Preoperative Use of 3D Volume Rendering to Demonstrate Renal Tumors and Renal Anatomy1
Deirdre M. Coll, FFR, RCSI,
Brian R. Herts, MD,
William J. Davros, PhD ,
Robert G. Uzzo, MD and
Andrew C. Novick, MD
1 From the Departments of Radiology (D.M.C., B.R.H., W.J.D.) and Urology (R.G.U., A.C.N.), Cleveland Clinic Foundation, Cleveland, Ohio. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received June 3, 1999; revision requested June 28 and received October 13; accepted October 20. Address reprint requests to D.M.C., New York Presbyterian Hospital, New York Cornell Campus, 525 E 68th St, New York, NY 10021 (e-mail: dmc2001@mail.med.cornell.edu).
View larger version (119K):
[in a new window]
|
Figure 1a. Polar nephrectomy. (a) Drawing illustrates a large upper pole renal tumor. The venous branches supplying the tumor are already ligated. The renal artery is clamped, and the segmental arterial branch supplying the tumor can be identified. (b) Drawing illustrates the kidney after removal of the tumor and upper pole. The apical arterial and venous branches are ligated.
|
|
View larger version (104K):
[in a new window]
|
Figure 1b. Polar nephrectomy. (a) Drawing illustrates a large upper pole renal tumor. The venous branches supplying the tumor are already ligated. The renal artery is clamped, and the segmental arterial branch supplying the tumor can be identified. (b) Drawing illustrates the kidney after removal of the tumor and upper pole. The apical arterial and venous branches are ligated.
|
|
View larger version (148K):
[in a new window]
|
Figure 2. Normal renal anatomy. Three-dimensional volume-rendered image (posterior view) shows the normal position of the kidneys. The relationship of the upper poles to the 12th ribs (arrows) is also demonstrated.
|
|
View larger version (150K):
[in a new window]
|
Figure 3. Upper pole tumor. Three-dimensional volume-rendered image shows an enlarged kidney with an upper pole tumor (arrow). The tumor lies cephalad to the main renal artery and vein. Removal of the 11th and 12th ribs and extension of the incision to the iliac crest (arrowhead) were required.
|
|
View larger version (173K):
[in a new window]
|
Figure 4a. Tumor extension. Three-dimensional volume-rendered images obtained with a clip plane in the coronal (a) and sagittal (b) orientations show an upper pole tumor with extension (arrow). A cyst is incidentally noted in the lower pole (arrowhead in b).
|
|
View larger version (181K):
[in a new window]
|
Figure 4b. Tumor extension. Three-dimensional volume-rendered images obtained with a clip plane in the coronal (a) and sagittal (b) orientations show an upper pole tumor with extension (arrow). A cyst is incidentally noted in the lower pole (arrowhead in b).
|
|
View larger version (127K):
[in a new window]
|
Figure 5a. Relationship of tumor to the collecting system. (a) On a 3D volume-rendered image, a central tumor with low opacity (arrow) is seen displacing and effacing the renal collecting system. (b) Three-dimensional volume-rendered image obtained in a different patient shows a radiolucent central tumor en face. The renal pelvis and calices are clearly visualized.
|
|
View larger version (151K):
[in a new window]
|
Figure 5b. Relationship of tumor to the collecting system. (a) On a 3D volume-rendered image, a central tumor with low opacity (arrow) is seen displacing and effacing the renal collecting system. (b) Three-dimensional volume-rendered image obtained in a different patient shows a radiolucent central tumor en face. The renal pelvis and calices are clearly visualized.
|
|
View larger version (101K):
[in a new window]
|
Figure 6a. Normal renal segmental arterial anatomy. Drawings of the kidney from an anterior (a) and posterior (b) perspective demonstrate the apical, anterior, posterior, and basilar branches of the renal artery.
|
|
View larger version (96K):
[in a new window]
|
Figure 6b. Normal renal segmental arterial anatomy. Drawings of the kidney from an anterior (a) and posterior (b) perspective demonstrate the apical, anterior, posterior, and basilar branches of the renal artery.
|
|
View larger version (157K):
[in a new window]
|
Figure 7. Tumor supply. Three-dimensional volume-rendered image shows the anterior segmental arterial branch (arrow) supplying an upper pole renal tumor.
|
|
View larger version (163K):
[in a new window]
|
Figure 8. Renal arterial variant. Three-dimensional volume-rendered image shows an anatomic variant of an apical polar branch (arrow) entering the renal parenchyma directly without traversing the renal hilum.
|
|
View larger version (157K):
[in a new window]
|
Figure 9. Multiple renal veins. Three-dimensional volume-rendered image demonstrates two right renal veins (arrowheads) and two lower pole renal tumors (white arrows). The right gonadal vein, which normally drains directly into the inferior vena cava, is seen draining into the lower right renal vein. An upper pole cyst is also noted (black arrow).
|
|
View larger version (137K):
[in a new window]
|
Figure 10. Complex renal anatomy. Three-dimensional volume-rendered image demonstrates a crossed-fused ectopic kidney with a large hilar tumor (arrow). Multiple renal arteries and veins and their relationships to the tumor are clearly depicted.
|
|
View larger version (184K):
[in a new window]
|
Figure 11. Renal pseudotumor due to respiratory misregistration. Three-dimensional volume-rendered image shows two pseudotumors (arrows) caused by posterior lobulation and inferior movement of the kidney during respiration.
|
|
Copyright © 2000 by the Radiological Society of North America.
