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Pediatric Radiology

, Volume 33, Issue 11, pp 745–751 | Cite as

The value of colour Doppler ultrasonography for identification of crossing vessels in children with pelvi-ureteric junction obstruction

  • Corinne Veyrac
  • Catherine Baud
  • Christophe Lopez
  • Alain Couture
  • Magali Saguintaah
  • Michel Averous
Original Article

Abstract

Background

Pelvi-ureteric junction (PUJ) obstruction is caused by the presence of an aperistaltic dysplastic segment at the PUJ. Besides this intrinsic aetiology, extrinsic abnormalities, mainly crossing vessels, may be an associated factor.

Objective

To determine the reliability of colour Doppler US in the detection of crossing vessels in children with surgically proven PUJ obstruction.

Materials and methods

Forty-eight patients (50 kidneys) with PUJ obstruction, surgically treated from 1998 to 2001, were prospectively studied by colour Doppler US prior to open pyeloplasty. There were 33 boys and 15 girls (age 2 months—12 years; median 3.5 years). There were 24 right kidneys and 26 left kidneys. The indication for surgery was according to the usual criteria. The crossing vessel was considered as present when depicted on colour Doppler US at the PUJ.

Results

Colour Doppler assessment of the crossing vessels was correct in all but two patients. At surgery, a crossing vessel was found in 14 kidneys (i.e. 28%). Colour Doppler US results were correlated with intra-operative findings in 50 renal units. Surgically proven vessels in 14 kidneys were identified by colour Doppler US in 13, and not shown in 1. In PUJ obstruction without a crossing vessel (n=36), US findings were concordant in 26, discordant in 8 and inconclusive in 2 (with kidney malrotation) cases. Colour Doppler US had a sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of 92.8%, 76.5%, 62%, 96.3% and 78%, respectively. The reliability of colour Doppler US was greatly improved with the increasing experience of the sonographer, as shown by the results of the last 2 years (26 kidneys):Se=100%, Sp=87.5%, PPV=81.8%, NPV=100%, accuracy=88.5%.

Conclusions

Colour Doppler US is reliable in the detection of crossing vessels at the PUJ.

Keywords

Anatomy Urinary Kidney Arteries Congenital Pelvi-ureteric junction obstruction Ultrasound Colour ultrasound 

References

  1. 1.
    Gupta M, Smith AD (1998) Crossing vessels. Endourologic implications. Urol Clin North Am 25:289–293PubMedGoogle Scholar
  2. 2.
    Hoffer FA, Lebowitz RL (1985) Intermittent hydronephrosis: a unique feature of ureteropelvic junction obstruction caused by a crossing renal vessel. Radiology 156:655–658PubMedGoogle Scholar
  3. 3.
    Rooks VJ, Lebowitz RL (2001) Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol 31:120–124CrossRefPubMedGoogle Scholar
  4. 4.
    Sampaio FJ (1991) Relationship between segmental arteries and pelviureteric junction. Br J Urol 68:214–217PubMedGoogle Scholar
  5. 5.
    Sampaio FJ, Favorito LA (1993) Ureteropelvic junction stenosis: vascular anatomical background for endopyelotomy. J Urol 150:1787–1791PubMedGoogle Scholar
  6. 6.
    Van Cangh PJ, Nesa S, Galeon M, et al (1996) Vessels around the ureteropelvic junction: significance and imaging by conventional radiology. J Endourol 10:111–119PubMedGoogle Scholar
  7. 7.
    Lopez C, Ach S, Veyrac C, et al (2000) Lower pole pedicle in a series of 84 pyelo-ureteral junction syndromes surgically treated in children (in French). Prog Urol 10:638–643PubMedGoogle Scholar
  8. 8.
    Figenshau RS, Clayman RV (1998) Endourologic options for management of ureteropelvic junction obstruction in the pediatric patient. Urol Clin North Am 25:199–209PubMedGoogle Scholar
  9. 9.
    Tan HL (1999) Laparoscopic Anderson-Hynes dismembered pyeloplasty in children. J Urol 162:1045–1047PubMedGoogle Scholar
  10. 10.
    Nagai A, Nasu Y, Hashimoto H, et al (2001) Retroperitoneoscopic pyelotomy combined with the transposition of crossing vessels for ureteropelvic junction obstruction. J Urol 165:23–26PubMedGoogle Scholar
  11. 11.
    Stephens FD (1982) Ureterovascular hydronephrosis and the "aberrant" renal vessels. J Urol 128:984–987PubMedGoogle Scholar
  12. 12.
    Cassis AN, Brannen GE, Bush WH, et al (1991) Endopyelotomy: review of results and complications. J Urol 146:1492–1495PubMedGoogle Scholar
  13. 13.
    Bagley DH, Liu TB, Grasso M, et al (1994) Endoluminal sonography in evaluation of the obstructed ureteropelvic junction. J Endourol 8:287–292PubMedGoogle Scholar
  14. 14.
    Siegel CL, McDougall EM, Middleton WD, et al (1997) Preoperative assessment of ureteropelvic junction obstruction with endoluminal sonography and helical CT. AJR 168:623–626Google Scholar
  15. 15.
    Keeley FX Jr, Moussa SA, Miller J, et al (1999) A prospective study of endoluminal ultrasound versus computerized tomography angiography for detecting crossing vessels at the ureteropelvic junction. J Urol 162:1938–1941PubMedGoogle Scholar
  16. 16.
    Pereira Arias JB, Ibarluzea Gonzalves JG, Capelastegui Alber A, et al (1997) Usefulness of MR angiography in the diagnosis of polar vessel in stenosis of pyeloureteral junction. Arch Esp Urol 50:983–994PubMedGoogle Scholar
  17. 17.
    Herts BR (1998) Helical CT and CT angiography for the identification of crossing vessels at the ureteropelvic junction. Urol Clin North Am 25:259–269PubMedGoogle Scholar
  18. 18.
    Pfister C, Thoumas D, Simon I, et al (1997) Value of helical CT scan in the preoperative assessment of the ureteropelvic junction syndrome (in French). Prog Urol 7:594–599PubMedGoogle Scholar
  19. 19.
    Quillin SP, Brink JA, Heiken JP, et al (1996) Helical CT angiography for identification of crossing vessels at the ureteropelvic junction. AJR 166:1125–1130Google Scholar
  20. 20.
    Kumon H, Tsugawa M, Hashimoto H, et al (1997) Impact of 3-dimensional helical CT on selection of operative methods for ureteropelvic junction obstruction. J Urol 158:1696–1700PubMedGoogle Scholar
  21. 21.
    Mitsumori A, Yasui K, Akaki S, et al (2000) Evaluation of crossing vessels in patients with ureteropelvic junction obstruction by means of helical CT. Radiographics 20:1383–1393PubMedGoogle Scholar
  22. 22.
    Farres MT, Pedron P, Gattegno B, et al (1998) Helical CT and 3D reconstruction of ureteropelvic junction obstruction: accuracy in detection of crossing vessels. J Comput Assist Tomogr 22:300–303CrossRefPubMedGoogle Scholar
  23. 23.
    Rouviere O, Lyonnet D, Berger P, et al (1999) Ureteropelvic junction obstruction: use of helical CT for preoperative assessment—comparison with intraarterial angiography. Radiology 213:668–673PubMedGoogle Scholar
  24. 24.
    Frauscher F, Janetschek G, Helweg G, et al (1999) Crossing vessels at the ureteropelvic junction: detection with contrast-enhanced colour Doppler imaging. Radiology 210:727–731PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Corinne Veyrac
    • 1
  • Catherine Baud
    • 1
  • Christophe Lopez
    • 2
  • Alain Couture
    • 1
  • Magali Saguintaah
    • 1
  • Michel Averous
    • 2
  1. 1.Department of Paediatric RadiologyHospital Arnaud de Villeneuve Montpellier Cedex 5France
  2. 2.Department of Paediatric UrologyHospital LapeyronieMontpellierFrance

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