Helical computerized tomography arteriography for evaluation of live renaldonors undergoing laparoscopic nephrectomy

Purpose: Traditionally, live renal donors are evaluated with excretory urog raphy and renal arteriography. Helical computerized tomography (CT) arterio graphy offers a less invasive alternative for demonstrating necessary anato mical information before laparoscopic allograft harvest. We evaluate the ac curacy of helical CT arteriography in depicting renal vascular anatomy with an emphasis on the detection of arterial and venous anomalies. Materials and Methods: Imaging studies were done on 175 patients according to a standard CT arteriography protocol with early arterial phase scanning (14 to 20-second delay), and 1 mm. axial and 3-dimensional maximum intensit y projection reconstructions. Renal vascular anatomy was mapped with attent ion to aberrant arterial and venous anatomy. Intraoperative findings were c orrelated at laparoscopic donor nephrectomy. Results: There was overall agreement between CT arteriography and laparosco pic findings in 163 cases (93%). Supernumerary renal arteries were identifi ed in 40 cases (23%). Sensitivity, specificity and accuracy of CT arteriogr aphy for arterial anatomy were 91, 98 and 96%, respectively. Cases with les s than 2 mm. accessory arteries or early branching single vessels simulatin g dual arteries were misdiagnosed. Venous anomalies occurred in 11 patients (6.3%). Sensitivity, specificity and accuracy of CT arteriography for veno us anatomy were 65, 100, and 97%, respectively. Misdiagnoses included early venous bifurcations and supernumerary tributary veins, which were poorly o pacified. Conclusions: Helical CT is highly accurate and specific for the demonstrati on of renal arterial anatomy. Poor opacification resulted in a lower sensit ivity for venous anatomy. Overall, helical CT provides essential anatomical information, and is an alternative to standard urography and arteriography .