Utility of CT angiography for evaluation of living kidney donors

We reviewed our initial experience with helical computed tomography (CT) angiography in the evaluation of living kidney donors which, until now, has necessitated arteriography. Nineteen donors (12 women, 7 men) have had their renal anatomy evaluated solely by CT angiography preoperatively.All scans demonstrated normal collecting systems and single ureters. Five donors (26%) had supernumerary renal arteries. Fourteen donors had single, 4 donors had two, and 1 donor had three renal arteries. Helical CT demonstrated small polar vessels in several donors. Two donors (10%) had supernumerary renal veins. Accuracy of vascular anatomy defined on CT was 90% when confirmed at operation. Anatomically all CT findings were consistent with operative findings except in 1 donor who was found to have a 0.8 cm lesion near the renal hilum.At our institution, the total charges for selective renal arteriography are $3845 and for helical CT with three-dimensional (3-D) reconstruction are $1546. The amount of contrast dye (approximately 100 mL) is equivalent. Patients uniformly reported that the CT scan was a convenient and painless procedure.The accuracy of helical CT angiography is equivalent to arteriography in assessing renal vascular anatomy (with the additional benefit of imaging venous and parenchymal anatomy). Charges for helical CT are 59% less. There is greater patient acceptance and potentially less morbidity associated with the non-invasive nature of helical CT. We believe that CT angiography is the radiologic procedure of choice for the assessment of renal anatomy in potential living kidney donors.     

Intravenous digital subtraction angiography for the evaluation of renal artery blood flow following the removal of a neuroblastoma

There have been several reports of acute renal failure following the resection of an abdominal neuroblastoma combined with ipsilateral nephrectomy as well as the atrophy or disappearance of an unresected kidney after tumor resection. Spasms or thrombosis of the renal artery during tumor excision are considered to be the major cause. Since 1989, intravenous digital subtraction angiography (IVDSA) has been used to evaluate the renal artery blood flow immediately following surgery in seven patients with abdominal neuroblastomas. IVDSA was performed using a central venous catheter inserted prior to surgery. In all seven patients, IVDSA provided clear images for the evaluation of renal artery blood flow. In one of the two patients whose kidneys briefly became cyanosed during tumor excision, IVDSA demonstrated an occlusion of the renal artery and prompt measures could be taken to reestablish the blood flow. No complications of IVDSA occurred in any of the seven patients. IVDSA using a central venous catheter was thus considered to be useful for evaluating the renal artery blood flow in patients with a suspected renal artery blood flow disturbance without any risk of complications, and this modality obviated the need for intraarterial angiography.     

Giant spinal cord angioma diagnosed by digital subtraction intravenous angiography and computerized tomography

The case of a giant spinal cord angioma initially diagnosed by digital subtraction intravenous angiography is reported. A brief discussion of this lesion is presented.     

A comparison between ultrasonography and mammography,computed tomography and digital subtraction angiography for the detection of breast cancers

Ultrasound (US) was compared with mammography (MMG), computed tomography (CT), and digital subtraction angiography (DSA) in its effectiveness to detect breast cancer masses and metastatic axillary nodes. Forty-seven breast cancer patients who all underwent MMG, US, CT, and DSA preoperatively in our institution between 1986 and 1990 were studied. US was able to detect tumors in all cases regardless of tumor size, whereas DSA detected T1-size tumors and MMG detected T2-size tumors in 40% and 64.7% of cases, respectively, being specifically inferior to US. It was found that MMG was least likely to detect papillotubular carcinoma, although microcalcification alone without a tumor mass on MMG improved detectability from 46.2% to 76.9%, according to the histological type. CT was found to be most sensitive to axillary node metastases (81.8%), followed by US (72.7%), but DSA was significantly unfavorable (42.9%). Thus, we concluded that US was superior to MMG, CT, and DSA for detecting breast cancer masses, but that CT was more advantageous than US, while DSA was of little value for evaluating axillary nodal status.     

Comparison of computerized tomography angiography and digital subtraction angiography in ruptured cerebral aneurysm surgery

Objective: The aim of the present study was to review the efficacy of 16‐row multislice computerized tomography angiography (CTA) in ruptured cerebral aneurysm surgery by comparison with conventional digital subtraction angiography (DSA). Methods: A systemic review of patients suffering from ruptured cerebral aneurysm was performed. We report the results obtained during the 19‐month period from April 2003 to October 2004. In total, 32 patients had undergone aneurysm surgeries, in which 11 patients had both DSA and CTA performed. Results: Among the 11 patients with both DSA and CTA performed, two aneurysms were missed in DSA in two patients. The sensitivity and specificity of CTA were 100%. The correlation of CTA with DSA in operative findings was 100%. Our CTA could detect the aneurysm size down to 2 mm in diameter. Conclusion: The diagnostic accuracy of 16‐row multislice CTA is promising and it compares well with DSA for detection and evaluation of ruptured cerebral aneurysms. It is safe and effective to establish treatment decision on the basis of CTA alone in the majority of cases.     

计算机断层扫描血管造影和数字减影血管造影在主动脉夹层诊断及术前评估中的应用比较

目的探讨计算机断层扫描血管造影(CTA)和数字减影血管造影(DSA)在主动脉夹层(AD)的诊断及术前评估的作用及一致性。方法回顾性分析60例AD患者的临床资料,比较CTA及DSA两种检查方法显示的AD破口近侧锚定区的距离、左锁骨下动脉左侧平面胸主动脉直径、主动脉夹层累及的范围及主动脉主要分支血管的累及情况。结果 60例患者均同期行CTA、DSA检查,CTA、DSA检查破口近端锚定区的距离大于或等于15mm者分别为44例(44/51,86.2%)、46例(46/56,82.1%);小于15mm者分别为7例(7/51,13.7%)、10例(10/56,17.8%),两种方法比较差异无统计学意义。CTA发现夹层累及左髂动脉(LIA)36例(36/60,60.0%)、累及右髂动脉(RIA)28例(28/60,46.7%),DSA仅发现夹层累及LIA14例(14/60,23.0%)、累及RIA13例(13/60,21.7%),两种方法比较差异有统计学意义(P=0.012,P=0.022);CTA、DSA在显示左锁骨下动脉左侧胸主动脉直径及内脏动脉受累情况比较差异无统计学意义。结论 CTA、DSA两种检查方法有较好的一致性,CTA因其无创性在EVAR术前评估中有重要价值。     

Usefulness of 3-dimensional reconstructed images of renal arteries using rotational digital subtraction angiography

PURPOSE: We assess the feasibility of a 3-dimensional (D) reconstruction technique of rotational digital subtraction angiography (DSA) for visualization of the renal arteries. MATERIALS AND METHODS: We evaluated 28 kidneys in 20 patients. Rotational DSA images were obtained during a deep inspiratory pause after contrast material injection through the renal artery. Acquired data were transferred to an image workstation and reconstructed as 3-D images. Visibility of the main trunk of the renal artery, segmental arteries, interlobar arteries and arcuate arteries was classified as grade 4-excellent, grade 3-good, grade 2-satisfactory and grade 1-poor. The 3-D reconstructed images were compared with conventional 2-D DSA performed just before the rotational DSA. The criteria for evaluation were visibility of the aneurysm neck in 8 cases of aneurysm, delineation of the feeding arteries in 6 cases of renal lesions and visibility of the relationship between renal branches in other cases. RESULTS: Delineation of grades 4 to 1 was 93%, 7%, 0% and 0% for the main renal artery, 66%, 21%, 7% and 6% for segmental arteries, 61%, 11%, 21% and 7% for interlobar arteries, and 36%, 18%, 36% and 10% for arcuate arteries, respectively. The 3-D images had the advantage over 2-D DSA in 75% of cases. In all cases of aneurysm 3-D images were obviously more useful than 2-D DSA. CONCLUSIONS: 3-D images of renal arteries obtained with rotational DSA are considered acceptable for clinical use.     

Digital subtraction angiography and dynamic computed tomography for evaluating the hemodynamics in cases of giant intracranial aneurysm

Dynamic computed tomography (CT) and digital subtraction angiography were used for postoperative evaluation of the hemodynamic changes in five patients with giant or large intracranial aneurysms. The lesions in four of these cases were giant or large aneurysms of the internal carotid artery, and were treated by occlusion of the cervical internal carotid artery and superficial temporal-middle cerebral artery anastomosis. The lesion in the fifth case was a giant aneurysm of the right vertebral artery, which was treated by proximal clipping of the vertebral artery. Preoperative digital subtraction angiography revealed aneurysmal staining, and dynamic CT scanning indicated the rapid transit of contrast medium in the dome of the aneurysm. Dynamic CT scanning immediately after operation indicated a low flow state in all of the aneurysms, suggesting that they were thrombosed. Although within a few months the peripheral edges of the aneurysms became enhanced, dynamic CT scanning revealed a slower transit of contrast medium through the centers of the aneurysms than in the basilar artery, and digital subtraction angiography failed to demonstrate aneurysmal staining, suggesting that the aneurysms remained thrombosed. The present data indicate that dynamic CT scanning and digital subtraction angiography may be useful for relatively noninvasive evaluation of the hemodynamic changes in patients with giant intracranial aneurysms.     

Preoperative evaluation of living kidney donors using multirow detector computed tomography: comparison with digital subtraction angiography and intraoperative findings

To assess the accuracy of multirow detector computed tomography (MDCT) for the evaluation of renal anatomy for preoperative donor assessment in living related kidney transplantation. MDCT-scans (4- and 16-slice-CT) of 51 consecutive living kidney donors (age, 51.6 +/- 9.7 years; range, 28-68 years) were analysed by three blinded observers and compared with digital subtraction angiography (DSA) and surgery. Contrast-enhanced MDCT was performed with 1 mm slice thickness reconstruction interval during arterial and venous phases. Supernumerary renal arteries, veins, early branching of vessels and abnormalities of the ureters were documented. The overall accuracy of computed tomography angiography (CTA) for detection and classification of surgically relevant arterial variants was 97% (99/102). The interpretation of 16-channel MDCT images was correct in all cases (accuracy, 100%), while the four-channel CTA had three incorrect results regarding the differentiation of early branching vessels from double renal arteries (accuracy, 93%). The overall accuracy of DSA was 91%. Renal vein abnormalities were correctly diagnosed with MDCT in 100% compared with 89% correct findings with DSA. There were three kidneys with incomplete ureter duplication, detected both with MDCT and DSA. MDCT demonstrated superior accuracy compared with non-selective DSA for the preoperative assessment of renal anatomy in living kidney donors; and for the distinction of supernumerary arteries versus early branching patterns, 16-channel CTA data were better than those of the four-channel system.     

容积CT数字减影血管造影与同步匹配蒙片去骨法对颅内动脉瘤的诊断价值比较

目的探讨容积CT数字减影血管造影(VCTDSA)与同步匹配蒙片去骨(MMBE)法对颅内动脉瘤的诊断价值。方法分析临床怀疑颅内动脉瘤、并接受VCTDSA检查的57例患者资料,其中47例经3DDSA和/或手术证实,比较VCTDSA与MMBE的减影图像质量、对动脉瘤的检出率以及二者图像后处理时间。结果57例患者分别采用VCTDSA与同步MMBE的图像质量差异有统计学意义(P0.05)。经手术和/或3DDSA结果证实,47例患者共检出53个动脉瘤;VCTDSA对于IA的检出率为96.23%(51/53),高于MMBE(46/53,86.79%);VCTDSA对于颈内动脉瘤的检出率为94.12%(32/34),高于MMBE(27/34,79.41%)。VCTDSA对于3mm的动脉瘤的检出率为86.67%(13/15),高于MMBE(10/15,66.67%)。VCTDSA的平均后处理时间为(3.87±0.73)min,同步MMBE的平均后处理时间为(4.05±0.79)min,二者差异有统计学意义(P0.05)。结论 VCTDSA是一种方便、快速的检查方法,图像真实、可靠,对颅内动脉瘤的检出与诊断优于同步MMBE。     

Intravenous digital subtraction angiography in the evaluation of potential renal donors

Of 65 surgically removed donor kidneys intravenous digital subtraction angiography demonstrated accurately the number of renal arteries in 58 (89 per cent). All accessory vessels missed at digital subtraction angiography were small and their presence did not interfere with successful transplantation in those donated. Of 50 surgically removed donor kidneys examined with conventional aortography only before the routine use of intravenous digital subtraction angiography the number of renal arteries was demonstrated accurately in 46 (92 per cent). Intravenous digital subtraction angiography offers advantages over conventional aortography, including most importantly the routine performance on an outpatient basis, and decreased film cost and examination time. Although the accuracy of conventional aortography (92 per cent) in detecting the number of renal arteries is slightly greater than that for intravenous digital subtraction angiography (89 per cent), the advantages of the digital examination justify its use as the initial examination for the potential renal donor. Conventional aortography can be reserved for use in patients with equivocal or technically inadequate digital examinations.     

Evaluation of the vascular anatomy in potential living kidney donors with gadolinium‐enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings

Asgari MA, Dadkhah F, Ghadian AR, Razzaghi MR, Noorbala MH, Amini E. Evaluation of the vascular anatomy in potential living kidney donors with gadolinium‐enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings.
Clin Transplant 2011: 25: 481–485. © 2010 John Wiley & Sons A/S. Abstract: Background: X‐ray contrast arteriography has traditionally been used for pre‐operative evaluation in living kidney donors. However, magnetic resonance angiography (MRA) offers a non‐invasive alternative, which has been considered to be less accurate. This study was performed to determine whether MRA in the pre‐operative investigation of living kidney donors provides sufficient information. Methods: From December 2005 to December 2007, 173 potential live donors were evaluated in this study. Donors performed digital subtraction angiography (DSA) and those with one or more accessory arteries at least on one side recruited for further evaluation with three‐dimensional gadolinium‐enhanced MRA. Results: A total of 30 donors constituted the study population. When compared with DSA as the reference method, MRA detected 20 of 36 renal accessory arteries which indicates a sensitivity of 55.6%. The difference between MRA and DSA in identifying accessory renal arteries was significant (p‐value <0.001). Considering intraoperative findings as the standard of reference, MRA depicted correctly four of six (66.7%) accessory arteries on the transplanted kidneys. Conclusions: MRA has the advantage of avoiding exposure to ionizing radiation and is non‐invasive. These are important considerations in pre‐operative evaluation of a generally healthy donor population. However, MRA provides suboptimal accuracy in detecting small accessory arteries.     

Evaluation of extracranial occlusive disease by digital subtraction angiography

The intravenous injection of contrast medium for angiography is a relatively new means of studying the arteries of the head and neck. Digital subtraction angiography allows the evaluation of patients with suspected vascular disease without the risk of arterial catheterization.     

Intravenous digital subtraction arteriography in the evaluation of vascular grafts

Between 1982 and 1986 intravenous digital subtraction arteriography was used to evaluate vascular grafts in 97 patients (54 males, 43 females). Indications included recurrent symptoms, absent or diminished pulses, a drop in Doppler pressure measurements, and clinical uncertainty with respect to graft patency. Problems identified included graft stenosis, stenosis of the anastomosis or its distal vessels, false aneurysm, arteriovenous fistula and emboli. Forty-eight operations were carried out following intravenous digital subtraction arteriography, and radiographic findings were verified surgically. Twice, intravenous digital subtraction arteriography did not show significant graft findings which were discovered at surgery. Thus intravenous digital subtraction arteriography showed a sensitivity of 95.8% and specificity of 100%. Complications following intravenous digital subtraction arteriography were: two patients developed urticaria, and one superficial thrombophlebitis. There were no cases of pulmonary edema or death. In conclusion intravenous digital subtraction arteriography is very useful in the diagnosis of graft-related problems if done on a selective basis looking at graft and anastomosis site only, intravenous digital subtraction arteriography is done on an outpatient basis, has high sensitivity and specificity, good patient acceptance, is safe, fast and is less expensive than conventional arteriography.     

Prospective study comparing three-dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors

OBJECTIVE: To prospectively compare the accuracy of multislice spiral computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) in evaluating the renal vascular anatomy in potential living renal donors. SUBJECTS AND METHODS: Thirty-one donors underwent multislice spiral CTA and gadolinium-enhanced MRA. In addition to axial images, multiplanar reconstruction and maximum intensity projections were used to display the renal vascular anatomy. Twenty-four donors had a left laparoscopic donor nephrectomy (LDN), whereas seven had right open donor nephrectomy (ODN); LDN was only considered if the renal vascular anatomy was favourable on the left. CTA and MRA images were analysed by two radiologists independently. The radiological and surgical findings were correlated after the surgery. RESULTS: CTA showed 33 arteries and 32 veins (100% sensitivity) whereas MRA showed 32 arteries and 31 veins (97% sensitivity). CTA detected all five accessory renal arteries whereas MRA only detected one. CTA also identified all three accessory renal veins whereas MRA identified two. CTA had a sensitivity of 97% and 47% for left lumbar and left gonadal veins, whereas MRA had a sensitivity of 74% and 46%, respectively. CONCLUSION: Multislice spiral CTA with three-dimensional reconstruction was more accurate than MRA for both renal arterial and venous anatomy.     

Internal carotid artery agenesis: correlation by conventional and digital subtraction angiography, and by computed tomography

A case is presented of agenesis of the right internal carotid artery in a fifteen-year-old female with an unrelated seizure disorder. Conventional angiography revealed an absent right internal carotid artery, supply to the right anterior cerebral artery from the left internal carotid artery, and supply to the right middle cerebral artery by anastomosis through the vertebral basilar system. The congenital nature of the anomaly was confirmed by intravenous digital subtraction angiography, which revealed no portion or remnant of the right internal carotid artery to be present, and by computerized tomography of the base of the skull, which demonstrated no bony carotid canal on the right side. This is the first reported case of internal carotid artery agenesis to be elucidated by intravenous digital subtraction angiography. A brief discussion concerning the congenital nature of this anomaly is presented, including the role of angiography and computed tomography in establishing the diagnosis of this condition.     

代谢综合征患者肾动脉狭窄的SCTA与DSA对比研究

目的探讨代谢综合征(MS)患者中肾动脉狭窄的发生率及无创性筛检的必要性与可靠性。方法45例MS患者预行肾动脉螺旋CT血管造影(SCTA),对所检出的14例肾动脉狭窄者行肾动脉数字减影血管造影(DSA)对照,并对SCTA及DSA结果进行对比分析。结果45例MS患者中SCTA显示肾动脉正常31例,其余14例患者存在单侧或双侧肾动脉狭窄,DSA对照显示肾动脉正常6条,肾动脉狭窄22条,与SCTA显示的情况基本符合。结论MS患者中肾动脉狭窄的发生率约31.1%,对可疑患者应常规予以肾动脉SCTA检查。     

Helical computed tomography angiography in the evaluation of Chinese living renal donors

OBJECTIVE: To determine the suitability of helical computed tomography angiography (CTA), recently used in the anatomical evaluation of potential living renal donors (LRDs) in the Caucasian population, for Chinese LRDs. SUBJECTS AND METHODS: Eighteen consecutive potential LRD candidates underwent both CTA and conventional renal angiography (CRA). Results from each were interpreted while unaware of the results from the other. Renal function was monitored after each radiological procedure. RESULTS: Both procedures were able to identify all four accessory renal arteries present. One prehilar branch of < 1 mm in diameter was not recognized on CTA. Renal artery ostial stenosis in one subject with normal blood pressure was identified on CTA, but not on CRA. CTA better delineated the renal venous and parenchymal anatomy and cost 60% less than CRA. There was no change in renal function after either procedure. CONCLUSION: Despite there being few subjects. CTA has potential value as an alternative to CRA for the anatomical assessment of potential LRDs in Hong Kong. Advantages include a short examination time, non-invasiveness and lower cost. CTA may provide an opportunity to living-related and unrelated renal donor transplantation in this conservative Chinese culture.