Diagnostic Performance of a Non–Contrast-Enhanced Magnetic Resonance Imaging Protocol for Potential Living Related Kidney Donors

Authors: Robert Goetti, MD, Stephan Baumueller, MD, Hatem Alkadhi, MD, MPH, Pierre-Alain Clavien, MD, Marc Schiesser, MD, Thomas Pfammatter, MD, Roger Hunziker, MD, Gilbert Puippe, MD


Rationale and Objectives


The objective of the study was to evaluate the performance of a non–contrast-enhanced magnetic resonance (MR) imaging protocol for preoperative screening of living related kidney donors.


Materials and Methods


Forty consecutive subjects (mean age 52.2 ± 11.3 years, range 29–73 years) underwent MR imaging with T2-weighted sequences (coronal and axial plane), with a non–contrast-enhanced respiratory-gated three-dimensional steady state free precession MR angiography (NCE-MRA) sequence and with contrast-enhanced magnetic resonance MR angiography (CE-MRA) sequences in the arterial and venous phases. Two blinded readers independently assessed arterial and venous anatomy and potential kidney lesions. Results of non–contrast-enhanced images were compared to CE-MRA and in a subgroup of 21 subjects to surgery as standard of reference.


Results
Regarding arterial anatomy, NCE-MRA yielded sensitivity, specificity, and accuracy of 100%, 89%, and 91% compared to CE-MRA. Three kidneys were found to have more accessory renal arteries at NCE-MRA than at CE-MRA. In the subgroup of 21 subjects, 1 surgically proven accessory artery was depicted with NCE-MRA but not with CE-MRA. Accuracy of T2-weighted images regarding accessory veins or variant venous course was 99%, with one missed circumaortic vein on T2-weighted images. Two simple cysts were missed on T2-weighted and NCE-MRA but not on CE-MRA images.


Conclusion


A non–contrast-enhanced MR imaging protocol including NCE-MRA and T2-weighted images allows for the accurate screening of living related kidney donors and may serve as an alternative to CE-MRA.