New Dimensions in Renal Transplant Sonography: Applications of 3-Dimensional Ultrasound

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Abstract

Background

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.

Methods

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.

Results

The reviewers directly visualized the anastomosis more often with 3D ultrasound (

Results

JOURNAL/trans/04.02/00007890-201706000-00032/math_32MM1/v/2017-07-22T045746Z/r/image-tiff

Results

=97.5%) compared with 2D (

Results

JOURNAL/trans/04.02/00007890-201706000-00032/math_32MM2/v/2017-07-22T045746Z/r/image-tiff

Results

=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 [

Results

JOURNAL/trans/04.02/00007890-201706000-00032/math_32MM3/v/2017-07-22T045746Z/r/image-tiff

Results

= 95.3%, (95% CI = 91.9%-98.7%) regarding anastomosis visualization among reviewers with wide-ranging experience.

Conclusions

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.

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