Contrast enhanced spiral computerized tomography in live kidney donors: a single session for anatomical and functional assessment.

Abstract

We evaluated contrast enhanced spiral computerized tomography (CT) as a single session for anatomical and functional assessment of potential live kidney donors. The study included 80 consecutive kidney donors. In addition to routine donor evaluation, radiological imaging of the kidneys was performed with spiral CT, which was also used for selective determination of the glomerular filtration rate (GFR) of each kidney. All donors underwent 99mTc-mercaptoacetyltriglycine renal scan as a gold standard for GFR determination. Anatomical results of spiral CT were compared to operative findings at donor nephrectomy. Moreover, the results of CT GFR were compared with those of standard 99mTc-mercaptoacetyltriglycine GFR. Spiral CT detected major renal abnormalities that might be potentially significant for safe renal donation in 4 of the 80 donors (5%). Spiral CT had 100% sensitivity, 85.7% specificity and 97.2% overall accuracy for detecting the number of renal arteries. To identify the number of renal veins spiral CT had 100% sensitivity, 92.3% specificity and 98.6% overall accuracy. A comparison between the isotope GFR of each kidney with the corresponding CT GFR showed a perfect correlation (r = 0.54, p <0.001). For the right and left kidneys mean isotope clearance was not significantly different from that of mean CT clearance. Multidetector row spiral CT with contrast medium can provide accurate information regarding the anatomy of the urinary tract and vasculature of the kidney. Moreover, it can detect renal and vascular abnormalities that might be potentially significant for safe renal donation. In addition, it can accurately demonstrate selective GFR of each kidney. Therefore, we recommend spiral CT with contrast material as a single radiological diagnostic modality for the assessment of potential live kidney donors.