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Prospective Evaluation of the Accuracy of MDCT Angiography for Living Kidney Donor.

Kim MU, Choi KH, Yang SC, Oh YT, Han WK - Korean J Urol (2011)

Bottom Line: Accuracy did not differ significantly on the left and right sides (artery: p=0.124; vein: p=0.174).In 199 patients, the CT findings for the lumbar vein were compared with the surgical findings.However, close attention to the interpretation of the CT findings for the lumbar vein may be required.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea.

ABSTRACT

Purpose: In donor nephrectomy, it is important to understand the exact anatomy of the blood vessels during minimally invasive surgery. We prospectively analyzed the accuracy of the vessel structures obtained by use of 64-row multi-detector computed tomography (MDCT) angiography compared with the actual vessel structure observed during surgery.

Materials and methods: We analyzed 238 patients who underwent donor nephrectomy from July 2007 to August 2010. Before the operation, MDCT angiography was performed, and after the operation, the surgeons themselves wrote the protocol. The ipsilateral artery, the number of veins, the association with the run of the hilar vessel, and other vascular anomalies in computed tomography (CT) angiography and in the donor protocol were summarized.

Results: Among 238 patients, nephrectomy was performed on the left side in 199 patients. The accuracy of MDCT for the artery and the vein was 93.3% and 92.4%, respectively. Accuracy did not differ significantly on the left and right sides (artery: p=0.124; vein: p=0.174). In 199 patients, the CT findings for the lumbar vein were compared with the surgical findings. The overall accuracy was shown to be 84.9%, and the accuracy of the group drained to the inferior vena cava (54%) was significantly different (p<0.01) from that of the group drained to the renal vein (98.6%). Thus, it may be necessary to pay close attention to the interpretation of the findings for the lumbar vein.

Conclusions: MDCT angiography is important for understanding the exact anatomy of blood vessels before minimally invasive surgery. We showed that 64-channel MDCT has high accuracy in the main vessel and hilar vessels. However, close attention to the interpretation of the CT findings for the lumbar vein may be required.

No MeSH data available.


Related in: MedlinePlus

(A) Actual image of the operation. (B) Structure with 1 renal artery (§) and 2 renal veins (★). 2 lumbar veins (†) merge and enter the lower renal vein. On the left side, the gonadal vein (*) is drained to the upper renal vein. The communication between the lumbar vein and the gonadal vein is shown. (C) Muti-detector computed tomography angiography of the same patient showing 1 renal artery and 2 renal veins. Lumbar veins were drained to the renal vein.
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Figure 1: (A) Actual image of the operation. (B) Structure with 1 renal artery (§) and 2 renal veins (★). 2 lumbar veins (†) merge and enter the lower renal vein. On the left side, the gonadal vein (*) is drained to the upper renal vein. The communication between the lumbar vein and the gonadal vein is shown. (C) Muti-detector computed tomography angiography of the same patient showing 1 renal artery and 2 renal veins. Lumbar veins were drained to the renal vein.

Mentions: In minimally invasive surgery, because of the limited field of view, assessment of the main vessels and the hilar vessels before surgery can be considered to be important [16]. There are examples, Fig. 1 and Fig. 2 shows actual surgical field in operation. Case of Fig. 1, MDCT finding was exact to actual anatomy. Fig. 3 is example of actual renal vescular structure was different from MDCT findings. As CT becomes more accurate, not only the main vessels but also the hilar vessels can be assessed. Nevertheless, regarding the hilar vessels, reports of accuracy were limited in several studies, and the patient group was limited in many cases. Lewis et al reported the accuracy of the hilar veins in 2004. The accuracy for the gonadal vein was 33/37 (83%), that for the adrenal vein was 27/33 (83%), and that for the lumbar vein was 13/20 (75%) [17]. Bhatti et al reported that the accuracy for the gonadal veins was 74% and that for the lumbar veins was 81% [18].


Prospective Evaluation of the Accuracy of MDCT Angiography for Living Kidney Donor.

Kim MU, Choi KH, Yang SC, Oh YT, Han WK - Korean J Urol (2011)

(A) Actual image of the operation. (B) Structure with 1 renal artery (§) and 2 renal veins (★). 2 lumbar veins (†) merge and enter the lower renal vein. On the left side, the gonadal vein (*) is drained to the upper renal vein. The communication between the lumbar vein and the gonadal vein is shown. (C) Muti-detector computed tomography angiography of the same patient showing 1 renal artery and 2 renal veins. Lumbar veins were drained to the renal vein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3045718&req=5

Figure 1: (A) Actual image of the operation. (B) Structure with 1 renal artery (§) and 2 renal veins (★). 2 lumbar veins (†) merge and enter the lower renal vein. On the left side, the gonadal vein (*) is drained to the upper renal vein. The communication between the lumbar vein and the gonadal vein is shown. (C) Muti-detector computed tomography angiography of the same patient showing 1 renal artery and 2 renal veins. Lumbar veins were drained to the renal vein.
Mentions: In minimally invasive surgery, because of the limited field of view, assessment of the main vessels and the hilar vessels before surgery can be considered to be important [16]. There are examples, Fig. 1 and Fig. 2 shows actual surgical field in operation. Case of Fig. 1, MDCT finding was exact to actual anatomy. Fig. 3 is example of actual renal vescular structure was different from MDCT findings. As CT becomes more accurate, not only the main vessels but also the hilar vessels can be assessed. Nevertheless, regarding the hilar vessels, reports of accuracy were limited in several studies, and the patient group was limited in many cases. Lewis et al reported the accuracy of the hilar veins in 2004. The accuracy for the gonadal vein was 33/37 (83%), that for the adrenal vein was 27/33 (83%), and that for the lumbar vein was 13/20 (75%) [17]. Bhatti et al reported that the accuracy for the gonadal veins was 74% and that for the lumbar veins was 81% [18].

Bottom Line: Accuracy did not differ significantly on the left and right sides (artery: p=0.124; vein: p=0.174).In 199 patients, the CT findings for the lumbar vein were compared with the surgical findings.However, close attention to the interpretation of the CT findings for the lumbar vein may be required.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea.

ABSTRACT

Purpose: In donor nephrectomy, it is important to understand the exact anatomy of the blood vessels during minimally invasive surgery. We prospectively analyzed the accuracy of the vessel structures obtained by use of 64-row multi-detector computed tomography (MDCT) angiography compared with the actual vessel structure observed during surgery.

Materials and methods: We analyzed 238 patients who underwent donor nephrectomy from July 2007 to August 2010. Before the operation, MDCT angiography was performed, and after the operation, the surgeons themselves wrote the protocol. The ipsilateral artery, the number of veins, the association with the run of the hilar vessel, and other vascular anomalies in computed tomography (CT) angiography and in the donor protocol were summarized.

Results: Among 238 patients, nephrectomy was performed on the left side in 199 patients. The accuracy of MDCT for the artery and the vein was 93.3% and 92.4%, respectively. Accuracy did not differ significantly on the left and right sides (artery: p=0.124; vein: p=0.174). In 199 patients, the CT findings for the lumbar vein were compared with the surgical findings. The overall accuracy was shown to be 84.9%, and the accuracy of the group drained to the inferior vena cava (54%) was significantly different (p<0.01) from that of the group drained to the renal vein (98.6%). Thus, it may be necessary to pay close attention to the interpretation of the findings for the lumbar vein.

Conclusions: MDCT angiography is important for understanding the exact anatomy of blood vessels before minimally invasive surgery. We showed that 64-channel MDCT has high accuracy in the main vessel and hilar vessels. However, close attention to the interpretation of the CT findings for the lumbar vein may be required.

No MeSH data available.


Related in: MedlinePlus