Role of CT Angio in Urology

Renal Artery Stenosis

 Spiral CT technology imaging of the renal arteries using thin (2-mm) slices
during the arterial phase of contrast material injection is performed while the
patient holds a single breath.
 Three-dimensional reconstruction of the axial image is then carried out,
showing the abdominal aorta with its main branches.
 Atherosclerotic disease affecting the aorta and the renal arteries can be
visualized, as well as renal morphology and parenchymal lesions.
 Spiral CTA lacks the ability to define disease distal to the main stem renal
artery, and a relatively large volume of intravenous (IV) iodinated contrast
material is required to perform the study;
 Advantages of cost, convenience, and widespread availability
 Modern CT technology can also be used to perform virtual endoscopy,
which can be helpful for evaluating renal artery stenoses and positioning
arterial stents
 Multiple detector–row CT angiography is a new method of CT angiography
more accurate depiction of the renal and other visceral arteries

UPJ Obstruction -
 Spiral CT angiography in failed endopyelotomy, to rule out a crossing
vessel. If a significant vessel is found, repeat endopyelotomy is generally not
recommended
Angiomyolipoma

 CT-angiography aneurysmal dilation is found in 50% of angiomyolipomas .

The size of the aneurysms has been reported to correlate with the risk of
rupture
 Renal cell carcinoms
 Before partial nephrectomy, evaluation of patients with renal cortical tumors should
include imaging to identify locally extensive or metastatic disease.
 Preoperative imaging should also delineate relevant regional anatomy, intrarenal
anatomy, and vasculature to minimize blood loss and damage to adjacent renal
parenchyma
 Non invasive 3D CT angiography, offers excellent anatomic detail. 3D CT
integrates information from arteriography, venography, excretory urography, and
conventional two-dimensional CT in to a single imaging modality
 In addition to tumor staging, 3D reconstructions of contrast enhanced CT
angiograms, are useful for planning site and extent of planned resection and to
determine proximity to the renal hilum, intrarenal vasculature, and collecting
system
 3D CT accurately demonstrates involvement of the collecting system by tumor

TRAUMA-INDUCED RENAL VASCULAR HYPERTENSION

 Suspected traumatic hypertension, evaluation with radiographic studies
(CT angiography), to rule out an arteriovenous fistula or a pseudoaneurysm as
the source of the hypertension