Schlunt LB, Harper JD, Broome DR, Baron PW, Watkins GE, Ojogho OK, Baldwin DD. . "Improved Detection of Renal Vascular Anatomy Using Mulit-detector CT Angiography:is 100 % Detection Possible ?." Journal of Endourology 2007; 21(1): 12-17. ( 7/2007 - 7/2008 )
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Background and Purpose: Multidetector CT angiography (MDCTA) is being used increasingly to evaluate vascular anatomy prior to donor nephrectomy. To improve the ability of MDCTA to predict donor renal anatomy, a novel protocol including four-phase imaging with three-dimensional reconstruction and maximum intensity projections (MIPs) was incorporated into the standard donor evaluation. The purpose of this study was to determine the results of this protocol. Patients and Methods: Seventy consecutive patients who underwent hand-assisted laparoscopic donor nephrectomy between January 2003 and September 2004 were reviewed. All MDCTA studies were examined initially by a radiologist alone, after which, a second preoperative reading was performed by a radiologist and the operating surgeon together. The two reviews were compared with the operative findings. Results: Using this protocol to detect the total number of renal arteries, veins, and ureters, the sensitivity of the initial radiologist was 97%, 100%, and 96%, respectively. These values increased to 100%, 100%, and 99% when the films were reviewed by a radiologist together with the surgeon who would operate on the donor. The sensitivity, specificity, and accuracy in predicting supernumerary arteries, including early (1-cm) arterial branching was 89%, 100%, and 97%, respectively after the single reading but increased to 100%, 100%, and 100% with the combined reading. Conclusions: An MDCTA study with this protocol provides excellent anatomic detail prior to donor nephrectomy. Its ability to predict renal-arterial and ureteral anatomy is enhanced when the films are reviewed simultaneously by a radiologist and the operating surgeon. http://www.ncbi.nlm.nih.gov/pubmed/17263601 |
