Roberto Iezzi MD, Presenter: Nothing to Disclose

Michele Fabio La Torre MD, Abstract Co-Author: Nothing to Disclose

Alessandra Guerra MD, Abstract Co-Author: Nothing to Disclose

Massimiliano Nestola MD, Abstract Co-Author: Nothing to Disclose

FRANCO CITTERIO MD, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

To evaluate the diagnostic performance of a triple bolus dual-phase acquisition protocol (unenhanced/combined artero-venous-excretory phases) for the preoperative assessment of kidney anatomy in renal laparoscopic living donors.

Twenty consecutive patients, referring to our department to undergo CT evaluation prior to living donor nephrectomy, were enrolled in our single-center prospective randomized comparison of 2 CT-acquisition protocols. Ten patients (Group A) underwent standard quadri-phase CT-examination (unenhanced, arterial, venous, and delayed phases) during a single injection bolus of 100 ml of contrast medium whereas the last 10 patients (Group B) underwent a dual-phase CT protocol (unenhanced and combined artero-venous-excretory phases). Combined artero-venous-excretory phase (Renal Triple-Rule-Out) was performed with a triple split-bolus injection protocol (CM: 30+30+40 ml, @4mL/sec) and an optimized time delay triggered to obtain both artery, veins and renal pelvis opacification at the same time. CT-images were quantitatively and qualitatively compared by two blinded independent readers. The 2 protocol were also compared in terms of diagnostic performance using the surgical assessment during nephrectomy, as gold standard.

All CT examinations were considered technically adequate and no complications occurred. Significantly higher vascular attenuation values (renal arteries and veins) were obtained in Group A. No significant differences were noted in terms of image quality with either axial source images or 3D reconstructions. Likewise, no significant differences were found among the two protocols in terms of noise. No beam-hardening artifacts due to renal pelvis opacification affecting image interpretation were found. No significant differences were found among the two groups with regard to diagnostic performance. Overall dose reduction of 60% was achieved in Group B. 

Renal Triple-Rule-Out CT Protocol by using a triple-bolus injection protocol is feasible and effective in the preoperative planning of laparoscopic living kidney donors, without compromising image quality and diagnostic performance with a substantial reductions of radiation dose. 

Renal-Triple-Rule-Out CT protocol may allow a significant reduction in radiation burden in renal laparoscopic living donor without affecting an accurate pre-treatment planning.

Iezzi, R, La Torre, M, Guerra, A, Nestola, M, CITTERIO, F, Bonomo, L, Dual-Phase Triple Split-Bolus Protocol for Pre-Operative CT Evaluation of Laparoscopic Donor Kidney Anatomy: A Way for Dose Reduction.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014212.html