Radiologic Evaluation

The optimal imaging modality remains a matter of debate. Angiography, the classic gold standard for defining renal anatomy, is now rarely used. Currently Computerized Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA) is used to evaluate the donor kidneys, define vascular anatomy, and assess donors for other abdominal anomalies or pathology [8]. These imaging modalities are particularly important for assessing anatomic variations affecting the renal arteries, veins, or ureters (Fig. 2.1), which are an important consideration in determining the suitability of an individual for living kidney donation. In providing precise information on the anatomy of the renal vasculature and possible variants and diseases prior to surgery, CTA has reduced the risks and complications during and after renal transplantation, improving the likelihood of a successful outcome [10]. MRA is, however, considered equally accurate in defining renal anatomy and detecting incidental findings that may influence the decision about an individual’s suitability to be a living kidney donor. While MRA has the advantage of avoiding ionizing radiation and potentially

The CTA gives us wealth of information on the arterial anatomy. It gives us an idea about the prehilar branching, the number of vessels, and the relation of splenic vessels to the upper pole

Fig. 2.1 The CTA gives us wealth of information on the arterial anatomy. It gives us an idea about the prehilar branching, the number of vessels, and the relation of splenic vessels to the upper pole

nephrotoxic contrast agents, it is much less sensitive in detecting small renal or ureteral stones [9]. Ultimately the choice of imaging modality should probably be based on local imaging expertise and specific protocols.

All potential donors should have a chest x-ray.

Knowledge of the surgical techniques performed and the exclusion criteria allows radiologists to write an accurate radiological report. The radiological arterial report must include renal artery atherosclerosis, aneurysms, arteriovenous malformations and arteriovenous fistulas, dissection, thrombosis, and fibromuscular dysplasia.

The venous report should include the venous variants of the inferior vena cava (duplication, left location, etc.) and the renal veins (retroaortic, circumaortic) and the location, number, diameter, and variants of gonadal, adrenal, and lumbar veins (Fig. 2.2). A delayed topogram acquired in the excretory phase, delayed CT images, or conventional abdominal radiography must be performed to evaluate the collecting system and ureters and screen for a possible duplication anomaly [11, 12].

 
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