Rofo 2010; 182(11): 1001-1009
DOI: 10.1055/s-0029-1245685
Gefäße

© Georg Thieme Verlag KG Stuttgart · New York

Gadofosveset-Enhanced MR Imaging for the Preoperative Evaluation of Potential Living Kidney Donors: Correlation with Intraoperative Findings

Gadofosveset-unterstützte MR-Bildgebung zur präoperativen Evaluation potenzieller Lebendnierenspender: Vergleich mit intraoperativen BefundenJ. Kuhlemann1 , D. Blondin1 , D. Grotemeyer2 , P. Zgoura3 , D. Reichelt1 , W. Heinen1 , A. Scherer1 , R. S. Lanzman1
  • 1Institut für Radiologie, Uniklinikum Düsseldorf
  • 2Klinik für Gefäßchirurgie und Nierentransplantation, Universitätsklinikum Düsseldorf
  • 3Klinik für Nephrologie, Uniklinikum Düsseldorf
Weitere Informationen

Publikationsverlauf

received: 11.3.2010

accepted: 28.7.2010

Publikationsdatum:
04. Oktober 2010 (online)

Zusammenfassung

Ziel: Das Ziel dieser Studie war die Evaluierung des Kontrastmittels Gadofosveset, welches in der Magnetresonanzangiografie (MRA) zur präoperativen Abklärung der renalen Gefäßanatomie bei potenziellen Lebendnierenspendern (LNS) eingesetzt wurde. Material und Methoden: Von 28 potenziellen LNS (13 Männer, 15 Frauen; Durchschnittsalter 55,14 Jahre ± 11,97), die initial in diese prospektive Studie eingeschlossen wurden, sind 20 operiert und weiterführend untersucht worden. Zur Beurteilung der Gefäßanatomie und des harnableitenden Systems sind bei 1,5 Tesla nach Applikation von Gadofosveset 7 Aufnahmeserien einer 3D T 1-gewichteten FLASH-Sequenz zu festgelegten Zeitpunkten durchgeführt worden. Alle MRT wurden prospektiv von 2 Radiologen im Konsensusmodus vor dem chirurgischen Eingriff analysiert. ROI-basierende relative Signalrauschverhältnisse in der Vena cava inferior und Aorta abdominalis wurden errechnet. Ergebnisse: Die MR-Datenakquisition wurde in allen potenziellen LNS vollständig durchgeführt. Bei 8 Nierenspendern waren zusätzliche CT-Untersuchungen vorliegend, die zur Evaluation der gegenüberliegenden, nicht gespendeten Niere dienten, wodurch sich eine Gesamtanzahl von 28 untersuchten Nieren ergab. Die MRA zeigte 36 Nierenarterien, bei 8 akzessorische Arterien, die in 8 Patienten gefunden worden sind. Eine akzessorische Arterie und ein Fall einer fibromuskulären Dysplasie wurden von der MRA übersehen. Die venöse Anatomie und die ableitenden Harnwege sind mit der MRT-Untersuchung korrekt identifiziert worden. Daneben wurden durch die MRT-Untersuchung zwei Nierenzellkarzinome diagnostiziert. Auf einer Pro-Nieren-Basis betragen in Zusammenschau die Sensitivität und der positive prädiktive Wert der gadofosveset-unterstützten MRT-Untersuchung 92,9 % bzw. 100 %. Schlussfolgerung: Gadofosveset ermöglicht eine präzise Evaluation von potenziellen LNS.

Abstract

Purpose: The purpose of this study was to evaluate the blood pool contrast agent gadofosveset for MR angiography (MRA) of the renal vasculature in living kidney donors (LKD). Materials and Methods: Of the 28 consecutive potential LKDs (13 men, 15 women; mean age 55.14 years ± 11.97) initially included in this prospective study, 20 patients underwent surgery and were considered for further evaluation. 7 acquisitions of a 3D T 1-weighted FLASH sequence were performed following administration of gadofosveset for the assessment of the vascular anatomy and collecting system at predefined time points at 1.5 T. All MR exams were prospectively analyzed by 2 radiologists in consensus mode prior to surgery. In addition, ROI-based relative SNR measurements were performed in the vena cava inferior and abdominal aorta. Results: MR image acquisition was completed in all 20 potential living donors. In 8 donors an additional CT scan was available for further comparison with the collateral anatomy, resulting in a total of 28 analyzed kidneys. MRA disclosed 36 renal arteries, since 8 accessory arteries were found in 8 subjects. One accessory artery and one case of fibromuscular dysplasia were missed by MRA. The venous anatomy and the collecting system were assessed correctly with MRI. In addition, MRI diagnosed two renal cell carcinomas. The overall sensitivity and positive predictive value of gadofosveset-enhanced MRI on a per kidney basis were 92.9 % and 100 %, respectively. Conclusion: Gadofosveset enables accurate evaluation of potential LKDs.

References

  • 1 Barry J M, Murray J E. The first human renal transplants.  J Urol. 2006;  176 888-890
  • 2 Murray J E. The first successful organ transplants in man.  J Am Coll Surg. 2005;  200 5-9
  • 3 Eurotransplant International Foundation .Leiden, Netherlands. http://www.eurotransplant.nl/files/statistics/year_2009.pdf
  • 4 Kälble T, Lucan M, Nicita G et al. European Association of Urology. EAU guidelines on renal transplantation.  Eur Urol. 2005;  47 156-66, Review
  • 5 Delmonico F. Council of the Transplantation Society . A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines.  Transplantation. 2005;  79 (6 Suppl) S53-S66, Review
  • 6 Sasaki T M, Finelli F, Bugarin E et al. Assessment of 100 live potential renal donors for laparoscopic nephrectomy the new criterion standard?.  Arch Surg. 2000;  135 943-947
  • 7 Patil U D, Ragavan A, Nadaraj et al. Helical CT angiography in evaluation of live kidney donors.  Nephrol Dial Transplant. 2001;  16 1900-1904
  • 8 Pollak R, Prusak B F, Mozes M F. Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation.  Am Aurg. 1986;  52 233-235
  • 9 Hänninen E L, Denecke T, Stelter L et al. Preoperative evaluation of living kidney donors using multirow detector computed tomography: comparison with digital subtraction angiography and intraoperative findings.  Transpl Int. 2005;  18 1134-1141
  • 10 El Fettouh H A, Herts B R, Nimeh T et al. Prospective comparison of 3-dimensional volume rendered computerized tomography and conventional renal arteriography for surgical planning in patients undergoing laparoscopic donor nephrectomy.  J Urol. 2003;  170 57-60
  • 11 Lemke U, Taupitz M, Klüner C et al. Donor-Evaluation vor Lebendnierenspende: Vergleich von CE-MRA und DSA an 78 Patienten.  Fortschr Röntgenstr. 2008;  180 48-54
  • 12 Blondin D, Andersen K, Kroepil P et al. Analysis of 64-row multidetector CT images for preoperative angiographic evaluation of potential living kidney donors.  Der Radiologe. 2008;  48 673-680
  • 13 Vasbinder G B, Nelemans P J, Kessels A G. the Renal Artery Diagnostic Imaging Study in Hypertension (RADISH) Study Group . Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis.  Ann Intern Med. 2004;  141 674-682
  • 14 Rankin S C, Jan W, Koffman C G. Noninvasive imaging of living related kidney donors: evaluation with CT angiography and gadolinium-enhanced MR angiography.  Am J Roentgenol. 2001;  177 349-355
  • 15 Grist T M, Korosec F R, Peters D C et al. Steady-state and dynamic MR angiography with MS-325: initial experience in humans.  Radiology. 1998;  207 539-544
  • 16 Nikken J J, Krestin G P. MRI of the kidney – state of the art.  Eur Radiol. 2007;  17 2780-2793
  • 17 Lauffer R B, Parmelee D J, Dunham S U et al. MS-325: albumin-targeted contrast agent for MR angiography.  Radiology. 1998;  207 529-538
  • 18 Parmelee D J, Wlovitvh R C, Ouellet H S et al. Preclinical evaluation of the pharmacokinetics, biodistribution, and elimination of MS-325, a blood pool agent for magnetic resonance imaging.  Invest Radiol. 1997;  32 741-747
  • 19 Heverhagen J T. Noise Measurement and estimation in MR imaging experiments.  Radiology. 2007;  245 638-639
  • 20 Nikolaou K, Kramer H, Grosse C et al. High-spatial-resolution multistation MR angiography with parallel imaging and blood pool contrast agent: initial experience.  Radiology. 2006;  241 861-872
  • 21 Anzidei M, Napoli A, Marincola B C et al. Gadofosveset-enhanced MR angiography of carotid arteries: does steady-state imaging improve accuracy of first-pass imaging? Comparison with selective digital subtraction angiography.  Radiology. 2009;  251 457-466
  • 22 Hadizadeh D R, Gieseke J, Lohmaier S H et al. Peripheral MR angiography with blood pool contrast agent: prospective intraindividual comparative study of high-spatial-resolution steady-state MR angiography versus standard-resolution first-pass MR angiography and DSA.  Radiology. 2008;  249 701-711
  • 23 Sharafuddin M J, Stolpen A H, Dang Y M et al. Comparison of MS-325- and gadodiamide-enhanced MR venography of iliocaval veins.  J VascInterv Radiol. 2002;  13 1021-1027
  • 24 Stracke C P, Katoh M, Wiethoff et al. Molecular MRI of cerebral venous sinus thrombosis using a new finbrin-specific MR contrast-agent.  Stroke. 2007;  38 1476-1481
  • 25 Hodgson D J, Jan W, Rankin S et al. Magnetic resonance renal angiography and venography: an analysis of 111 consecutive scans before donor nephrectomy.  BJU Int. 2006;  97 584-586
  • 26 Israel G M, Lee V S, Edye M et al. Comprehensive MR imaging in the preoperative evaluation of living donor candidates for laparoscopic nephrectomy: initial experience.  Radiology. 2002;  225 427-432
  • 27 Lee V S, Rofsky N M, Krinsky G A et al. Sinlge-dose reath-hold gadolinium-enhanced three-dimensional MR angiography of the renal arteries.  Radiology. 1999;  211 69-78
  • 28 Bhatti A A, Chugtai A, Haslam P et al. Prospective study comparing three-dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors.  BJU Int. 2005;  96 1105-1108
  • 29 Fenchel M, Nael K, Deshpande V S et al. Renal magnetic resonance angiography at 3.0 Tesla using a 32-element phased-array coil systsem and parallel imaging in 2 directions.  Invest Radiol. 2006;  41 125-132
  • 30 Galanski M, Prokop M, Chavan A et al. Leistungsfähigkeit der CT-Angiographie beim Nachweis Nierenarterienstenosen.  Fortschr Röntgenstr. 1994;  161 519-525
  • 31 Rieumont M J, Kaufman J A, Geller S C et al. Evaluation of renal artery stenosis with dynamic gadolinium-enhanced MR angiography.  Am J Roentgenol. 1997;  169 39-44
  • 32 Farres M T, Lammer J, Schima W et al. Spiral computed tomographic angiography of the renal arteries: a prospective comparison with intravenous and intraarterial digital subtraction angiography.  Cardiovasc Intervent Radiol. 1996;  19 101-106
  • 33 Kim T S, Chung J W, Park J H et al. Renal artery evaluation: comparison of spiral CT angiography to intra-arterial DSA.  J Vasc Interv Radiol. 1998;  9 553-559
  • 34 Schoenberg S O, Knopp M V, Londy F et al. Morphologic and functional magnetic resonance imaging of renal artery stenosis: a multireader tricenter study.  J Am Soc Nephrol. 2002;  13 158-169
  • 35 Vasbinder G B, Maki J H, Nijenhuis R J et al. Motion of the distal renal artery during three-dimensional contrast-enhanced breath-hold MRA.  J Magn Reson Imaging. 2002;  16 685-696
  • 36 Herborn C U, Watkins D M, Runge V M et al. Renal arteries: comparison of steady-state free precession MR angiography and contrast-enhanced MR angiography.  Radiology. 2006;  239 263-268
  • 37 Wyttenbach R, Braghetti A, Wyss M et al. Renal artery assessment with nonenhanced steady-state free precession versus contrast-enhanced MR angiography.  Radiology. 2007;  245 186-195
  • 38 Lanzman R S, Voiculescu A, Walther C et al. ECG-gated nonenhanced 3D steady-state free precession (SSFP) MR angiography (MRA) in assessment of transplant renal arteries: comparison with digital substraction angiography (DSA).  Radiology. 2009;  252 914-921
  • 39 Katoh M, Buecker A, Stuber M et al. Free-breathing renal MR angiography with steady-state free-precession (SSFP) and slab-selective spin inversion: Initial results.  Kidney International. 2004;  66 1272-1278
  • 40 Lanzman R S, Kröpil P, Schmitt P et al. Nonenhanced free-breathing ECG-gated steady-state free precession 3D MR angiography of the renal arteries: comparison between 1.5T and 3T.  Am J Roentgenol. 2010;  194 794-798
  • 41 Nikken J J, Krestin G P. MRI of the kidney-state of the art.  Eur Radiol. 2007;  17 2780-2793, Review
  • 42 Low R N, Martinez A G, Steinberg S M et al. Potential renal transplant donors: evaluation with gadolinium-enhanced MR angiography and MR urography.  Radiology. 1998;  207 165-172
  • 43 Iezzi R, Soulez G, Thurnher S et al. Contrast-enhanced MRA of the renal and aorto-iliac-femoral arteries: Comparison of gadobenate dimeglumine and gadofosveset trisodium.  Eur J Radiology. 2009;  Aug 2010 [epub ahead of print]
  • 44 Anzidei M, Napoli A, Marincola B C et al. High-resolution steady-state magnetic resonance angiography of the carotid artery: Are intravascular agents necessary?.  Invest Radiol. 2009;  44 784-792
  • 45 Brismar T B, Dahlstrom N, Edsborg N et al. Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA: a comparison in healthy volunteers.  Acta Radiol. 2009;  50 709-715
  • 46 Regier M, Nolte-Ernsting C, Adam G et al. Intraindividual comparison of image quality in MR urography at 1.5 and 3 tesla in an animal model.  Fortschr Röntgenstr. 2008;  180 915-921
  • 47 Kramer U, Thiel C, Seeger A et al. Preoperative Evaluation of Potential Living Related Kidney Donors with High-Spatial -Resolution Magnetic Resonance (MR) Angiography at 3 Tesla.  Invest Radiol. 2007;  42 747-755
  • 48 Michaely H J, Nael K, Schoenberg S O et al. The feasibility of spatial high-resolution magnetic resonance angiography (MRA) of the renal arteries at 3.0T.  Fortschr Röntgenstr. 2005;  177 800-804

PD Dr. Dirk Blondin

Institut für Diagn. Radiologie, Uniklinikum Düsseldorf

Moorenstr. 5

40225 Düsseldorf

Telefon: ++ 49/2 11/8 11 77 54

Fax: ++ 49/2 11/8 11 94 87

eMail: blondin@med.uni-duesseldorf.de