Israel Gary M, Lee Vivian S, Edye Michael, Krinsky Glenn A, Lavelle Michael T, Diflo Thomas, Weinreb Jeffrey C
Department of Radiology, NYU Medical Center, 560 First Ave, Suite HW 202, New York, NY 10016, USA.
Radiology. 2002 Nov;225(2):427-32. doi: 10.1148/radiol.2252011671.
To evaluate the accuracy of magnetic resonance (MR) imaging in the preoperative evaluation of potential living renal donors who are candidates for laparoscopic nephrectomy.
Twenty-eight donor candidates who underwent subsequent laparoscopic nephrectomy were examined by using a torso phased-array coil at 1.5 T. Gadolinium-enhanced MR angiograms, MR venograms, and MR urograms were obtained in all patients by using an interpolated three-dimensional T1-weighted spoiled gradient-echo sequence (3.4-6.8/1.2-2.3 [repetition time msec/echo time msec], 25 degrees -40 degrees flip angle). Interpretation of the MR images was used to assess the arterial, venous, and ureteral anatomy, as well as parenchymal masses and scarring, and findings were compared with the surgical findings in all patients. Statistical evaluation was performed, with the surgical findings as the reference standard.
At MR imaging, 31 of 32 renal arteries and one of three early-branching arteries were identified correctly. The correct venous anatomy was identified in 23 of 28 patients, including a single left renal vein anterior to the aorta (n = 16), retroaortic left renal vein (n = 2), circumaortic left renal vein (n = 2), and single right renal vein (n = 3). A single collecting system in all harvested kidneys was identified correctly with MR urography. Overall, MR imaging correctly depicted vascular, ureteral, and parenchymal anatomy in 21 of 28 patients. Twenty-seven of 28 patients underwent successful laparoscopic donor nephrectomy on the basis of the MR findings. One procedure was converted to open nephrectomy on the basis of complex venous anatomy not prospectively identified on the MR images. The sensitivity and positive predictive value of MR imaging in correctly determining the combined vascular, ureteral, and parenchymal anatomy in the harvested kidney were 75% (21 of 28) and 95% (21 of 22), respectively.
Comprehensive gadolinium-enhanced MR imaging can depict the vascular anatomy, collecting system, and renal parenchyma preoperatively in patients who are candidates for laparoscopic living-donor nephrectomy.
评估磁共振（MR）成像在术前评估拟行腹腔镜肾切除术的潜在活体肾供者中的准确性。
对28例随后接受腹腔镜肾切除术的供者候选者，采用体部相控阵线圈在1.5T磁场下进行检查。所有患者均采用插值三维T1加权扰相梯度回波序列（3.4 - 6.8/1.2 - 2.3[重复时间毫秒/回波时间毫秒]，25° - 40°翻转角）获得钆增强MR血管造影、MR静脉造影和MR尿路造影。通过对MR图像的解读来评估动脉、静脉和输尿管的解剖结构，以及实质肿块和瘢痕形成情况，并将所有患者的检查结果与手术结果进行比较。以手术结果作为参考标准进行统计学评估。
在MR成像中，32条肾动脉中的31条以及3条早期分支动脉中的1条被正确识别。28例患者中有23例的静脉解剖结构被正确识别，包括16例主动脉前方的单一左肾静脉、2例主动脉后方左肾静脉、2例主动脉周围左肾静脉和3例单一右肾静脉。MR尿路造影正确识别了所有切除肾脏中的单一集合系统。总体而言，MR成像在28例患者中的21例正确描绘了血管、输尿管和实质的解剖结构。28例患者中有27例基于MR检查结果成功进行了腹腔镜供肾切除术。1例手术因MR图像未前瞻性识别出的复杂静脉解剖结构而转为开放性肾切除术。MR成像在正确确定切除肾脏中血管、输尿管和实质联合解剖结构方面的敏感性和阳性预测值分别为75%（28例中的21例）和95%（22例中的21例）。
综合钆增强MR成像能够在拟行腹腔镜活体供肾切除术的患者术前描绘血管解剖结构、集合系统和肾实质。
