Prospective Comparison of Magnetic Resonance Angiography with Selective Renal Angiography for Living Kidney Donor Assessment

Neville, Christopher; House, Andrew A.; Nguan, Christopher Y.; Beasley, Kenneth A.; Peck, David; Thain, Lisa M.F.; Rankin, Richard; McAlister, Vivian C.; Spouge, Alison R.; Luke, Patrick P.W.

doi:10.1016/j.urology.2007.10.030

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Volume 71, Issue 3 , Pages 385-389, March 2008

Prospective Comparison of Magnetic Resonance Angiography with Selective Renal Angiography for Living Kidney Donor Assessment

Christopher Neville
- Division of Urology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Andrew A. House
- Department of Nephrology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Christopher Y. Nguan
- Division of Urology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Kenneth A. Beasley
- Division of Urology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
David Peck
- Department of Radiology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Lisa M.F. Thain
- Department of Radiology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Richard Rankin
- Department of Radiology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Vivian C. McAlister
- Department of Surgery, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Alison R. Spouge
- Department of Radiology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
Patrick P.W. Luke
- Division of Urology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
- Reprint requests: Patrick Luke, London Health Sciences Centre–University Campus, 339 Windermere Road, London, Ontario, Canada, N6A 5A5.

Received 22 December 2006; accepted 19 October 2007.

Objectives

For years, the reference standard in the evaluation of living donor vascular anatomy has been selective renal angiography (SRA). Because of the potential morbidity associated with SRA, we prospectively evaluated magnetic resonance angiography (MRA) in the assessment of renal donors.

Methods

All patients had SRA and 53 renal units were prospectively evaluated by MRA. We used SRA supplemented by findings at donor nephrectomy (DN) as our standard. We defined a positive test as the detection of any abnormality in the number of renal arteries.

Results

Selective renal angiography yielded a sensitivity of 86%, specificity of 95%, positive predictive value (PPV) of 75%, and negative predictive value (NPV) of 97% compared with findings at DN. MRA had a sensitivity of 64%, 88% specificity, 58% PPV, and 90% NPV. MRA correctly identified only 7 of 11 renal units with accessory arteries. MRA also incorrectly identified 5 accessory arteries not present on SRA or DN. Two patients diagnosed with fibromuscular dysplasia by SRA were missed using MRA.