Lemke U, Taupitz M, Klüner C, Giessing M, Schönberger B, Hamm B, Kröncke T J
Institut für Radiologie, Charité-Universitätsmedizin Berlin, Berlin.
Rofo. 2008 Jan;180(1):48-54. doi: 10.1055/s-2007-963698.
To evaluate contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) in comparison with the intraoperative findings in living kidney donors.
A total of 156 kidneys in 78 potential kidney donors were prospectively examined using CE-MRA (0.2 mmol Gd/kg, voxel size 1.3 x 0.8 x 2.0) and DSA. Two experienced radiologists assessed the images in consensus regarding the renal vascular anatomy and variants. The results for the 67 candidates accepted for donation were compared to the intraoperative findings. In the other kidneys not accepted for donor nephrectomy, MRA and DSA were compared with each other.
Nineteen arterial variants were identified intraoperatively, of which 11 (58%) were also detected by preoperative CE-MRA and 10 (53%) by preoperative DSA. Of the 10 venous variants found intraoperatively, CE-MRA detected 8 (80%) and DSA 3 (30%). The agreement (kappa test) between MRI and DSA for all 156 evaluated kidneys was 0.7 for arterial variants (McNemar p=0.12) and 0.3 for venous variants (McNemar p=0.01). The preoperative choice of kidney (right or left) made on the basis of the renal vascular anatomy seen on CE-MRA and DSA differed in 22% of the 78 potential donors (McNemar p=0.3).
Our results in a large group of potential living kidney donors suggest that CE-MRA and DSA are comparable for detecting arterial renal variants while CE-MRA is superior for identifying venous variants. The preoperative choice of transplant kidney was not significantly influenced by the different results of CE-MRA and DSA.
评估对比增强三维磁共振血管造影（CE-MRA）和数字减影血管造影（DSA）与活体肾供体术中所见的对比情况。
对78名潜在肾供体的156个肾脏进行前瞻性检查，采用CE-MRA（0.2 mmol钆/千克，体素大小1.3×0.8×2.0）和DSA。两名经验丰富的放射科医生就肾血管解剖结构和变异情况达成共识后对图像进行评估。将67名被接受捐赠的候选者的检查结果与术中所见进行比较。在其他未被接受进行供肾切除术的肾脏中，对MRA和DSA进行相互比较。
术中发现19种动脉变异，其中术前CE-MRA检测出11种（58%），术前DSA检测出10种（53%）。术中发现的10种静脉变异中，CE-MRA检测出8种（80%），DSA检测出3种（30%）。对于所有156个评估肾脏，MRI和DSA在动脉变异方面的一致性（kappa检验）为0.7（McNemar p = 0.12），在静脉变异方面为0.3（McNemar p = 0.01）。基于CE-MRA和DSA所见的肾血管解剖结构在术前对肾脏（右或左）的选择上，78名潜在供体中有22%存在差异（McNemar p = 0.3）。
我们在一大组潜在活体肾供体中的研究结果表明，CE-MRA和DSA在检测肾动脉变异方面具有可比性，而CE-MRA在识别静脉变异方面更具优势。CE-MRA和DSA的不同结果对移植肾的术前选择没有显著影响。
