Background:
The addition of more detector rows in a helical CT from 4 to 8 to 16 (and now up to 64) allow acquisition of near isotropic voxels of data. The increased speed has enhanced the quality of axial as well as the two-dimensional (2D) and 3D images of the renal anatomy.
The purpose of our study was to assess if these technical improvements with the 16-MDCT translated into improved overall performance in the evaluation of living renal donors and if review of the 3D dataset alone from surgical perspective can allow evaluation of renal donor anatomy.
Methods:
This was a HIPAA compliant and Institutional Review Board approved study. Between Jul. 2002 and Aug. 2004, forty-six renal donors (male: 18, female: 28, mean age of 42 yrs) were studied on a 16-slice MDCT. Considering surgical findings as the standard of reference, two blinded reviewers (R1 and R2) studied the renal vascular and urographic anatomy of each donor CT exam independently, using a defined pattern namely 3D images alone first, then axial alone, and finally, axial in conjunction with the 3D dataset. Image quality, degree of diagnostic confidence and time taken for review were also recorded.
Results:
A total of 46 donor nephrectomies were performed. The sensitivity and (specificity) of MDCT for the evaluation of accessory arteries when read by R1 and R2 using 3D images alone were 100% (100%) and 89% (97%), using axial alone, 89% (100%) and 89% (100%), and using axial in conjunction with 3D datasets, 100% (100%) and 89% (100%), respectively. Likewise, the sensitivity and (specificity) for evaluation of venous anomalies when read by the R1 and R2 using 3D images alone were 100% (98%) and 100% (98%), using axial alone, 100% (98%) and 100% (95%), and using axial in conjunction with 3D datasets, 100% (98%) and 100% (98%), respectively.
Conclusions:
The near isotropic voxel resolution of 16-MDCT routinely provides excellent quality 3D images of renal donors’ vascular and excretory realms. Review of the 3D dataset alone can provide focused renal vascular and pyelographic results with high sensitivity and specificity with good diagnostic confidence and can serve to reduce the necessary review time. Furthermore, the 3D images may also help surgeons by providing fewer and relevant images of the donor anatomy for their review and display in a way they are familiar with from surgery rather than confining them to the traditional imaging format of axial dataset.

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