Kidney Lower Pole Pelvicaliceal Anatomy: Comparative Analysis Between Intravenous Urogram and Three-Dimensional Helical Computed Tomography

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Abstract
Objective: The aim of our study was to evaluate if there is any advantage of three-dimensional helical computed tomography (3D-HCT) over intravenous urogram (IVU) in the morphometric and morphological analysis of lower pole spatial anatomy of the kidney. Patients and Methods: We analyzed 52 renal collecting systems in 30 patients, ranging in age from 23 to 80 years. The study compared the following features: (1) the angle formed between the lower infundibulum and the renal pelvis (i.e., lower infundibulum–pelvic angle [IPA]), (2) the lower infundibulum diameter (ID), and (3) the spatial distribution and number of lower pole calices (i.e., caliceal distribution [CD]). The study started with the 3D-HCT images obtained for posterior reconstruction and analysis. Afterward, we obtained anteroposterior and oblique IVU images. Results: For IPA (in degrees) we found a mean ± standard deviation (SD) value of 75.79 ± 15.3 with 3D-HCT and 77.4 ± 17.17 with IVU, which were not statistically significant. For ID (in mm) we found a mean ± SD value of 7.5 ± 2.92 with 3D-HCT and 8.15 ± 3.27 with IVU. For CD we found a mean ± SD value of 2.37 ± 0.75 calices with 3D-HCT and 2.43 ± 0.67 calices with IVU. On analyzing the difference between 3D-HCT and IVU, we found a mean ± SD value of 0.06 ± 0.51, and we verified that 74.5% of the examinations compared did not present statistically significant difference, with a Wilcoxon p-value of 0.405. Conclusion: Although 3D-HCT is more precise to study calculus location, tumors, and vessels, IVU was also demonstrated to be as precise as 3D-HCT for studying the lower pole spatial anatomy. We did not observe any statistically significant difference in the measurements of IPA, ID, and CD obtained using 3D-HCT when compared with those obtained using IVU. Therefore, 3D-HCT does not present any advantage over IVU in the evaluation of lower pole caliceal anatomy.

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