Preoperative Imaging in 78 Living Kidney Donors using CE-MRA and DSA

PURPOSE: 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. MATERIALS AND METHODS: 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 × 0.8 × 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. RESULTS: 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). CONCLUSION: 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.