European Radiology

, Volume 28, Issue 10, pp 4195–4204 | Cite as

Non-contrast-enhanced magnetic resonance angiography: a reliable clinical tool for evaluating transplant renal artery stenosis

  • Long Jiang ZhangEmail author
  • Jin Peng
  • Jiqiu WenEmail author
  • U. Joseph Schoepf
  • Akos Varga-Szemes
  • L. Parkwood Griffith
  • Yuan Meng Yu
  • Shu Min Tao
  • Yan Jun Li
  • Xue Feng Ni
  • Jian Xu
  • Dong Hong Shi
  • Guang Ming Lu



To evaluate image quality of non-contrast-enhanced magnetic resonance angiography (MRA) and compare transplant renal artery stenosis (TRAS) seen by non-contrast-enhanced MRA with digital subtraction angiography (DSA) as the gold standard.

Materials and methods

330 patients receiving 369 non-contrast-enhanced MRA examinations from July 2014 to June 2017 were included. Thirty patients received at least two MRA examinations. Image quality was independently assessed by two radiologists. Inter-observer agreement was analyzed. Transplant renal artery anatomy and complications were evaluated and compared with DSA. If possible, accuracy was calculated on a per-artery basis.


Good or excellent image quality was found in 95.4 % (352/369) of examinations with good inter-observer agreement (K=0.760). Twenty-two patients with DSA had 28 non-contrast-enhanced MRA examinations within a 2-month period. Of these, 19 patients had TRAS, two patients had pseudoaneurysms, and one patient had a normal transplant renal artery but an occluded external iliac artery. Non-contrast-enhanced MRA correctly detected 19 TRAS and nine normal arteries, giving 96.6 % accuracy on a per-artery basis.


Non-contrast-enhanced MRA demonstrates a good depiction of the transplanted renal artery and shows good correlation with DSA in cases where there was TRAS.

Key Points

• Good or excellent image quality was found in 95.4 % of examinations.

• Non-contrast-enhanced MRA can clearly map transplant renal artery anatomy.

• Non-contrast-enhanced MRA is a reliable tool to detect TRAS.


Angiography, digital subtraction Renal artery obstruction Kidney transplantation Magnetic resonance angiography Magnetic resonance imaging 



Chronic kidney disease


CT angiography


Digital subtraction angiography


Inflow inversion recovery


Magnetic resonance angiography


Steady-state free precession


Transplant renal artery stenosis



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Long Jiang Zhang.

Conflict of interest

UJS is a consultant for and/or receives research support from Astellas, Bayer, General Electric, Guerbet and Siemens Healthineers. AVS received research support from Siemens Healthineers. All other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Long Jiang Zhang
    • 1
    Email author
  • Jin Peng
    • 2
  • Jiqiu Wen
    • 3
    Email author
  • U. Joseph Schoepf
    • 1
    • 4
  • Akos Varga-Szemes
    • 4
  • L. Parkwood Griffith
    • 4
  • Yuan Meng Yu
    • 1
  • Shu Min Tao
    • 1
  • Yan Jun Li
    • 1
  • Xue Feng Ni
    • 2
  • Jian Xu
    • 1
  • Dong Hong Shi
    • 1
  • Guang Ming Lu
    • 1
    • 2
  1. 1.Department of Medical ImagingJinling Hospital, Medical School of Nanjing UniversityNanjingChina
  2. 2.Department of Medical ImagingJinling Hospital, Nanjing Clinical School, Southern Medical UniversityNanjingChina
  3. 3.National Clinical Research Center of Kidney DiseaseJinling Hospital, Medical School of Nanjing UniversityNanjingChina
  4. 4.Division of Cardiovascular Imaging, Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA

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