Evaluation of crossing vessels in patients with ureteropelvic junction obstruction by means of helical CT.

Mitsumori A, Yasui K, Akaki S, Togami I, Joja I, Hashimoto H, Kumon H, Hiraki Y.
Department of Radiology, Himeji Red Cross Hospital, 5-30-1 Tatsuno-cho, Himeji City, Hyogo 670-8540, Japan.

Radiographics. 2000 Sep-Oct;20(5):1383-93; discussion 1393-5

Helical computed tomography (CT) was used to demonstrate the distribution of crossing vessels in patients with ureteropelvic junction (UPJ) obstruction for planning surgical management. Twenty patients with symptomatic UPJ obstruction were evaluated with dual-phase contrast material-enhanced helical CT. In addition to axial images, coronal, sagittal, and curved paracoronal images along the crossing vessels or the UPJ were obtained by means of multiplanar reconstruction. Crossing vessels were evaluated according to type, position, and association with UPJ obstruction. Fifteen vessels in 12 of the 20 patients were found to cross the UPJ at helical CT. Nine vessels were arteries and six were veins; seven vessels crossed anteriorly and eight crossed posteriorly. In 11 patients, crossing vessels were thought to be associated with UPJ obstruction at helical CT; retroperitoneoscopic repair was performed, and the diagnosis was found to have been accurate in all except one. In the eight patients in whom no significant vessels were seen and the one patient in whom the crossing vessel was not associated with UPJ obstruction at helical CT, endopyelotomy was performed and UPJ obstruction was relieved, with no complications. Helical CT is useful for evaluation of vessels crossing the UPJ and for planning surgical management.

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