Objective: To evaluate the prevalence of incidental findings on preoperative abdominal computed tomography angiography-computed tomography urography in asymptomatic prospective renal donors.
Methods: A Health Insurance Portability and Accountability Act (HIPAA)-compliant, Institutional Review Board (IRB)-approved retrospective study of 1,597 subjects undergoing renal transplant evaluation from June 1, 2006, to March 31, 2011, was performed. Candidates underwent multiphasic multidetector computed tomography angiography-computed tomography urography for presurgical evaluation of renal vascular and parenchymal anatomy. All scans were reviewed by one of three fellowship-trained abdominal radiologists. The diagnoses were made on the basis of computed tomography characteristics of each lesion, and pathology confirmation was available for seven patients. We calculated the prevalence of each incidental finding, performed Fisher exact test or chi-square test for categorical variables between the cohort that did and did not undergo donor nephrectomy, and performed simple linear logistic regression analysis of incidental findings which predicted renal donation.
Results: Of the 1,597 potential donors, 58.4% were female, and the mean age was 42.6 years (range, 18-74). One thousand one hundred ninety-five (74.9%) had a total of 2,105 incidental findings. Based on American College of Radiology Incidental Findings Committee White Paper on Managing Incidental Findings on Abdominal Computed Tomography, 17.3% had incidentalomas and 1.1% required follow-up. Majority of the incidental findings (16 of 17) were in patients who did not undergo renal donation. The prevalence of pathologically proven malignancy was 0.1% (3 of 1,597).
Conclusion: Preoperative computed tomography angiography-computed tomography urography not only identifies vascular anatomy but may also help detect clinically significant unanticipated findings in an otherwise healthy population.