Role of Multidetector Computed Tomography in the Preoperative - - PowerPoint PPT Presentation

Role of Multidetector Computed Tomography in the Preoperative Evaluation of Donor Kidney

Afak Durur Karakaya,Department of Radiology, Istanbul Medipol University, Istanbul, Turkey. Akin Levent,Department of Radiology, Ataturk University, Faculty of Medicine, Erzurum, Turkey.

Introduction/Background

• Multi-detector computed tomography (MDCT)

is an effective, fast, relatively non-invasive method for the preoperative evaluation of renal vascular structures.

Objective/Purpose

• This prospective study aimed to explore the role
• f MDCT in the pre-operative evaluation of

living donor kidneys.

Imaging Technique and Assessment

• The images of the donors were taken preoperatively using MDCT

angiography.

• (Toshiba aqullion 16 dedector CT, 16x0.5 mm colimation, 1,0 mm slice

thickness, 1,0 mm interslice gap).

• Nonionic contrast material with iodine with automatic injector was

applied with a speed of 4 – 4,5 ml/s. (90 cc, 300 mg/ml)

• The contrasted images were taken in the 35th second following IV

contrast material injection.

Imaging Technique and Assessment

• T

T T The images he images he images he images

• T

T T The axial original images, he axial original images, he axial original images, he axial original images,

• Multiplanar

Multiplanar Multiplanar Multiplanar reconstruction reconstruction reconstruction reconstruction (MPR) (MPR) (MPR) (MPR)

• Volume

Volume Volume Volume rendering rendering rendering rendering

• Maximal

Maximal Maximal Maximal intensity intensity intensity intensity projection projection projection projection (MIP) (MIP) (MIP) (MIP)

• 48 adult volunteers

48 adult volunteers 48 adult volunteers 48 adult volunteers

• Patients were examined for appropriateness for transplantation.

Patients were examined for appropriateness for transplantation. Patients were examined for appropriateness for transplantation. Patients were examined for appropriateness for transplantation.

• Vascular findings on MDCT were compared to operative findings by

Vascular findings on MDCT were compared to operative findings by Vascular findings on MDCT were compared to operative findings by Vascular findings on MDCT were compared to operative findings by Pearson’s correlation test for the operated patients Pearson’s correlation test for the operated patients Pearson’s correlation test for the operated patients Pearson’s correlation test for the operated patients

Imaging Technique and Assessment

• In the donors,
• Renal parenchym,
• Renal vascular structure
• Intraabdominal pathologies
• Renal artery
• Polar accessory
• Hilar accessory.
• Early branching
• The renal veins were named according to the relations with the vena cava inferior.
• Retroaortic
• Circumaortic

Findings and cases

• 48

48 48 48 patients patients patients patients (25 (25 (25 (25 -

• 60

60 60 60 age age age age) ) ) )

• 30

30 30 30 males males males males, 18 , 18 , 18 , 18 females females females females. . . .

• Of

Of Of Of these these these these patients patients patients patients, , , , only

• nly
• nly
• nly 28

28 28 28 were were were were found found found found to to to to be be be be convenient convenient convenient convenient donors donors donors donors. . . .

Findings and cases

• In the parenchymal assesment

Simple cyst Kidney stone

• In the arterial assessment

Early branching (3) Left accessory renal artery (5) Right accessory renal artery (2) Bilateral accessory renal artery (2)

• In the venous assessment, we found 4 cases.
• They were all on the left.
• Circumaortic renal vein (1)
• Retoaortic renal vein (3).

Discussion

When assessing the donor, kidney localisation and size, renal vascular structure, and the existence of tumour diseases accompanied must be well known. MDCT is a fast, non- invasive method with a low morbidity (1,2). MDCT enables us to evaluate both the renal parancim and the vascular structures together (3,4).

Conclusion

• MDCT is a non-invasive, cheap, easy imaging

method with a temporal and spatial high resolution.

References

• 1. Kawamoto S, Montgomery RA, Lawler LP, et al. Multidetector row CT evaluation
• f living renal donors prior to laparoscopic nephrectomy. Radiographics 2004; 24:

453–466.

• 2. Kim JK, Park SY, Kim HJ, et al. Living donor kidneys: usefulness of multi detector

row CT for comprehensive evaluation. Radiology 2003;229:869–876.

• 3. Rubin GD, Alfrey EJ, Dake MD, et al. Assessment of living renal donors with spiral
• CT. Radiology; 1995;195:457–462.
• 4. Platt JF, Ellis JH, Korobkin M, et al. Potential renal donors: comparison of

conventional imaging with helical CT. Radiology 1996;198:419–423.