Vascular Renal Anatomy and the Ureteropelvic Junction: Preoperative Multidetector CT Scanning with Split-Bolus Injection as a Predictor of Laparoscopic Findings

Abstract

Purpose:To compare multidetector CT scan (MDCT) results with intraoperative findings in the detection of an inferior-pole pedicle crossing the ureteropelvic junction.Patients and Methods: Over the 2-year study period, 35 patients receiving laparoscopic pyeloplasty underwent preoperative investigation with a novel MDCT protocol in order to detect crossing vessels. Postprocessing, including maximum intensity projection, volume-rendering technique, and multiplanar reconstruction, was used in addition to standard axial views.Results: All the arteries found during laparoscopic surgery were detected by MDCT, but one radiologic false-positive was noted at the beginning of the series. Seven veins were not detected with MDCT. In the only case featuring an isolated inferior-pole vein, the aberrant vessel was identified by MDCT.Conclusion: Multidetector CT scanning is a highly accurate way of providing all the information necessary preoperatively concerning renal parenchymal anomalies, urinary stones, and collecting system and vessel anatomy. It helps physicians make appropriate therapeutic decisions and gives surgeons information about what they can expect during laparoscopic procedures.

Laparoscopic Anderson-Hynes procedure as a treatment of ureteropelvic junction obstruction caused by fibroepithelial polyp.

“…Preoperative radiographic diagnosis of FEPs based on excretory urography could be challenging, because they usually present as a filling defect, which may be caused by blood clots, radiolucent calculi, neoplasm or a crossing vessel [5]. To determine the polyps multidetector computed tomography (CT) scanning or virtual CT ureteroscopy can be helpful but neither of these techniques is routinely used in patients with suspected UPJO [6, 7]. In our case the results of excretory urography (IVU) and diuretic renography were typical of UPJO; hence we did not perform any other diagnostic procedures.…”

Multidetector computed tomography findings and correlations with proteinuria in nutcracker syndrome

“…To compare the amount of proteinuria between the two groups, we examined the 24-h urine protein level and the ratio of protein:creatinine. In the NS group, the male:female ratio was 0.71 and mean age was 13.4 (range [11][12][13][14][15][16][17] years. In the control group, the male:female ratio was 0.55 and the mean age was 11.7 (range [8][9][10][11][12][13][14] years.…”

“…By virtue of shortened scan times, the kidneys can be depicted in welldefined phases of contrast enhancement, thereby allowing lesions to be characterized more precisely [14,15]. Different phases of contrast uptake can be differentiated as the arterial, corticomedullary, nephrographic, and excretory phases [15,16].…”

Dual bolus intravenous contrast injection technique for multiregion paediatric body CT

“…A similar principle, although involving boluses separated by 5-10 minutes, can provide excretory phase in addition to vascular phase information in adult prepyeloplasty [15] and renal donor evaluation [16]. These studies have demonstrated equal or improved vascular opacification, parenchymal enhancement and lesion conspicuity, with significant dose savings from obviating the need for multi-phase scanning commonly associated with adult protocols.…”