Use of helical CT in assessment of crossing vessels in pelviureteric junction obstruction

AIM: The purpose of this study is to confirm the accuracy of non-invasive helical computed tomography (CT) with multiplanar reformatting in the diagnosis of crossing, vessels in patients with pelviureteric junction (PUJ) obstruction, MATERIALS AND METHODS: Nineteen patients with confirmed PUJ obstruction underwent CT of the renal area with intravenous contrast medium. Patients shown to have crossing vessels had to undergo a pyeloplasty by open surgery or laparoscopy, Patients with no vessels could have their PUJ obstruction safely treated with less invasive techniques such as balloon dilatation, RESULTS: Fourteen patients were shown to have crossing vessels. Of these, 10 had their relationship to the PUJ confirmed at a subsequent laparotomy, Of the remaining four patients, one was lost to follow-up and two were unwell due to unrelated disease. The other patient had already had a vessel moved at a previous laparotomy, Of the five patients without obstructing vessels, two were confirmed not to have a related vessel at laparotomy, one has undergone balloon dilatation and the other two were lost to follow-up. CONCLUSION: Helical CT is an accurate and non-invasive method of demonstrating crossing vessels in PUJ obstruction. Diagnosis of these vessels has a major role in the choice of therapeutic treatment. (C) 2000 The Royal College of Radiologists.