title: Helical (spiral) CT angiography for identification of crossing vessels at the ureteropelvic junction.
abstract: OBJECTIVE
  The purpose of this study was to determine the feasibility of imaging crossing vessels at the ureteropelvic junction (UPJ) with helical (spiral) CT angiography for planning surgical repair of symptomatic UPJ obstruction.
  
  
  METHODS
  Twenty-four consecutive patients with symptomatic UPJ obstruction were imaged with dual-phase, contrast-enhanced helical CT (collimation, 3 mm; pitch, 1.3-1.7; reconstruction interval, 2 mm; early phase, 20-42 sec; and delayed phase, 90-112 sec after initiation of IV contract material injection [125 ml of ioversol containing 320 mg of iodine per ml, delivered at 4-5 ml/sec]). All imaging data were viewed interactively on an imaging workstation. Prospective on-line interpretations were correlated with subsequent surgical and clinical findings at laparoscopy (n=3), open surgical repair (n=2), or ureteronephroscopic endopyelotomy (n=11). Vessels at the UPJ that were 2 mm or more in diameter were believed to be significant. Review of the transaxial images was performed to determine qualitatively the relative usefulness of the early versus the delayed phases for distinguishing arteries from veins. Multiplanar reformations also were retrospectively reviewed and compared with direct pyelograms to determine the accuracy with which the location of the UPJ and the proximal ureteral course were depicted with helical CT.
  
  
  RESULTS
  Eleven of 24 (46%) patients collectively had 11 anterior and three posterior vessels (> or = 2 mm in diameter) crossing the UPJ on helical CT. Distinction between arteries and veins was significantly better on early-phase than on delayed-phase images (p=.01). Visualization of the UPJ and the proximal ureteral course was good or excellent for 18 (78%) of 23 patients for whom pyelograms were available, regardless of the presence of a ureteral stent (p>.05). Laparoscopy and open surgery findings were in agreement with helical CT angiograms for five of five patients. Uncomplicated endopyelotomy was performed for 11 patients in whom no significant vessels were seen posterior or posterolateral to the UPJ.
  
  
  CONCLUSIONS
  Helical CT angiography can depict vessels crossing the UPJ and is valuable in planning surgical management.
authors.affiliation: Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Quillin
authors.forename: J A
authors.initials: JA
authors.lastname: Brink
authors.forename: J P
authors.initials: JP
authors.lastname: Heiken
authors.forename: C L
authors.initials: CL
authors.lastname: Siegel
authors.forename: B L
authors.initials: BL
authors.lastname: McClennan
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000295:instrumentation / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D014513:Ureter / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D003287:Contrast Media