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CT Evaluation of Renovascular Disease¹

¹ From the Departments of Radiology (A.K., C.M.S., R.D.E., E.P.T., S.M.G.) and Urology (C.M.S., S.M.G.), University of Texas Medical School, Houston; the Department of Radiology, Lyndon B. Johnson General Hospital, 5656 Kelley St, Houston, TX 77026 (A.K., C.M.S., R.D.E., S.M.G.); and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Md (E.K.F.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received May 3, 1999; revision requested July 13 and received May 1, 2000; accepted May 4. Address correspondence to A.K. (e-mail: akira.kawashima@uth.tmc.edu).

Computed tomography (CT) plays an important role in evaluation and management of primary renovascular disease. Nonenhanced CT is useful for demonstrating renal hemorrhage, renal parenchymal or vascular calcifications, and masses. Contrast material–enhanced CT is essential to identify global or regional nephrographic abnormalities resulting from the vascular process (eg, renal infarcts, ischemia secondary to renal artery stenosis, arteriovenous communications). In addition, renal manifestations of a systemic disease (eg, vasculitis, thromboembolic disease) can be seen at CT. In trauma, occlusion of the main renal artery can be accurately diagnosed with contrast-enhanced CT. In cases of spontaneous renal hemorrhage without an apparent cause (eg, vasculitis, coagulopathy), a careful CT study should be performed to exclude renal cell carcinoma. The presence of fat in a hemorrhagic renal mass larger than 4 cm in diameter is characteristic of angiomyolipoma complicated by hemorrhage. Acute renal vein thrombosis appears as a clot in a distended renal vein, whereas renal vein retraction with collateral vessels is highly indicative of chronic thrombosis. Helical CT, especially with multiplanar two-dimensional and three-dimensional reconstruction following an intravenous injection of iodinated contrast material, has greatly improved our ability to directly image the proximal renal arteries and detect vascular lesions.

Index Terms: Aneurysm, renal, 81.73, 96.73 • Arteriovenous malformations, renal, 81.1494, 96.149 • Fistula, arteriovenous, 81.494, 96.494 • Kidney, hemorrhage, 81.367, 96.367 • Kidney, infarction, 81.77, 96.771 • Kidney, injuries, 81.48, 96.41 • Renal arteries, stenosis or obstruction, 961.72 • Renal veins, thrombosis, 81.751, 966.751 • Ureter, stenosis or obstruction, 821.844 • Vasculitis, 81.62, 96.62

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