Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Eur Radiol. 2023 Sep;33(9):6592-6598. doi: 10.1007/s00330-023-09578-0. Epub 2023 Apr 5.
We sought to examine the contribution of routine ultrasound when performed with computed tomography in identifying exclusion criteria in potential living kidney donors.
We performed a 10-year retrospective cohort study including all cases of potential renal donors at our center. For each case, the donor workup ultrasound (US) and multiphase computed tomography (MPCT) original reports and imaging were reviewed by a fellowship-trained abdominal radiologist in consultation with a transplant urologist and placed into one of 3 groups: (1) no significant US contribution, (2) US was useful to characterize an incidental finding (either US exclusive or US aided in CT interpretation) but did not impact donor eligibility, and (3) an US exclusive finding contributed to donor exclusion.
A total of 432 potential live renal donors were evaluated (mean age 41, 263 women). In total, 340 (78.7%, group 1) cases had no significant US contribution. In 90 cases (20.8%, group 2), US helped to characterize one or more incidental findings but did not contribute to donor exclusion. In 1 (0.2%, group 3) case, an US exclusive finding (suspected medullary nephrocalcinosis) contributed towards donor exclusion.
US provided limited contribution to renal donor eligibility decisions when performed routinely with MPCT.
Routine ultrasound could potentially be omitted in the live renal donor workup, with alternative strategies including a selective approach to incorporating ultrasound and an expanded role of dual-energy CT.
• Ultrasound is performed routinely with CT for renal donor assessment in some jurisdictions; however, this practice has come into question particularly with advances in dual-energy CT. • Our study found that routine use of ultrasound provided limited contribution, primarily assisting CT in characterization of benign findings with only 1/432 (0.2%) potential donors in a 10-year period excluded based in part on an ultrasound exclusive finding. • The role of ultrasound can be narrowed to a targeted approach for certain at-risk patients, and can be further reduced if dual-energy CT is utilized.
我们旨在研究在潜在活体供肾者中，当与计算机断层扫描（CT）联合使用时，常规超声检查对排除标准的贡献。
我们进行了一项为期 10 年的回顾性队列研究，纳入了我院所有潜在肾供者的病例。对于每个病例，由一名经过 fellowship培训的腹部放射科医生与移植泌尿科医生协商，对供者检查的超声（US）和多期 CT（MPCT）原始报告和影像进行审查，并将其归入以下 3 组之一：（1）US 无显著贡献；（2）US 有助于对偶然发现进行特征描述（US 单独或有助于 CT 解读），但不影响供者资格；（3）US 单独发现导致供者排除。
共评估了 432 例潜在的活体肾供者（平均年龄 41 岁，263 例女性）。共有 340 例（78.7%，组 1）无明显 US 贡献。在 90 例（20.8%，组 2）中，US 有助于对一个或多个偶然发现进行特征描述，但不影响供者排除。在 1 例（0.2%，组 3）中，US 单独发现（疑似髓质肾钙质沉着症）导致供者排除。
当与 MPCT 常规联合使用时，US 对肾供者资格决策的贡献有限。
在活体肾供者检查中，常规超声检查可能可以省略，替代策略包括选择性地采用超声检查和扩大双能 CT 的作用。
• 在某些司法管辖区，CT 常规用于评估肾供者；然而，随着双能 CT 的进步，这种做法受到了质疑。• 我们的研究发现，常规使用超声检查的贡献有限，主要是通过协助 CT 对良性发现进行特征描述，在 10 年期间，仅 1/432（0.2%）的潜在供者因部分基于超声单独发现而被排除。• 超声检查的作用可以缩小到对某些高危患者的靶向方法，如果使用双能 CT，还可以进一步减少。
