Use of gadolinium-enhanced, ultrafast, three-dimensional, spoiled gradient-echo magnetic resonance angiography in the preoperative evaluation of living renal allograft donors.

BACKGROUND: Renal allograft retrieval from live donors requires an accurate determination of kidney anatomy including the renal arterial supply. Traditionally, conventional angiography has served as the gold standard for obtaining this information. More recently, magnetic resonance angiography (MRA) has been compared with conventional angiography. Although MRA has been shown to be more cost effective and to have none of the co-morbidity associated with the angiographic process, it still has been perceived to be less accurate than angiography. METHODS: We compared images obtained using a relatively new technique of gadolinium-enhanced, ultrafast, three-dimensional, spoiled gradient-echo MRA with surgical findings in 15 living renal donors. In addition, average patient charge for MRA was compared with that of conventional angiogram. RESULTS: Fourteen patients were evaluated with the gadolinium-enhanced, ultrafast, three-dimensional, spoiled gradient-echo modality and the findings confirmed at surgery. On one occasion, a discrepancy occurred in which an accessory renal artery was suggested on the MRA but was not detected by conventional angiography. The accessory renal artery was later encountered at surgery. MRA was also used to evaluate patient 15 but was unsuccessful due to technical error. This patient was later found to have a positive cross-match with the recipient and therefore did not undergo surgery. CONCLUSIONS: We have found the gadolinium-enhanced MRA technique to be 100% accurate and as reliable as conventional angiography in determining renal vascular anatomy in living kidney donors. Additionally, it shares none of the associated potential angiographic complications and allows a 31% cost savings over angiography.

Reversibility of CT and MR findings in neuro-Behçet disease.

A woman with neuro-Behçet disease characterized by recurrent attacks of meningoencephalitis is reported. During an attack of brain stem dysfunction characterized by dysarthria, diplopia, and ataxia, the postcontrast CT showed an enhancing lesion of the upper brain stem. During a subsequent attack characterized by subcortical dementia and amnesia, magnetic resonance (MR) showed abnormal signal intensity in the hypothalamus and upper brain stem. Upon remission of her symptoms, follow-up contrast enhanced CT and MR were entirely normal. Magnetic resonance is especially useful in localizing acute inflammatory lesions in Behçet disease. This case suggests that abnormal MR and CT findings in neuro-Behçet disease are potentially reversible and that radiographic improvement parallels clinical improvement.