Impact of MR Angiography on the Diagnosis and Management of Renal Transplant Dysfunction

Abstract

To evaluate the impact of magnetic resonance angiography (MRA) on referring physicians' diagnoses and treatment of patients with renal transplant dysfunction. Physicians of the renal transplant service at the authors' university hospital prospectively completed questionnaires before and after MRA was performed in the evaluation of renal transplants. The questionnaires asked physicians to estimate the probability (0%-100%) of their most likely diagnosis before and after receiving the imaging information. They were also asked to provide their anticipated and final treatment plans. The authors calculated the mean gain in diagnostic percentage confidence and the proportion of patients with changed initial diagnoses or anticipated management. A paired t test was used to assess statistical significance of the gains in diagnostic percentage confidence. Pre-MRA and post-MRA questionnaires were prospectively completed on 31 separate patients. The mean gain in diagnostic certainty percentage from MRA was 33% (95% CI, 19%-51%; P < .001). MRA changed physicians' initial diagnoses in 20 patients (65%; 95% CI, 47%-79%). Immediate clinical management changed in 16 patients (52%; 95% CI, 35%-68%). Invasive procedures were avoided in 12 patients (39%). MRA has considerable impact on referring physicians' diagnoses and treatment of patients with suspected renal allograft dysfunction.