Korean J Urol.  2011 Feb;52(2):124-129.

Prospective Evaluation of the Accuracy of MDCT Angiography for Living Kidney Donor

• Kim MU
• Choi KH
• Yang SC
• Oh YT
• Han WK

Abstract

PURPOSE
In donor nephrectomy, it is important to understand the exact anatomy of the blood vessels during minimally invasive surgery. We prospectively analyzed the accuracy of the vessel structures obtained by use of 64-row multi-detector computed tomography (MDCT) angiography compared with the actual vessel structure observed during surgery.
MATERIALS AND METHODS
We analyzed 238 patients who underwent donor nephrectomy from July 2007 to August 2010. Before the operation, MDCT angiography was performed, and after the operation, the surgeons themselves wrote the protocol. The ipsilateral artery, the number of veins, the association with the run of the hilar vessel, and other vascular anomalies in computed tomography (CT) angiography and in the donor protocol were summarized.
RESULTS
Among 238 patients, nephrectomy was performed on the left side in 199 patients. The accuracy of MDCT for the artery and the vein was 93.3% and 92.4%, respectively. Accuracy did not differ significantly on the left and right sides (artery: p=0.124; vein: p=0.174). In 199 patients, the CT findings for the lumbar vein were compared with the surgical findings. The overall accuracy was shown to be 84.9%, and the accuracy of the group drained to the inferior vena cava (54%) was significantly different (p<0.01) from that of the group drained to the renal vein (98.6%). Thus, it may be necessary to pay close attention to the interpretation of the findings for the lumbar vein.
CONCLUSIONS
MDCT angiography is important for understanding the exact anatomy of blood vessels before minimally invasive surgery. We showed that 64-channel MDCT has high accuracy in the main vessel and hilar vessels. However, close attention to the interpretation of the CT findings for the lumbar vein may be required.

Keyword

Kidney transplantation; Living donors; Renal artery; Renal veins; Spiral computed tomography

MeSH Terms

Angiography
Arteries
Blood Vessels
Glycosaminoglycans
Humans
Kidney
Kidney Transplantation
Living Donors
Nephrectomy
Prospective Studies
Renal Artery
Renal Veins
Tissue Donors
Tomography, Spiral Computed
Veins
Vena Cava, Inferior
Glycosaminoglycans

Figure

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  FIG. 1 (A) Actual image of the operation. (B) Structure with 1 renal artery (§) and 2 renal veins (★). 2 lumbar veins (†) merge and enter the lower renal vein. On the left side, the gonadal vein (*) is drained to the upper renal vein. The communication between the lumbar vein and the gonadal vein is shown. (C) Muti-detector computed tomography angiography of the same patient showing 1 renal artery and 2 renal veins. Lumbar veins were drained to the renal vein.

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  FIG. 2 (A) Actual image of the operation. (B) The lumbar vein (*) is drained to the renal vein (★), and the adrenal vein (◎) is drained to the renal vein.

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  FIG. 3 Muti-detector computed tomography (MDCT) angiography image of a 60-year-old man. Although 1 renal artery and 1 renal vein (▾) were observed in the left kidney, an additional vein was found on the upper pole of the kidney during the actual operation.

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