Three-dimensional helical CT angiography in renal transplant recipients: A new problem-solving tool

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 11/1999; 173(4):1085-9. DOI: 10.2214/ajr.173.4.10511184
Source: PubMed


OBJECTIVE: Our objective was to describe the use of three-dimensional helical CT angiography for the evaluation of renal transplant recipients presenting with hypertension, graft dysfunction, or both after transplantation by evaluating the native and transplanted renal arteries in a single examination. CONCLUSION: Early results indicate that three-dimensional helical CT angiography of renal transplant recipients presenting with hypertension, graft dysfunction, or both after transplantation yields valuable information that can be used to guide further therapy.

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    ABSTRACT: Over a 5-year period, 346 helical computed tomographic (CT) studies were performed in renal transplant recipients. Helical CT proved useful in this context by depicting parenchymal, perirenal, renal sinus, pyeloureteral, and vascular complications in great detail. CT often delineates fluid collections and their anatomic relationship to adjacent structures better than ultrasonography (US), particularly in obese patients. CT-guided puncture and drainage can be performed in cases in which US is deemed inadequate. CT angiography can depict arterial diseases such as stenosis, thrombosis, arteriovenous fistulas, aneurysms, and pseudoaneurysms in the graft artery and in the recipient iliac arterial system, thereby obviating conventional angiography in some cases. Helical CT with three-dimensional image reformatting allows accurate imaging of the entire course of ureteral and periureteral diseases (eg, hydronephrosis, ureteral leak and stricture, pyeloureteral obstruction). CT can be used in the confirmation and staging of malignancies of the renal parenchyma and urothelium. It is also helpful in evaluating associated disease in the native kidneys, acute and chronic rejection, graft embolization, and end-stage disease. Although US and nuclear medicine examination are the imaging modalities of choice in renal transplantation, helical CT is a valuable alternative when these techniques are inconclusive.
    Radiographics 09/2001; 21(5):1103-17. DOI:10.1148/radiographics.21.5.g01se131103 · 2.60 Impact Factor
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    ABSTRACT: Three-dimensional volume-rendered computed tomographic (CT) angiography represents an increasingly important clinical tool that, in many institutions, is replacing conventional angiography in the depiction of normal vascular anatomy and the diagnosis of vascular disorders. Evaluation of conditions affecting the renal vasculature constitutes a major focus of volume-rendered CT angiography, which has documented utility for demonstrating both arterial and venous disease. Arterial disorders include renal artery stenosis, renal artery aneurysms, and dissection. Venous disorders include splenorenal shunts, thrombosis, and intravascular tumor extension. In addition, volume-rendered CT angiography accurately displays the normal and variant renal vascular anatomy, which is crucial to detect before surgery, especially partial nephrectomy and laparoscopic nephrectomy. CT angiography is also useful in the evaluation of the renal vasculature following renal transplantation. Familiarity with proper CT protocols and data acquisition techniques are crucial for accurate diagnosis.
    Radiographics 03/2001; 21(2):373-86; questionnaire 549-55. DOI:10.1148/radiographics.21.2.g01mr19373 · 2.60 Impact Factor
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    ABSTRACT: RESUMO Paciente do sexo masculino, com 47 anos de idade, com diagnóstico de doença renal crônica estágio 5 por doença renal policística e em terapia dialítica por cinco anos foi submetido a transplante renal. No pós-operatório, o paciente apresentou disfunção do enxerto e hipertensão não-contro-lada, havendo necessidade de reintrodução da diálise. Ultrassom Doppler da artéria de rim transplantado foi suges-tiva de estenose, e angiotomografia computadorizada con-firmou o achado. No 49 o dia de pós-operatório, foi realizada angiografia rotacional tridimensional da artéria do enxerto renal e visualizou-se imagem de dissecção causando estenose grave. Foi realizada angioplastia com implante de stent com sucesso e o paciente não mais necessita de diálise e mantém boa evolução do quadro nos últimos seis meses. Estenose de artéria renal é complicação comum, secundária, na maioria das vezes, a placa aterosclerótica. Rastreamento com ultrassom Doppler e confirmação diagnóstica com angiografia são as estratégias recomendadas, visando à intervenção. Dissecção é uma possível causa de estenose de artéria de rim transplantado.
    01/2011; 19(4). DOI:10.1590/S2179-83972011000400017
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