Published online January 16, 2004, 10.1148/rg.e20
Multi-Detector Row CT of the Kidneys and Urinary Tract: Techniques and Applications in the Diagnosis of Benign Diseases1
Sheila Sheth, MD and
Elliot K. Fishman, MD
1 From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 N Wolfe St, Baltimore, Md 21287. Presented as an educational exhibit at the 2002 RSNA scientific assembly. Received April 18, 2003, revision requested August 12, final revision received and accepted November 28. Address correspondence to S.S. (e-mail: ssheth@jhmi.edu).
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Figure 1a. Phases of renal enhancement at multidetector CT. (a) Unenhanced axial CT at level of renal hilum. (b) Late arterial phase axial CT at level of renal hilum. There is good opacification of the left renal artery (black arrow) and vein (white arrow). (c) Nephrographic phase axial CT at level of renal hilum. (d) Excretory phase axial CT at level of renal hilum.
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Figure 1b. Phases of renal enhancement at multidetector CT. (a) Unenhanced axial CT at level of renal hilum. (b) Late arterial phase axial CT at level of renal hilum. There is good opacification of the left renal artery (black arrow) and vein (white arrow). (c) Nephrographic phase axial CT at level of renal hilum. (d) Excretory phase axial CT at level of renal hilum.
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Figure 1c. Phases of renal enhancement at multidetector CT. (a) Unenhanced axial CT at level of renal hilum. (b) Late arterial phase axial CT at level of renal hilum. There is good opacification of the left renal artery (black arrow) and vein (white arrow). (c) Nephrographic phase axial CT at level of renal hilum. (d) Excretory phase axial CT at level of renal hilum.
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Figure 1d. Phases of renal enhancement at multidetector CT. (a) Unenhanced axial CT at level of renal hilum. (b) Late arterial phase axial CT at level of renal hilum. There is good opacification of the left renal artery (black arrow) and vein (white arrow). (c) Nephrographic phase axial CT at level of renal hilum. (d) Excretory phase axial CT at level of renal hilum.
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Figure 2a. Classic renal vascular anatomy in a 36-year-old potential renal donor. Coronal volume-rendering images in the (a) arterial and (b) venous phases.
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Figure 2b. Classic renal vascular anatomy in a 36-year-old potential renal donor. Coronal volume-rendering images in the (a) arterial and (b) venous phases.
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Figure 3a. Multiple renal arteries in a 57-year-old potential renal donor. Two left renal arteries (arrows) are nicely depicted in the MIP image (a) as well as in the coronal volume-rendered image (b).
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Figure 3b. Multiple renal arteries in a 57-year-old potential renal donor. Two left renal arteries (arrows) are nicely depicted in the MIP image (a) as well as in the coronal volume-rendered image (b).
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Figure 4. Circumaortic renal vein in a 43-year-old potential renal donor. Axial volume-rendered image of the kidneys shows the circumaortic left renal vein (arrows).
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Figure 5. Coronal excretory phase scout CT in a potential renal donor. The collecting system of both kidneys appears normal.
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Figure 6. Right renal artery stenosis in a 65-year-old patient with evidence of right renal infarct at prior examination. Coronal volume-rendered image nicely demonstrates an 80% stenosis in the proximal right renal artery caused by a partially calcified plaque (white arrow). There is a large infarct involving the upper pole of the right kidney (black arrows).
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Figure 7a. Renal artery stenosis in a 52-year-old woman with hypertension. (a) Axial volume-rendered image in the arterial phase shows a tight stenosis at the origin of the right renal artery (arrow) with poststenotic dilatation. (b) Preangioplasty angiogram confirms the findings.
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Figure 7b. Renal artery stenosis in a 52-year-old woman with hypertension. (a) Axial volume-rendered image in the arterial phase shows a tight stenosis at the origin of the right renal artery (arrow) with poststenotic dilatation. (b) Preangioplasty angiogram confirms the findings.
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Figure 8. Left renal artery stent in a 60-year-old man who was successfully treated for renovascular hypertension. Coronal volume-rendered image nicely demonstrates the stent at the origin of the left renal artery (arrow). The left renal artery beyond the stent is clearly patent.
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Figure 9a. Multiple left renal artery aneurysms in a 57-year-old woman. (a) Coronal MIP image shows three small aneurysms of the distal left renal artery (arrows). (b) Coronal volume-rendered image.
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Figure 9b. Multiple left renal artery aneurysms in a 57-year-old woman. (a) Coronal MIP image shows three small aneurysms of the distal left renal artery (arrows). (b) Coronal volume-rendered image.
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Figure 10. Pseudoaneurysm of a renal artery branch in a 72-year-old man with a history of partial nephrectomy of the right kidney for renal cell carcinoma. Coronal MIP image shows a pseudoaneurysm arising from a renal artery branch at the resection site. A large renal cell carcinoma replaces the lower pole of the left kidney.
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Figure 11a. Crossing vessel in a patient with ureteropelvic junction obstruction. Coronal volume-rendered images from anterior (a) and posterior (b) show a lower pole artery (arrow) to the left kidney crossing a dilated renal pelvis.
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Figure 11b. Crossing vessel in a patient with ureteropelvic junction obstruction. Coronal volume-rendered images from anterior (a) and posterior (b) show a lower pole artery (arrow) to the left kidney crossing a dilated renal pelvis.
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Figure 12a. Right renal vein thrombosis in a 46-year-old woman with Escherichia coli urinary tract infection and pyelonephritis. (a) Axial CT image in the corticomedullary phase shows an enlarged right kidney with delayed function. The renal parenchyma appears infiltrated by the inflammatory process and interstitial edema. There is lack of opacification of the right renal vein and the inferior vena cava (arrow). (b) Axial CT image in the corticomedullary phase at the upper pole of the right kidney shows a normal inferior vena cava (arrow) at that level. (c) Coronal reformation shows the right renal vein thrombus (arrow) extending into the inferior vena cava.
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Figure 12b. Right renal vein thrombosis in a 46-year-old woman with Escherichia coli urinary tract infection and pyelonephritis. (a) Axial CT image in the corticomedullary phase shows an enlarged right kidney with delayed function. The renal parenchyma appears infiltrated by the inflammatory process and interstitial edema. There is lack of opacification of the right renal vein and the inferior vena cava (arrow). (b) Axial CT image in the corticomedullary phase at the upper pole of the right kidney shows a normal inferior vena cava (arrow) at that level. (c) Coronal reformation shows the right renal vein thrombus (arrow) extending into the inferior vena cava.
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Figure 12c. Right renal vein thrombosis in a 46-year-old woman with Escherichia coli urinary tract infection and pyelonephritis. (a) Axial CT image in the corticomedullary phase shows an enlarged right kidney with delayed function. The renal parenchyma appears infiltrated by the inflammatory process and interstitial edema. There is lack of opacification of the right renal vein and the inferior vena cava (arrow). (b) Axial CT image in the corticomedullary phase at the upper pole of the right kidney shows a normal inferior vena cava (arrow) at that level. (c) Coronal reformation shows the right renal vein thrombus (arrow) extending into the inferior vena cava.
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Figure 13a. Left renal abscess in a 46-year-old man with a history of human immunodeficiency virus (HIV) infection, left flank pain, and fevers. (a) Axial CT image in the corticomedullary phase of enhancement does not show any abnormality. (b) Axial CT image in the late nephrographic phase. The hypoenhancing lesion in the left renal parenchyma is clearly demonstrated (arrow). This case illustrates the importance of tailoring image acquisitions to the clinical indication. This small lesion would have been missed in the corticomedullary phase image. A few milliliters of pus were aspirated from this lesion.
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Figure 13b. Left renal abscess in a 46-year-old man with a history of human immunodeficiency virus (HIV) infection, left flank pain, and fevers. (a) Axial CT image in the corticomedullary phase of enhancement does not show any abnormality. (b) Axial CT image in the late nephrographic phase. The hypoenhancing lesion in the left renal parenchyma is clearly demonstrated (arrow). This case illustrates the importance of tailoring image acquisitions to the clinical indication. This small lesion would have been missed in the corticomedullary phase image. A few milliliters of pus were aspirated from this lesion.
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Figure 14a. Acute pyelonephritis of the right kidney in a 32-year-old HIV-positive man. (a) Corticomedullary phase contrast-enhanced axial CT shows an almost normal-appearing right kidney. (b) Early excretory phase contrast-enhanced axial CT clearly shows multiple low-attenuation lesions (arrows) in the right renal parenchyma.
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Figure 14b. Acute pyelonephritis of the right kidney in a 32-year-old HIV-positive man. (a) Corticomedullary phase contrast-enhanced axial CT shows an almost normal-appearing right kidney. (b) Early excretory phase contrast-enhanced axial CT clearly shows multiple low-attenuation lesions (arrows) in the right renal parenchyma.
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Figure 15a. Acute pyelonephritis of the left kidney in a 46-year-old woman. (a) Corticomedullary phase contrast-enhanced axial CT shows a patchy striated nephrogram in the left kidney (arrows). (b) There are areas of persistent enhancement (arrows) in the early excretory phase, likely due to vasospasm.
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Figure 15b. Acute pyelonephritis of the left kidney in a 46-year-old woman. (a) Corticomedullary phase contrast-enhanced axial CT shows a patchy striated nephrogram in the left kidney (arrows). (b) There are areas of persistent enhancement (arrows) in the early excretory phase, likely due to vasospasm.
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Figure 16a. Emphysematous pyelonephritis in a 45-year-old woman with sepsis. Axial (a) unenhanced and (b) corticomedullary phase CT shows extensive intraparenchymal gas (arrows) in a poorly functioning enlarged left kidney. Gas bubbles extend into the perinephric space.
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Figure 16b. Emphysematous pyelonephritis in a 45-year-old woman with sepsis. Axial (a) unenhanced and (b) corticomedullary phase CT shows extensive intraparenchymal gas (arrows) in a poorly functioning enlarged left kidney. Gas bubbles extend into the perinephric space.
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Figure 17a. Xanthogranulomatous pyelonephritis in a 80-year-old woman with chronic pyuria. (a) Coronal unenhanced volume-rendered image shows a large staghorn calculus (arrow) in the left kidney. (b) Coronal volume-rendered image in early excretory phase shows, in addition to the staghorn calculus (arrow), marked hydronephrosis of the left kidney with poor function. Incidental multiple renal cysts are present in the right kidney.
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Figure 17b. Xanthogranulomatous pyelonephritis in a 80-year-old woman with chronic pyuria. (a) Coronal unenhanced volume-rendered image shows a large staghorn calculus (arrow) in the left kidney. (b) Coronal volume-rendered image in early excretory phase shows, in addition to the staghorn calculus (arrow), marked hydronephrosis of the left kidney with poor function. Incidental multiple renal cysts are present in the right kidney.
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Figure 18. Duplicated left renal collecting system in a 50-year-old woman with a possible left renal mass. Coronal volume-rendered image in the excretory phase shows a duplicated left renal collecting system and no renal mass.
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Figure 19. Normal collecting system and ureters in a 35-year-old man with acute flank pain. Coronal volume-rendered image in the excretory phase depicts the entire collecting system. Both ureters are seen along their entire course.
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Figure 20. Reflux nephropathy of left kidney in a 40-year-old woman with a history of reflux and recurrent urinary tract infections. Coronal volume-rendered image of the left kidney and ureter in excretory phase shows blunting of the upper pole calyces with substantial loss of renal cortex (arrows). The lower pole calyx is dilated and there is loss of renal cortical thickness. A calculus obstructing the lower pole calyx was seen on the precontrast image (not shown). The left ureter is seen along its entire course and is normal.
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Figure 21a. Left ureteral stent in a 55-year-old woman with severe recurrent left flank pain. (a) Coronal volume-rendered image in the excretory phase shows the ureteral stent in the left ureter. There is no hydronephrosis or urine leak. (b) Coronal posteroanterior volume-rendered image.
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Figure 21b. Left ureteral stent in a 55-year-old woman with severe recurrent left flank pain. (a) Coronal volume-rendered image in the excretory phase shows the ureteral stent in the left ureter. There is no hydronephrosis or urine leak. (b) Coronal posteroanterior volume-rendered image.
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Copyright © 2004 by the Radiological Society of North America.
