Türkvatan Aysel, Akinci Serkan, Yildiz Sener, Olçer Tülay, Cumhur Turhan
Department of Radiology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
Surg Radiol Anat. 2009 Apr;31(4):227-35. doi: 10.1007/s00276-008-0428-0. Epub 2008 Oct 25.
Currently, multidetector computed tomographic (MDCT) angiography has become a noninvasive alternative imaging modality to catheter renal angiography for the evaluation of renal vascular anatomy in living renal donors. In this study, we investigated the diagnostic accuracy of 16-slice MDCT in the preoperative assessment of living renal donors.
Fifty-nine consecutive living renal donors (32 men, 27 women) underwent MDCT angiography followed by open donor nephrectomy. All MDCT studies were performed by using a 16-slice MDCT scanner with the same protocol consisting of arterial and nephrographic phases followed by conventional abdominal radiography. The MDCT images were assessed retrospectively for the number and branching pattern of the renal arteries and for the number and presence of major or minor variants of the renal veins. The results were compared with open surgical results.
The sensitivity and specificity of MDCT for the detection of anatomic variants of renal arteries including the accessory arteries (n = 9), early arterial branching (n = 7) and major renal venous anomalies including the accessory renal veins (n = 3), late venous confluence (n = 4), circumaortic (n = 2) or retroaortic (n = 3) left renal veins were 100%. However, the sensitivity for identification of minor venous variants was 79%. All of three ureteral duplications were correctly identified at excretory phase conventional abdominal radiography.
Sixteen-slice MDCT is highly accurate for the identification of anatomic variants of renal arteries and veins. Dual-phase MDCT angiography including arterial and nephrographic phases followed by conventional abdominal radiography enables complete assessment of renal donors without significant increase of radiation dose. However, the evaluation of minor venous variants may be problematic because of their small diameters and poor opacification.
目前，多排螺旋计算机断层扫描（MDCT）血管造影已成为一种非侵入性的成像方式，可替代导管肾血管造影用于评估活体肾供体的肾血管解剖结构。在本研究中，我们调查了16层MDCT在活体肾供体术前评估中的诊断准确性。
59例连续的活体肾供体（32例男性，27例女性）接受了MDCT血管造影，随后进行开放性供肾切除术。所有MDCT检查均使用16层MDCT扫描仪，采用相同的方案，包括动脉期和肾实质期，随后进行常规腹部X线摄影。对MDCT图像进行回顾性评估，以确定肾动脉的数量和分支模式，以及肾静脉主要或次要变异的数量和存在情况。将结果与开放手术结果进行比较。
MDCT检测肾动脉解剖变异（包括副肾动脉，n = 9；早期动脉分支，n = 7）和主要肾静脉异常（包括副肾静脉，n = 3；晚期静脉汇合，n = 4；主动脉周围，n = 2或主动脉后，n = 3左肾静脉）的敏感性和特异性均为100%。然而，识别次要静脉变异的敏感性为79%。在排泄期常规腹部X线摄影中，所有3例输尿管重复均被正确识别。
16层MDCT在识别肾动静脉解剖变异方面具有高度准确性。包括动脉期和肾实质期的双期MDCT血管造影，随后进行常规腹部X线摄影，能够在不显著增加辐射剂量的情况下对肾供体进行全面评估。然而，由于其直径较小且造影剂充盈不佳，对次要静脉变异的评估可能存在问题。
