ROLE OF MAGNETIC RESONANCE ANGIOGRAPHY IN RENAL TRANSPLANTATION

Abstract

Renal transplantation has emerged as the treatment of choice for patients with end-stage-renal disease (ESRD), providing improved quality of life and lower healthcare costs compared with other treatment options. Because of the prevalence of graft failure, reliable non invasive imaging techniques are extremely valuable for early detection of complications, which involve both surgical and medical causes that may be categorized into prerenal (vascular) etiologies, renal (intrinsic) causes and post renal (obstructive) etiologies . Magnetic resonance (MR) angiography is a wildly used , non-invasive tool for evaluating the aorta and its branches . It is particularly used in renal transplantation recipient because it provides anatomic detail of the transplant artery without nephrotoxic effects. Volume rendering is an excellent technique which offers high-quality 3D angiographic images, especially in cases of tortuous or complex vascular anatomy . The MR imaging protocols including volume rendering allow rapid global assessment of the renal transplant arterial system, renal parenchyma and peritransplant region , also it can detect or exclude many of the various causes of transplant dysfunction . Invasive angiography can be avoided in patients with normal findings, instead being reserved for patients with MR angiography evidence of stenosis . Angiography can then help determine the hemodynamic significance of a stenosis and helps select patients for intervention. 3D gadolinium magnetic resonance imaging (MRA) has been established as a safe and reliable technique for detection and grading of renal artery stenosis . Due to the lack of need for nephrotoxic contrast agents and ionizing radiation , this technique is particularly attractive for patients with kidney transplant or those with renal failure .