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

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. 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. 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. 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.