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MR Angiography and Preoperative Evaluation for Laparoscopic Donor Nephrectomy

Reena C. Jha1, Shahin J. Korangy1, Susan M. Ascher1, Junko Takahama1, Paul C. Kuo2 and Lynt B. Johnson2

1 Department of Radiology, Georgetown University Hospital, 3800 Reservoir Rd., N.W., Washington, DC 20007.
2 Department of Surgery, Georgetown University Hospital, Washington, DC 20007.



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  		Fig. 1. —35-year-old man with bilateral renal artery anomalies. Maximum-intensity-projection image obtained from three-dimensional spoiled gradient-echo gadolinium-enhanced MR angiogram (TR/TE, 5.0/2.0; flip angle, 20°) shows two left renal arteries and dominant right renal artery with small right capsular branch (arrow) arising from aorta.

 


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  		Fig. 2. —58-year-old man with left renal artery extrahilar branching. Maximum-intensity-projection image obtained from three-dimensional gradient-echo gadolinium-enhanced MR angiogram (TR/TE, 5.0/2.0; flip angle, 20°) shows single left renal artery with early extrahilar branching (open arrow) at 1.4 cm from left renal artery ostium and two right renal arteries (solid arrows). Left kidney was selected for harvesting.

 


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  		Fig. 3. —48-year-old woman with venous anomaly. Maximum-intensity-projection image from MR angiogram (TR/TE, 5.0/2.0; flip angle, 20°) obtained during venous phase shows prominent retroaortic left renal vein (arrow) entering inferior vena cava lower than expected position of left renal vein. No circumaortic component was seen. Single renal arteries can be seen bilaterally. Venous anomaly was confirmed at time of left nephrectomy.

 


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  		Fig. 4A. —47-year-old female renal donor whose preoperative MR angiogram was misinterpreted. Targeted maximum-intensity-projection image of three-dimensional gadolinium-enhanced MR angiogram (TR/TE, 5.0/2.0; flip angle, 20°) shows single left renal artery with early extrahilar branching (solid arrow) occurring 1.7 cm from left renal artery ostium. Small accessory artery (open arrow) is faintly seen.

 


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  		Fig. 4B. —47-year-old female renal donor whose preoperative MR angiogram was misinterpreted. Targeted maximum-intensity-projection image obtained at slightly more anterior position than A shows 3-mm accessory branch (arrow) arising from aorta superior to dominant artery that was overlooked on MR imaging but seen at time of surgery. Arterial reconstruction was performed before anastomosis with recipient iliac artery.

 


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  		Fig. 5A. —35-year-old male potential donor whose preoperative MR angiogram was misinterpreted. Maximum-intensity-projection image obtained from MR angiogram (TR/TE, 5.0/2.0; flip angle, 20°) was initially interpreted as showing bilateral accessory renal arteries entering renal hila. However, at blinded retrospective analysis, this finding was seen to represent single renal arteries bilaterally (solid arrows) with early opacification of retroaortic component of circumaortic left renal vein (open arrows).

 


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  		Fig. 5B. —35-year-old male potential donor whose preoperative MR angiogram was misinterpreted. Axial reconstructed image shows main renal arteries (arrows).

 


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  		Fig. 5C. —35-year-old male potential donor whose preoperative MR angiogram was misinterpreted. Venous phase targeted maximum-intensity-projection image shows vessels (arrows) entering inferior vena cava.

 


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  		Fig. 6A. —57-year-old woman in whom small accessory left renal artery was seen on MR angiography but not confirmed at laparoscopic nephrectomy. Targeted maximum-intensity-projection image of interpolated three-dimensional MR angiogram (TR/TE, 4.6/1.8; flip angle, 30°) shows small arterial branch (arrow) arising from aorta.

 


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  		Fig. 6B. —57-year-old woman in whom small accessory left renal artery was seen on MR angiography but not confirmed at laparoscopic nephrectomy. Multiplanar reconstruction shows small branch (arrow) leading toward left kidney. This vessel could not be seen entering hilum or renal parenchyma and thus was described as possible accessory vessel. At surgery, single left renal artery was seen, with no accessory vessels identified.

 


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  		Fig. 7A. —37-year-old female renal donor in whom accessory left renal artery was missed on conventional angiography. Targeted maximum-intensity-projection interpolated three-dimensional MR angiogram (TR/TE, 4.6/1.8; flip angle, 30°) shows left kidney lying in horizontal plane. Dual arterial supply is seen, with an upper pole artery (solid arrow) and a slightly larger lower pole artery (open arrow).

 


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  		Fig. 7B. —37-year-old female renal donor in whom accessory left renal artery was missed on conventional angiography. Targeted maximum-intensity-projection of interpolated three-dimensional MR angiogram shows upper pole artery with early extrahilar branching and area of suspected ostial stenosis (arrow).

 


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  		Fig. 7C. —37-year-old female renal donor in whom accessory left renal artery was missed on conventional angiography. Targeted maximum-intensity-projection of interpolated three-dimensional MR angiogram shows accessory left renal artery supplying the lower pole (arrow), assumed to be arising from inferior mesenteric artery.

 


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  		Fig. 7D. —37-year-old female renal donor in whom accessory left renal artery was missed on conventional angiography. Angiogram shows upper left renal artery (arrow), but lower branch was not detected. At surgery, both left renal arteries were seen, but lower vessel originated from aorta rather than from inferior mesenteric artery, which was seen arising more inferiorly.

 

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