The aim of this study is to demonstrate the usefulness of adding 3-dimensional (3D) ultrasound in evaluation of renal transplant vasculature compared to 2-dimensional (2D) Duplex ultrasound.
One hundred thirteen consecutive renal transplant 2D and 3D ultrasound examinations were performed and retrospectively reviewed by 2 board-certified radiologists and a radiology resident individually; each reviewed 2D and then 3D images, including color and spectral Doppler. They recorded ability to visualize the surgical anastomosis and rated visualization on a subjective scale. Interobserver agreement was evaluated. Variant anastomosis anatomy was recorded. Tortuosity or stenosis was evaluated if localized Doppler velocity elevation was present.
The reviewers directly visualized the anastomosis more often with 3D ultrasound (
=97.5%) compared with 2D (
=54.5%) [difference in means (DM) = 43% (95% confidence interval (CI) = 36%-50%) (P < 0.001)]. The reviewers visualized the anastomosis more clearly with 3D ultrasound (P < 0.001) [difference in medians = 0.5, 1.0, and 1.0, (95% CI = 0.5-1.0, 0.5-1.0, and 1.0-1.5)]. Detection of variant anatomy improved with 3D ultrasound by 2 reviewers [DM = 7.1% and 8.9% (95% CI = 1%-13% and 4%-14%, respectively) (P < 0.05)]. There was high interobserver agreement [
= 95.3%, (95% CI = 91.9%-98.7%) regarding anastomosis visualization among reviewers with wide-ranging experience.
Direct visualization of the entire anastomosis was improved with 3D ultrasound. Three-dimensional evaluation improved detection of anatomic variants and identified tortuosity as the likely cause of borderline localized elevation in Doppler velocity. The data added by 3D ultrasound may obviate confirmatory testing with magnetic resonance angiography or computed tomographic angiography after equivocal 2D ultrasound results.
This study demonstrates that the use of 3-dimensional ultrasound improves visualization of the anastomosis and anatomic variants compared to 2-dimensional ultrasound in kidney transplant recipients, perhaps obviating confirmatory testing with magnetic resonance angiography or computed tomographic angiography in dubious cases.
1 Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, Montefiore Medical Center, Bronx, NY.
2 NYU Langone Medical Center, New York, NY.
3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
Received 19 October 2015. Revision received 24 February 2016.
Accepted 24 February 2016.
This publication was supported in part by the CTSA grant UL1RR025750, KL2RR025749 and TL1RR025748 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH.
The authors declare no conflicts of interest.
S.J.F. participated in study design, data collection and analysis, writing of article. W.R.W. participated in study design, data collection and analysis, writing of article. L.L. participated in study design, data collection and analysis, writing of article. H.W.C. participated in statistical analysis, editing of article. M.K. participated in study design, data collection and analysis, writing of article.
Our early experience with 3-dimensional ultrasound of renal transplants was originally presented as an educational exhibit at the American Roentgen Ray Society May 1–6, 2011 in Chicago, IL. In addition, some of our current material was presented as an educational exhibit at the 100th Radiologic Society of North America Scientific Society and Annual Meeting November 30 to December 5, 2014 in Chicago, IL.
Correspondence: Susan J. Frank, MD, Department of Radiology, Albert Einstein College of Medicine of Yeshiva University Montefiore Medical Center, Bronx, NY (email@example.com).
Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).