The Application Of Multi-detector Row Spiral CT In Preoperative Evaluation Of Living Renal Donors

Renal transplantation is the optimal treatment for end-stage renal disease. Living donor renal transplantation has developed rapidly playing more and more important role in the field of renal transplantation. With the development of living renal transplantation, comprehensive imaging evaluation of kidney donor is crucial in selecting candidates for living kidney transplantation and for determining the surgical technique to procure the renal graft. Digital subtraction angiography (DSA) and intravenous pyelography (IVP) was used to be considered as the golden standard in the preoperative evaluation of the living renal donor. With the development of imaging technique, multi-slice spiral computed tomography(MSCT) has drawn peple's attention for its characteristics of high time, high spatial and high density resolution. The original image and postprocessing image complement each other, they can manifestate the vessels, parenchyma and collecting system of kidney.The domestic literatures about this subject are few.Objective: The purpose of this paper was to study the use of MSCT in the preoperative evaluation of living renal donors.Materials and Methods: Between February 2006 and April 2007, a total of 17 living renal donors(7 men and 10 women; range of age, 24–57 years; mean age, 45.70 years) were evaluated preoperatively as potential living donors for renal transplantation. AllCT data were obtained with a sixteen-channel multi–detector row CT scanner (LightSpeed; General Electric Medical System). They had no history of renal diseases, no surgical contraindications, and their urine rutine,renal function and IVP tests showed normal, nephrectomy has been carried out on 12 LRDs, taking out 4 left kidney and 8 right kidneys in total. All the subjects fasted 4-6 hours, when the sensitivity test showed negative, the venous channel was established through the antecubital vein, non-iodic ion contrast agent ultavist or omnipaque, whose iodine content is 300mg/l, was injected by automatic high pressure injector with speed of 3ml/s and total dose of 80-100ml. after that we collected the data of cortical phase,parenchymal phase and pelvis secretion phase at 20-30s, 70-85s, 300-480s separately. X-ray tube voltage, tube current, and gantry rotation time for all scans were 120 kV, 300-350 mA, and 0.8 second per rotation respectively. Two blinded reviewers independently studied renal vascular, parenchyma and urographic anatomy of each donor CT scans by using original image and post-processing image, recorded the results and compared them with the surgical findings.Result: The examination time of all the LRDs was 6-10 minutes. No contrast agent adverse effect happened in all the LRDs. All the images were satisfactory. They could display the renal vascular, parenchyma and collecting system clearly. Apart from kidneys with normal structure, 9 kidneys were found with 15 accessory arteries (3 left kidneys, 6 right kidneys). 9 kidneys were found 11 early branchesof renal artery (4 left kidneys, 5 right kidenys). Different post-processing technique displayed the result a little differently. 1 renal artery was found calcified in the tubal wall. Of all the 34 renal veins, 1 abnormal passway and 2 abnormal branches were found.8 kidneys were found cysts in the parenchyma. The size, shape and density of any other kidney wasn't found abnormal. During detecting the relationship of kidney and ribs, 6 superior parts of the kidney, 14 central regions and 14 inferior parts were covered. In the secretion phase, all the collecting system was displayed well, without any abnormality. On the other hand, 4 abdominal aorta arteriosteogenesis and 1 hepatic angiocavemoma were found. The surgical findings of the 12 kidneys was in accord with the evaluation results done by MSCT.Conclusion: with only one examination, MSCT can reach the same effectiveness of conventional examinations as DSA, USG, IVP, etc, It can assess the supplied kidney all around and has a higher application value in the preoperative evaluation of living renal donors. It not only can provide more convenient, more effective examination to the clinical works but also has good practical value and clinical application perspective.