Neville Christopher, House Andrew A, Nguan Christopher Y, Beasley Kenneth A, Peck David, Thain Lisa M F, Rankin Richard, McAlister Vivian C, Spouge Alison R, Luke Patrick P W
Division of Urology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada.
Urology. 2008 Mar;71(3):385-9. doi: 10.1016/j.urology.2007.10.030.
For years, the reference standard in the evaluation of living donor vascular anatomy has been selective renal angiography (SRA). Because of the potential morbidity associated with SRA, we prospectively evaluated magnetic resonance angiography (MRA) in the assessment of renal donors.
All patients had SRA and 53 renal units were prospectively evaluated by MRA. We used SRA supplemented by findings at donor nephrectomy (DN) as our standard. We defined a positive test as the detection of any abnormality in the number of renal arteries.
Selective renal angiography yielded a sensitivity of 86%, specificity of 95%, positive predictive value (PPV) of 75%, and negative predictive value (NPV) of 97% compared with findings at DN. MRA had a sensitivity of 64%, 88% specificity, 58% PPV, and 90% NPV. MRA correctly identified only 7 of 11 renal units with accessory arteries. MRA also incorrectly identified 5 accessory arteries not present on SRA or DN. Two patients diagnosed with fibromuscular dysplasia by SRA were missed using MRA.
We have shown that MRA is not capable of replacing SRA as the reference standard in renal donor imaging.
多年来，活体供体血管解剖评估的参考标准一直是选择性肾血管造影（SRA）。由于SRA存在潜在的发病率，我们前瞻性地评估了磁共振血管造影（MRA）在肾供体评估中的应用。
所有患者均接受了SRA检查，并对53个肾单位进行了MRA前瞻性评估。我们将SRA辅以供体肾切除术（DN）的结果作为我们的标准。我们将检测到肾动脉数量的任何异常定义为阳性检查。
与DN的结果相比，选择性肾血管造影的敏感性为86%，特异性为95%，阳性预测值（PPV）为75%，阴性预测值（NPV）为97%。MRA的敏感性为64%，特异性为88%，PPV为58%，NPV为90%。MRA仅正确识别出11个有副肾动脉的肾单位中的7个。MRA还错误地识别出SRA或DN上不存在的5条副肾动脉。两名经SRA诊断为纤维肌发育不良的患者在使用MRA时被漏诊。
我们已经表明，MRA不能取代SRA作为肾供体成像的参考标准。
Zotero 插件