Preoperative evaluation of living renal donors with gadolinium-enhanced magnetic resonance angiography

Background. Preoperative evaluation of living renal donors includes an intr a-arterial digital subtraction angiography (DSA). Inasmuch as this techniqu e is invasive, uses radiation and an iodine-containing contrast medium, an alternative technique would be preferable. The purpose of this study was to determine the accuracy of gadolinium-enhanced magnetic resonance (MR) angi ography in the visualization of renovascular anatomy for the preoperative e valuation of renal donors. Methods. Twenty-four consecutive potential renal donors underwent gadoliniu m-enhanced MR angiography before the standard of reference, intra-arterial DSA. Both modalities were evaluated in a blinded manner. The results were c orrelated with the surgical findings. Results. Three MR angiograms were technically unacceptable because of inade quate breath-hold. The remaining 21 donors had 47 renal arteries, including 5 accessory renal arteries, which were all visualized by MR angiography. M R angiography failed to visualize one case of subtle fibromuscular dysplasi a in the distal part of a renal artery. In one donor, a small accessory ren al artery, which had not been visualized on DSA, was encountered during nep hrectomy. Conclusion. Gadolinium-enhanced MR angiography is an accurate minimally inv asive method for the detection of accessory renal arteries in the preoperat ive evaluation of potential renal donors. The accuracy for excluding stenos is in general is high; however, the depiction of stenosis that are located far distally, or in the branch vessels, is less accurate. Advantages of gad olinium-enhanced MR angiography over the currently used method, intra-arter ial DSA, are the minimal invasive nature, lower costs, and superiority in d etecting venous anomalies, renal cysts, and tumors.