Multidetector computed tomography with triple-bolus contrast medium administration protocol for preoperative anatomical and functional assessment of potential living renal donors

• Published in: European radiology 2010-11, Vol.20 (11), p.2590-2599
• Main Authors: Knox, Matthew K., Rivers-Bowerman, Michael D., Bardgett, Harry P., Cowan, Nigel C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Computed Tomography; Contrast Media - administration & dosage; Diagnostic Radiology; Female; Hospitals; Humans; Imaging; Internal Medicine; Interventional Radiology; Iopamidol - administration & dosage; Kidney - diagnostic imaging; Kidney - physiology; Kidney Transplantation; Kidneys; Laparoscopy; Living Donors; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Radiation; Radiation Dosage; Radioisotope Renography; Radiology; Radiopharmaceuticals; Renal Artery - diagnostic imaging; Renal Veins - diagnostic imaging; Sensitivity and Specificity; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography; Tomography, X-Ray Computed; Transplants & implants; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-010-1855-y

Objective To evaluate multidetector computed tomography (MDCT) with a triple-bolus contrast administration protocol for preoperative anatomical and functional assessment of living renal donors. Methods Fifty-five potential living renal donors underwent MDCT of which 27 proceeded to donor nephrectomy. A triple-bolus contrast administration protocol was used for simultaneous acquisition of arterial, nephrographic, and excretory phases. MDCT images were independently reviewed in random order by two radiologists blinded to surgical anatomy findings. Diagnostic accuracy for anatomical variants was quantified by sensitivity and specificity. Differential renal function (DRF) was derived from MDCT for 54 patients and compared with technetium-99 m dimercaptosuccinic acid renography (Tc-99 m DMSA). Results All triple-bolus MDCT examinations were technically adequate. Accessory renal arteries and veins were identified at surgery in 33% ( n  = 9/27) and 22% ( n  = 6/27) of donor kidneys. The mean difference between MDCT-derived DRF and DMSA was 0.8% (95% CI 0.1–1.6) with 95% limits of agreement of −4.6% (95% CI −3.3 to −5.9) to 6.3% (95% CI 5.0–7.6). MDCT delivered a mean (SD, range) radiation dose of 9.5 (3.6, 3.6–17.3) mSv. Conclusion MDCT with a triple-bolus contrast administration provides accurate anatomical and functional evaluation of living renal donors.