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Rotational digital subtraction angiography of the renal arteries: technique and evaluation in the study of native and transplant renal arteries

¹ Department of Radiology ² The Radiological Protection Centre, St George's Hospital, London, SW17 0QT UK

View larger version (69K): [in a new window]   Figure 1. Axial early phase contrast CT through the upper abdomen demonstrating the rotational arc of 120° for native renal artery rotational digital subtraction angiography. RAO, right anterior oblique; LAO, left anterior oblique.

View larger version (75K): [in a new window]   Figure 2. Axial unenhanced CT through the pelvis demonstrating the rotational arc for transplant renal artery rotational digital subtraction angiography. The rotational field isocentre is placed over the hemipelvis containing the transplant. RPO, right posterior oblique; LAO, left anterior oblique.

View larger version (91K): [in a new window]   Figure 3. (a–d) Series of four selected images from left-sided renal transplant rotational digital subtraction angiography. The entire series commences with the first subtraction image acquired at 94° left posterior oblique (compare Figure 2 for rotational arc), with images acquired approximately every 10°. The projections shown are at (a) 75° left anterior oblique (LAO), (b) 31° LAO, (c) 0° and (d) 32° right anterior oblique. (e) Larger view of (a), on which the transplant artery anastomosis is identified best in profile. This is clearly demonstrated on the static angiographic image obtained at 75° LAO.

View larger version (75K): [in a new window]   Figure 4. (a–f) A selection of six images from right-sided renal transplant rotational digital subtraction angiography, with images from 84° left anterior oblique (LAO) to 34° right anterior oblique. In this example, the transplant can be seen lying in a more horizontal orientation, with the hilum pointing inferiorly. (g) Larger view of (c), in which the transplant artery anastomosis is best seen. The static angiogram performed at 30° LAO clearly shows the end-to-side transplant artery anastomosis in profile.

View larger version (86K): [in a new window]   Figure 5. (a–d) A slightly smaller rotational arc was used in this renal transplant rotational digital subtraction angiography. The selected images are shown from 27° left anterior oblique to 43° right anterior oblique (RAO). The anatomy of the anastomosis is more varied than that seen in Figures 3 and 4, and the anastomosis is best seen at 43° RAO, i.e. the anastomosis has a more medial orientation than those seen previously. (e) Static angiogram acquired at 43° RAO.

View larger version (103K): [in a new window]   Figure 6. (a) Selection of images from right-sided renal rotational digital subtraction angiography (RDSA) showing images acquired from 87° left anterior oblique (LAO) to 10° right anterior oblique. There is an end-to-end anastomosis in this case. The transplant anastomosis is hidden behind the external iliac artery on many of the images, but is best seen at 44° LAO (enlarged in (b)). (b) A small peripheral arteriovenous malformation (arrowhead) noted during the RDSA was thought to be a sequel of post-transplant biopsy. (c) The static image at 44° LAO shows the anastomosis clearly (arrow) but no evidence of stenosis was identified.