Study of the renal segmental arterial anatomy with contrast-enhanced multi-detector computed tomography.

PURPOSE

To use triphasic multi-detector computed tomography (MDCT) to study the renal segmental arterial anatomy and its relationship with the urinary tract to plan nephron-sparing surgery (NSS).

METHODS

One hundred and fifty nine patients underwent abdominal contrast-enhanced MDCT. We evaluated renal arteries and parenchymal vasculature. In 61 patients, the arteries and the urinary tract were represented simultaneously.

RESULTS

86.60% presented a single renal artery; 13.4%, multiple arteries. All single renal arteries divided into anterior and posterior branch before the hilum. The anterior artery branched into a superior, middle, and inferior branch. In 43.14%, the inferior artery arose before the others; in 45.75%, the superior artery arose before the others; in 9.80%, the branches shared a common trunk. In 26.80%, the posterior artery supplies the entire posterior surface; in 73.20%, it ends along the inferior calyx. In 96.73%, the upper pole was vascularized by the anterior superior branch and the posterior artery: the "tuning fork". MDCT showed four vascular segments in 96.73% and five in 3.27%. MDCT showed two avascular areas: the first along the projection of the inferior calyx on the posterior aspect, the second between the branches of the "tuning fork".

CONCLUSIONS

The arterial phase provides the arterial tree representation; the delayed phase shows arteries and urinary tract simultaneously. MDCT provides a useful representation of the renal anatomy prior to intervascular-intrarenal NSS.