and cost of imaging in these subjects.