Holden Andrew, Smith Andrew, Dukes Paul, Pilmore Helen, Yasutomi Motohiko
Department of Radiology, Auckland City Hospital, Park Rd, Grafton, Auckland, New Zealand.
Radiology. 2005 Dec;237(3):973-80. doi: 10.1148/radiol.2373041303.
To retrospectively review the authors' experience with multi-detector row helical computed tomography (CT) in assessing 100 consecutive live potential renal donors.
Hospital ethical committee approval was obtained; informed patient consent was not required. One hundred potential renal donors underwent multi-detector row CT assessment. Nonenhanced, arterial phase, and nephrographic phase examinations were performed. Delayed topograms were acquired to visualize the collecting system anatomy. A vascular radiologist prospectively interpreted the multi-detector row CT images. A second vascular radiologist, blinded to the initial results, retrospectively reviewed the images. Eighty candidates subsequently underwent donor nephrectomy, including 70 laparoscopic donor nephrectomies (LDNs) and 10 open donor nephrectomies (ODNs). Surgical findings served as the reference standard for 80 kidneys. The imaging findings in all 100 candidates (200 kidneys) were reviewed, although these findings were considered observational data only because there was no reference standard for 120 kidneys.
Multi-detector row CT findings predicted uncomplicated LDN in 67 of 70 patients. Small upper-pole capsular arteries arising from the distal main renal artery in two patients were not described in the multi-detector row CT report: In one patient, the arising vessels resulted in conversion to ODN because of bleeding; in the other patient, arterial reconstruction was performed. In another patient, conversion to ODN was necessary because of ongoing bleeding from an avulsed large lumbar venous tributary to the left renal vein. Observational data revealed that multiple renal arteries--most of which were accessory renal arteries--were seen in 52 (26%) kidneys. Early branching of the main renal artery was seen in 24 (12%) kidneys, and main renal arterial abnormalities were identified in six (3%). Capsular arteries were detected in 10 (5%) kidneys. Major variations in the anatomy of the main renal veins--including multiple right renal veins, a retroaortic left renal vein, and a circumaortic left renal vein--were seen in 28 (14%) kidneys. Large (>5 mm in diameter) systemic tributaries to the left renal vein were seen in 25 (25%) kidneys. There was no significant interobserver disagreement between the vascular radiologists.
Multi-detector row CT findings can predict successful LDN in live potential renal donors.
回顾性分析作者使用多排螺旋计算机断层扫描（CT）评估100例连续活体潜在肾供体的经验。
获得医院伦理委员会批准；无需患者知情同意。100例潜在肾供体接受多排CT评估。进行了非增强、动脉期和肾实质期检查。采集延迟顶视图以显示集合系统解剖结构。一名血管放射科医生前瞻性解读多排CT图像。另一名血管放射科医生在不知道初始结果的情况下，回顾性复查图像。80名候选者随后接受了供体肾切除术，包括70例腹腔镜供体肾切除术（LDN）和10例开放性供体肾切除术（ODN）。手术结果作为80个肾脏的参考标准。对所有100名候选者（200个肾脏）的影像学结果进行了复查，不过由于120个肾脏没有参考标准，这些结果仅被视为观察性数据。
多排CT结果预测70例患者中的67例LDN无并发症。两名患者中源自肾动脉远端的小上极包膜动脉在多排CT报告中未被描述：一名患者中，出现的血管因出血导致转为ODN；另一名患者进行了动脉重建。另一名患者因左肾静脉撕脱的大腰静脉分支持续出血而有必要转为ODN。观察性数据显示，52个（26%）肾脏可见多条肾动脉——其中大多数为副肾动脉。24个（12%）肾脏可见肾动脉早期分支，6个（3%）肾脏发现肾动脉主干异常。10个（5%）肾脏检测到包膜动脉。28个（14%）肾脏可见肾静脉主干解剖结构的主要变异——包括多条右肾静脉、一条主动脉后左肾静脉和一条主动脉周围左肾静脉。25个（25%）肾脏可见左肾静脉的大（直径>5mm）体循环分支。血管放射科医生之间观察者间分歧不显著。
多排CT结果可预测活体潜在肾供体LDN的成功与否。
