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Published online before print May 23, 2006, 10.1148/radiol.2401050780
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Evaluation of Living Renal Donors: Accuracy of Three-dimensional 16-Section CT1

Neeraj Rastogi, MD, Dushyant V. Sahani, MD, Michael A. Blake, MD, Dicken C. Ko, MD and Peter R. Mueller, MD

1 From the Departments of Radiology (N.R., D.V.S., M.A.B., P.R.M.) and Transplant Surgery (D.C.K.), Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114. Received May 6, 2005; revision requested July 5; revision received August 14; accepted September 12; final version accepted October 4. Address correspondence to D.V.S. (e-mail: dsahani{at}partners.org).


Figure 1
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  		Figure 1a: Vascular phase (a) MIP and (b) volume-rendered CT images in a 54-year-old female renal donor show dominant renal artery (arrowhead) supplying upper pole of right kidney and two accessory arteries (white arrows) supplying mid and lower pole each. Two renal veins (black arrows) are draining the right kidney. (c) Coronal arterial phase MIP CT image shows lower polar accessory (arrow) and dominant (arrowhead) arteries on the left side. Laparoscopic nephrectomy was performed in left kidney because of more favorable anatomy.

 

Figure 1
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  		Figure 1b: Vascular phase (a) MIP and (b) volume-rendered CT images in a 54-year-old female renal donor show dominant renal artery (arrowhead) supplying upper pole of right kidney and two accessory arteries (white arrows) supplying mid and lower pole each. Two renal veins (black arrows) are draining the right kidney. (c) Coronal arterial phase MIP CT image shows lower polar accessory (arrow) and dominant (arrowhead) arteries on the left side. Laparoscopic nephrectomy was performed in left kidney because of more favorable anatomy.

 

Figure 1
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  		Figure 1c: Vascular phase (a) MIP and (b) volume-rendered CT images in a 54-year-old female renal donor show dominant renal artery (arrowhead) supplying upper pole of right kidney and two accessory arteries (white arrows) supplying mid and lower pole each. Two renal veins (black arrows) are draining the right kidney. (c) Coronal arterial phase MIP CT image shows lower polar accessory (arrow) and dominant (arrowhead) arteries on the left side. Laparoscopic nephrectomy was performed in left kidney because of more favorable anatomy.

 

Figure 2
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  		Figure 2a: (a, b) Coronal MIPs from multidetector CT angiography in a 45-year-old female renal donor show dominant left renal artery (arrowhead) and small accessory artery (arrow in a), which appears to originate in proximity to dominant renal artery mimicking early division. (b) Rotated MIP depicts separate origin of accessory artery (arrow). (c) Corresponding transverse CT image shows separate origin of dominant (arrowhead) and accessory (arrow) arteries, which can be missed if data set is not carefully reviewed.

 

Figure 2
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  		Figure 2b: (a, b) Coronal MIPs from multidetector CT angiography in a 45-year-old female renal donor show dominant left renal artery (arrowhead) and small accessory artery (arrow in a), which appears to originate in proximity to dominant renal artery mimicking early division. (b) Rotated MIP depicts separate origin of accessory artery (arrow). (c) Corresponding transverse CT image shows separate origin of dominant (arrowhead) and accessory (arrow) arteries, which can be missed if data set is not carefully reviewed.

 

Figure 2
View larger version (149K):

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  		Figure 2c: (a, b) Coronal MIPs from multidetector CT angiography in a 45-year-old female renal donor show dominant left renal artery (arrowhead) and small accessory artery (arrow in a), which appears to originate in proximity to dominant renal artery mimicking early division. (b) Rotated MIP depicts separate origin of accessory artery (arrow). (c) Corresponding transverse CT image shows separate origin of dominant (arrowhead) and accessory (arrow) arteries, which can be missed if data set is not carefully reviewed.

 

Figure 3
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  		Figure 3: Coronal MIP from CT angiography in a 53-year-old female renal donor shows a dominant left renal artery (arrowhead) and lower polar accessory artery (arrow). A more surgically preferable laparoscopic nephrectomy in left kidney was performed.

 

Figure 4
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  		Figure 4: Multi–detector row CT angiogram in a 39-year-old male renal donor shows one dominant renal artery (arrowhead) on the left and a smaller artery (arrow), which lies approximately 1 cm inferior to the dominant artery and was incorrectly read by one reviewer as an accessory artery. On retrospective review of 3D data set, this was found to be a branch of superior mesenteric artery crossing in front of left renal hilum.

 

Figure 5
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  		Figure 5a: Venous phase CT images in a 33-year-old renal donor with left retroaortic vein. (a, b) Transverse images show proximal (arrow in a) and distal (arrow in b) portion of left renal vein traversing behind aorta to drain into inferior vena cava. (c) Corresponding coronal MIP displays left retroaortic vein (arrow) anatomy.

 

Figure 5
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  		Figure 5b: Venous phase CT images in a 33-year-old renal donor with left retroaortic vein. (a, b) Transverse images show proximal (arrow in a) and distal (arrow in b) portion of left renal vein traversing behind aorta to drain into inferior vena cava. (c) Corresponding coronal MIP displays left retroaortic vein (arrow) anatomy.

 

Figure 5
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  		Figure 5c: Venous phase CT images in a 33-year-old renal donor with left retroaortic vein. (a, b) Transverse images show proximal (arrow in a) and distal (arrow in b) portion of left renal vein traversing behind aorta to drain into inferior vena cava. (c) Corresponding coronal MIP displays left retroaortic vein (arrow) anatomy.

 

Figure 6
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  		Figure 6a: (a, b) Venous phase coronal CT MIPs in a 49-year-old female renal donor show a small accessory renal vein (arrow) on the right. Arrowhead = dominant right renal vein. Left kidney had two arteries (not shown). Open flank nephrectomy was performed in right kidney.

 

Figure 6
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  		Figure 6b: (a, b) Venous phase coronal CT MIPs in a 49-year-old female renal donor show a small accessory renal vein (arrow) on the right. Arrowhead = dominant right renal vein. Left kidney had two arteries (not shown). Open flank nephrectomy was performed in right kidney.

 




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