ROLE OF Biphasic 3 T MRI angiography in planning for kidney tumor surgery


Authors: Milan Hora 1;  Petr Stránský 1;  Ivan Trávníček 1;  Tomáš Ürge 1;  Viktor Eret 1;  Boris Kreuzberg 2;  Jan Baxa 2;  Hynek Mírka 2;  Ondřej Hes 3;  Jan Kastner 2;  Jiří Ferda 2
Authors‘ workplace: Urologická klinika LF UK a FN Plzeň 1;  Klinika zobrazovacích metod LF UK a FN Plzeň 2;  Šiklův patologicko-anatomický ústav LF UK a FN Plzeň 3
Published in: Ces Urol 2013; 17(3): 183-192
Category: Original article

Overview

Aim:
Urologists are aware of the advantages of using MRI for imaging renal tumors compared to computerized tomography (CT). To date, MRI biphasic angiography (MRA) has not been used for planning surgeries due to the low resolution of 1.5T machines. Recent technical improvements in 3T MRA enable shorter acquisition time and higher spatial resolution compared to 1.5T MRA. This allows for relatively high quality reconstruction of renal vessels. We present our experience using a 3T MRA.

Methods:
This study analyzed 155 patients with kidney tumors, who underwent 3T MRI (Magnetom SKYRA 3T, Siemens), between April 2011 and March 2013. Of the 155 patients, 144 were also examined with CT, 34 including CT angiography – CTA (21.9%). In 142 (91.6%) MRA was compared with detailed intraoperative assessment of renal vessels (33 with CTA).

Results:
Aberantní renální tepny byly u 25,2 % vpravo a 19,4 % vlevo, aberantní renální žíly ve 22,6 % vpravo a 4,5 % vlevo. 3 T MRA souhlasilo s per-operačním nálezem v 90,8 % (129/142), CTA v 90,9 % (30/33). Nezachyceny byly vždy aberantní cévy. MRA a CTA se shodovaly v 88,2 % (30/34), přičemž vždy MRA oproti CTA nezachytilo drobné aberantní cévy.

Aberrant renal arteries were found on the right side in 25.2% cases and on the left side in 19.4% cases. Aberrant renal veins were documented in 22.6% and 4.5% cases on the right and left side respectively. In 90.8% (129/142) of cases, 3T MRA was confirmed by peroperative findings, and 90.9% (30/33) was found using CTA. In some cases MRA failed to identify aberrant vessels. MRA and CTA agreed in 88.2% (30/34) of cases; in 4 cases, small aberrant vessels were documented by CTA but not MRA.

Conclusion:
1. A 3T-MRA gives detailed information about the renal vasculature including its topographical anatomy. 2. With MRA, small aberrant vessels were missed more frequently than with CTA. 3. Our subjective assessment indicates that CTA can be reproduced better by urologists. 4. The quality of the 3D reconstruction is highly dependent on the skills of the radiologist. 5. A 3T MRA may be used for planning of laparoscopic surgeries, however CTA remains the gold standard.

Key words:
CT, MRI, angiography, kidney tumours, nephrectomy, laparoscopy.


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Paediatric urologist Nephrology Urology
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