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Contrast-Enhanced MR Angiography and Digital Subtraction Angiography in Living Renal Donors: Diagnostic Agreement, Impact on Decision Making, and Costs

Marc C. J. M. Kock1,2, Jan N. M. Ijzermans3, Karen Visser1,2, Shahid M. Hussain1, Willem Weimar4, Peter M. T. Pattynama1, Gabriel P. Krestin1 and M. G. Myriam Hunink1,2

1 Department of Radiology, Erasmus Medical Center, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
2 Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
3 Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
4 Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.



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  		Fig. 1 —Illustration shows combination of all variants of renal vascular and urinary anatomy found in our study. IVC = inferior vena cava, Ao = aorta.

 


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  		Fig. 2 —Coronal maximum-intensity-projection MR angiography image shows retroaortic left renal vein crossing aorta posteriorly (curved arrow) and large ovarian vein (straight arrow) in 70-year-old healthy female living renal donor.

 


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  		Fig. 3A —29-year-old healthy male living renal donor with false-positive imaging findings. Coronal maximum-intensity-projection MR angiography shows irregular right renal artery (arrow) that raises suspicion of fibromuscular dysplasia. Note that resolution and image quality were suboptimal and additional digital subtraction angiography was considered necessary. AS = anterosuperior, PI = posteroinferior.

 


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  		Fig. 3B —29-year-old healthy male living renal donor with false-positive imaging findings. Digital subtraction angiography image shows no irregularity of arterial wall.

 


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  		Fig. 4A —56-year-old healthy female living renal donor with stenosis of ostium of right renal artery. Volume maximum-intensity-projection MR angiography image using subtraction technique shows stenosis of ostium of right renal artery (arrow).

 


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  		Fig. 4B —56-year-old healthy female living renal donor with stenosis of ostium of right renal artery. Axial maximum-intensity-projection MR angiography image shows anterior origin of right renal artery with ostium stenosis (arrow).

 


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  		Fig. 4C —56-year-old healthy female living renal donor with stenosis of ostium of right renal artery. Digital subtraction angiography image that was insufficiently angulated does not show stenosis of ostium (arrow).

 


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  		Fig. 5A —26-year-old healthy male living renal donor with early retrocaval branching of right renal artery. Coronal maximum-intensity-projection MR angiography image shows retrocaval branching of right renal artery (arrow).

 


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  		Fig. 5B —26-year-old healthy male living renal donor with early retrocaval branching of right renal artery. Coronal maximum-intensity-projection MR venography image shows retrocaval branching of right renal artery in relation to inferior vena cava (arrow).

 


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  		Fig. 5C —26-year-old healthy male living renal donor with early retrocaval branching of right renal artery. Digital subtraction angiography image does not depict adequately relationship of branching artery to inferior vena cava (arrow).

 

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