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Differences of Renal Parenchymal Attenuation for Acutely Obstructed and Unobstructed Kidneys on Unenhanced Helical CT

A Useful Secondary Sign?

Christos S. Georgiades1, Carolyn J. Moore2 and David P. Smith3

1 Department of Radiology, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, and Johns Hopkins University School of Medicine, Baltimore, MD 21287.
2 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
3 Department of Radiology, Johns Hopkins Bayview Hospital, Baltimore, MD 21224.



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  		Fig. 1. —Axial unenhanced CT scan of 24-year-old man with acute-onset pain in right flank radiating to left lower abdomen and microhematuria. Image obtained at level of kidneys shows renal parenchyma on right (27 H) to be less dense than parenchyma on left (35 H). Obstructing 4-mm ureterovesicular junction calculus (not shown) was seen. Image of same patient is shown in Figure 6.

 


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  		Fig. 2. —Bar graph shows attenuation of renal parenchyma for obstructed and unobstructed kidneys. Third column shows average attenuation of healthy kidneys. Note significant difference between attenuation of obstructed kidney and that of unobstructed and healthy kidneys. The latter two show no significant difference. Error bars indicate standard deviations.

 


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  		Fig. 3. —Graph shows number of radiologists (maximum of 10) who visually detected lower attenuation in obstructed kidney versus actual percentage of difference in attenuation between acutely obstructed renal parenchyma and unobstructed side in three patients, A, B, and C. When difference in attenuation is great enough for most or all radiologists to detect visually, actual difference is more than two standard deviations (SD) above normal and, thus, a statistically significant finding; 1 SD and 2 SD indicate above-average attenuation difference between normal kidneys.

 


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  		Fig. 4. —Axial unenhanced helical CT scan obtained at level of kidneys in 55-year-old woman with right flank pain radiating to groin and microhematuria. Attenuation of right kidney is 36 H, and attenuation of left kidney is 38 H. One-millimeter calculus (not shown) was seen at right ureterovesicular junction. Patient is represented by "A" in Figure 3.

 


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  		Fig. 5. —Axial unenhanced helical CT scan obtained at level of kidneys in 44-year-old man with right flank pain and microhematuria. Attenuation of right kidney is 30 H and that of left kidney is 35 H. Two-millimeter calculus (not shown) was seen at right ureterovesicular junction. Patient is represented by "B" in Figure 3.

 


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  		Fig. 6. —Axial unenhanced helical CT scan obtained at level of kidneys in 24-year-old man with acute-onset pain in right flank radiating to right lower abdomen and microhematuria. Attenuation of right kidney is 27 H and that of left kidney is 35 H. Four-millimeter calculus (not shown) was seen at right ureterovesicular junction. Patient is represented by "C" in Figure 3.

 


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  		Fig. 7. —Graph illustrates relationship between degree of ureteral dilatation (dashed line and {blacktriangleup}) and percentage of attenuation difference between two kidneys (solid line and x). Correlation factor for these two secondary signs is 0.61; x-axis shows amount of attentuation in 26 patients with acute ureteral obstruction charted by increasing attenuation difference.

 


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  		Fig. 8. —Graph illustrates relationship between degree of perinephric stranding (dashed line and {blacktriangleup}) and percentage of attenuation difference between two kidneys (solid line and x). Correlation factor for these two secondary signs is 0.34; x-axis shows amount of attentuation in 26 patients with acute ureteral obstruction charted by increasing attenuation difference.

 

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