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 place of work:
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 the journal:
Ces Urol 2013; 17(3): 183-192
Category:
Original article
Summary
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.
Zdroje
1. Patil UD, Ragavan A, Nadaraj, Murthy K, Shankar R, Bastani B, Ballas SH. Helical CT angiography in evaluation of live kidney donors. Nephrol Dial Transplant 2001; 16(9): 1900–1904.
2. Hora M, Ferda J, Kreuzberg B, Klečka J, Hes O, Chudáček Z. Využití dvoufázové CT-angiografie při chirurgické léčbě nádorů ledvin (The use of two-phase CT-angiography in the surgical treatment of renal tumours. Ces Urol 2005; 9(1): 14–19.
3. Ferda J, Hora M, Hes O, Ferdová E, Kreuzberg B. Assessment of the kidney tumor vascular supply by two-phase MDCT-angiography. Eur J Radiol 2007, 62(2): 295–301.
4. Ferda J, Hora M, Hes O, Ürge T, Reischig T, Mírka H, Ferdová, E, Kreuzberg B, Ohlídalová K. Využití magnetické rezonance v zobrazení renálních karcinomů u nemocných s terminálním selháním ledvin (Application of magnetic resonance in imaging of renal carcinomas in patients with terminal kidneys failure). Ces Radiol 2006; 60(4): 196–202.
5. Ferda J, Kastner J, Ferdová E, Mírka H, Baxa J, Hora M, Hes O, Fínek J, Kreuzberg B. Zobrazení solidních nádorů ledvin (Imaging of solid kidney tumors. Ces Radiol 2012; 66(3): 271–281.
6. Ferda J, Hora M, Mírka H, Eret V, Kastner J, Baxa J, Kreuzberg B. Imaging of the vascular supply in renall tumors using the contrast enhanced magnetic resonance angiography on 3T MR system [Zobrazení cévního zásobení nádorů ledvin kontrastní MR angiografií pomocí 3T MRI]. Ces Radiol 2011; 65(4): 245–250.
7. Hora M, Stránský P, Trávníček I, Urge T, Eret V, Kreuzberg B, Baxa J, Mírka H, Petersson F, Hes O, Ferda J. Three-tesla MRI biphasic angiography: a method for preoperative assessment of the vascular supply in renal tumours-a surgical perspective. World J Urol 2012 Apr 19 [Epub ahead of print].
8. Kramer U, Thiel C, Seeger A, Fenchel M, Laub G, Finn PJ, Steurer W, Claussen CD, Miller S. Preoperative evaluation of potential living related kidney donors with high-spatial-resolution magnetic resonance (MR) angiography at 3 Tesla: comparison with intraoperative findings. Invest Radiol 2007; 42(11): 747–755.
9. Běhounek P, Hora M, Klečka J. Medicína založená na důkazech (Evidence based medicine). Ces Urol 2011; 15(1): 10–14.
10. Loewe C, Becker CR, Berletti R, Cametti CA, Caudron J, Coudyzer W, De Mey J, Favat M, Heautot JF, Heye S, Hittinger M, Larralde A, Lestrat JP, Marangoni R, Nieboer K, Reimer P, Schwarz M, Schernthaner M, Lammer J. 64-Slice CT angiography of the abdominal aorta and abdominal arteries: comparison of the diagnostic efficacy of iobitridol 350 mgI/ml versus iomeprol 400 mgI/ml in a prospective, randomised, double-blind multi-centre trial. Eur Radiol 2010; 20(3): 572–583.
11. Třeška V, Hora M, Ferda J, Hes O, Ňaršanská A, Matkovčík Z. Nádorový trombus dolní duté žíly u karcinomu ledviny (Neoplastic thrombosis of the inferior vena cava in kidney cancer). Rozhl Chir 2009; 88(4): 196–199.
12. Ferda J, Ferdová E, Hora M, Hes O. 18F-FDG-PETC/CT renálního karcinomu (18F-FDG-PETC/CT in renal-cell carcinoma). Ces Radiol 2011; 65(3): 190–195.
13. Kim JH, Bae JH, Lee KW, Kim ME, Park SJ, Park JY. Predicting the histology of small renal masses using preoperative dynamic contrast-enhanced magnetic resonance imaging. Urology 2012; 80(4): 872–876.
14. Lanzman RS, Robson PM, Sun MR, Patel AD, Mentore K, Wagner AA, Genega EM, Rofsky NM, Alsop DC, Pedrosa I. Arterial spin-labeling MR imaging of renal masses: correlation with histopathologic findings. Radiology 2012; 265(3): 799–808.
15. Vargas HA, Chaim J, Lefkowitz RA, Lakhman Y, Zheng J, Moskowitz CS, Sohn MJ, Schwartz LH, Russo P, Akin O. Renal cortical tumors: use of multiphasic contrast-enhanced MR imaging to differentiate benign and malignant histologic subtypes. Radiology 2012; 264(3): 779–788.
16. Ferda J, Hora M, Hes O, Kastner J, Ferdová E, Mírka H, Baxa J, Heidenreich F, Fínek J, Kreuzberg B. Prostate imaging with 3T MRI in patiens with elevated PSA levels [Zobrazení prostaty na 3T MRI u nemocných se zvýšenou hladinou PSA. Ces Radiol 2012; 66(1): 9–17.
17. Liefeldt L, Klüner C, Glander P, Giessing M, Budde K, Taupitz M, Rogalla P, Kroencke TJ. Non-invasive imaging of living kidney donors: intraindividual comparison of multislice computed tomography angiography with magnetic resonance angiography. Clin Transplant 2012; 26(4): E412–417.
18. Engelken F, Friedersdorff F, Fuller TF, Magheli A, Budde K, Halleck F, Deger S, Liefeldt L, Hamm B, Giessing M, Diederichs G. Pre-operative assessment of living renal transplant donors with state-of-the-art imaging modalities: computed tomography angiography versus magnetic resonance angiography in 118 patients. World J Urol 2013 Jan 8 [Epub ahead of print].
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2013 Číslo 3
Najčítanejšie v tomto čísle
- Is it appropriate to administer antibiotic prophylaxis to infants with severe hydronephrosis before pyeloplasty?
- Modern radiotherapy of localized prostate cancer
- Management of renal injury in the Department of Urology at the University Hospital in Pilsen
- Results from small renal mass biopsies in the Department of Urology University Hospital Ostrava