The shape of the calyx is formed by the impression of the renal papilla. The defect is the extension of sinus fat into the cortex, usually at the border of the upper pole and interpolar region of the kidney. The left kidney (not shown) had a similar appearance. Look for retroaortic or circumaortic left renal vein. In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. Table 18-1 provides a quick guide itemizing key imaging findings in the potential renal donor. All content published on Kenhub is reviewed by medical and anatomy experts. Advantages of scintigraphy include accurate quantitative measurement of function. In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. Ultrastructurally, the nephron is the functional representative of the kidney. All rights reserved. The anteromedial, aspect of the interpolar region is interrupted by the renal hilum to make a C shape. If the renal pelvis is entirely within the confines of the renal sinus, it is considered intrarenal. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space. 18-23). Figure 18-6 Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Figure 18-4 Illustration demonstrating the relation between the renal papilla and calyx. 18-12). The kidneys play a central role in homeostasis. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. Note that the left renal vein receives blood from the left suprarenal and left testicular veins. In adults, the normal kidney is 10-14 cm long in males and 9-13 cm long in females, 3-5 cm wide, 3 cm in antero-posterior thickness and weighs 150-260 g. The left kidney is usually slightly larger than the right. Other malfunctions of the kidney are presented through acute kidney failure, a serious and urgent medical condition. The isthmus connecting the kidneys is variable, ranging from normal renal cortex to a thin fibrous band. Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. The renal fascia which besides the kidneys also encloses the suprarenal gland and its surrounding fat. Because repeat imaging does not expose the patient to additional radiation, multiple phases including delayed images may be obtained and allow the creation of quantitative curves that define the initial filling and then clearing of dilated collecting system structures. Normal parenchymal enhancement on CT or MRI allows definitive characterization. Clinical significance [ edit] 18-20). Duplication of the urinary tract is discussed in detail in Chapter 19. The ureter and calyces were not dilated (not shown), helping to differentiate this anatomic variant from obstruction. 18-18). Caliectasis doesn't cause any symptoms on its own. Table 18-1 Imaging the Living Renal Donor. Renal artery At the Brady Urological Institute, we believe in the adage, "An ounce of prevention is worth a pound of cure," so we place great emphasis on a thorough metabolic evaluation, so that therapies can be appropriately directed towards reducing the risk of recurrent stone disease. Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney Aggressive tumors form, grow and spread very quickly. Static-fluid (T2-weighted) MR urography and phase-contrast MR angiography are useful techniques that do not require intravenous contrast material. Eliminating toxic metabolites through urine, regulation of blood homeostasis and blood pressure, production of some hormones, Positioned retroperitoneally, consists of the cortex and medulla, empties urine into the ureter (which carries urine to the urinary bladder), Renal artery (branch of the abdominal aorta), Renal vein (drains to the inferior vena cava), Third kidney, horseshoe kidney, kidney agenesis, kidney stones, acute kidney failure, Regulates the amount of fluid in the body by increasing or decreasing the urine production, Maintain the pH of blood at 7.4 by decreasing or increasing the excretion of hydrogen ions, Medial part of the lower half of superior pole, Lateral part of the lower half of superior pole, Lateral part of inferior half of anterior surface, Medial part of inferior half of anterior surface, The perinephric fat (perirenal fat capsule). 18-9). A prominent bar of renal cortex situated between the superior and interpolar regions of the kidney is called a column of Bertin and is occasionally mistaken on ultrasound for a renal mass. Renal size can be measured in several ways. As the lobules of metanephric blastema coalesce to form each kidney, they do not always result in a smooth, uniform band of cortex. Living renal donor allografts account for more than half of the transplanted kidneys in the United States. If, however, a vessel crosses the UPJ at the level of obstruction, a blind incision made from the inside of the ureteral lumen can result in severe hemorrhage. Diabetes, hypertension, acute tubular necrosis, Increased echogenicity has high association with parenchymal disease, Acute tubular necrosis usually results in an increased RI, whereas prerenal causes usually do not have an increased RI; postrenal causes often increase the RI, but hydronephrosis should be present in those cases, If present, suspect neurogenic bladder or outlet obstruction, Often severe aortic disease or fibromuscular dysplasia. The region where the renal pelvis joins the ureter is called the, If the renal pelvis is entirely within the confines of the renal sinus, it is considered intrarenal. Note that retroaortic components are usually near the inferior poles (Fig. Fever. Renal cysts are sacs of fluid that form in the kidneys. Table 18-7 Causes of Unilateral Small Smooth Kidney, Only gold members can continue reading. Creatinine is a breakdown product of creatine, found within muscle. 18-19). Axial image from unenhanced computed tomography of the kidneys performed 2 days after an angiographic procedure demonstrates stasis of contrast in the renal cortex, resulting in a persistent corticomedullary phase of enhancement. The left kidney (not shown) had a similar appearance. The upper poles are normally oriented more medially and posteriorly than the lower poles. IVC, Inferior vena cava. The vascularity of some tumors may be most apparent during this phase (Fig. General symptoms of kidney problems include: blood in your urine . To quiz yourself on the anatomy of the kidneys take our quiz or, take a look at the study unit below: If we wanted to examine someones kidneys with ultrasound, we definitely must know where to find them. In most cases, the kidneys are situated with the inferior poles slightly. The superior poles (extremities) (T12) of both kidneys are more medially pointed towards the spine than the inferior poles (extremities) (L3). BOX 18-3 Causes of Bilateral Hydronephrosis. However, T1-weighted images provide good corticomedullary differentiation. Ultrasound performed for acute renal failure demonstrates bilateral hydronephrosis caused by a bladder tumor. Look carefully for accessory arteries at upper and lower poles (Fig. On the other hand, babies with bilateral agenesis cannot survive without an immediate kidney transplant. The kidneys serve important . Advantages of scintigraphy include accurate quantitative measurement of function and parenchymal mass without the risks for nephrotoxicity associated with iodinated contrast media or nephrogenic systemic fibrosis associated with gadolinium contrast agents. Unenhanced CT can identify hydronephrosis and hydroureter, urinary stones, and some masses. and grab your free ultimate anatomy study guide! Note diameter of arteries because small accessory arteries may be sacrificed in many cases. Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace conventional angiography before UPJ repair (Fig. Normal magnetic resonance imaging appearance of the kidneys. Because the fascia of the retroperitoneum prevents significant extravasation, the incision usually heals to form a larger lumen. Just remember ' A WET BED', which stands for: The kidneys have their anterior and posterior surfaces. The normal appearance of the calyx is created by the impression of the renal papilla. This kidney measured 14 cm in length. If, however, a vessel crosses the UPJ at the level of obstruction, a blind incision made from the inside of the ureteral lumen can result in severe hemorrhage. For most people, obstruction of a single ureter does not induce renal failure. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. The phases of nephrogram. The medial border of the kidney contains a very important landmark called the hilum of the kidney, which is the entry and exit point for the kidney vessels and ureter. In cases of unilateral obstruction with acute renal failure, sonographic evaluation may show evidence of chronic renal parenchymal disease in the unobstructed kidney. Because they rarely cause symptoms, renal cysts are most often found during . For most people, obstruction of a single ureter does not induce renal failure. Look for duplication, large extrarenal pelvis. The portion of the kidney between the poles is called the interpolar region and contains the renal hilum (Fig. Figure 18-18 Single-detector computed tomographic images from ureteropelvic junction deformity in the right side of a horseshoe kidney. Most diagnosed kidney growths are small and localized masses. The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. It is important to note, however, that the appearance of hydronephrosis does not necessarily indicate urinary obstruction (see Hydronephrosis and Its Mimics section later in this chapter). When the renal cortex is more echogenic than the adjacent liver, there is a high correlation with renal disease, although sensitivity is relatively low, according to Platt and colleagues (Fig. Typically, one kidney sits on either side of your spine. The right kidney has a normal appearance (not shown). Unlike the excretory phase of enhanced CT, signal intensity within the renal collecting systems is reduced on T1- and T2-weighted MR images once excreted gadolinium-based contrast media becomes sufficiently concentrated. Created for people with ongoing healthcare needs but benefits everyone. The upper pelvis is the most common ectopic location for the kidney; most cases are also associated with abnormalities of rotation. Table 18-6 Causes of Bilateral Small Smooth Kidneys. Right-sided pain was related to crossed renal ectopia. Furthermore, since the left renal vein passes between the superior mesenteric artery and the abdominal aorta, an enlargement of the superior mesenteric artery can compress the left renalvein and cause an obstruction of drainage from all three structures that use the left renal vein for drainage (left suprarenal gland, left kidney, and left testicle). Crossed ectopia can be either fused or unfused. 18-5). 18-16). Last reviewed: December 28, 2022 Relation between the right renal artery and the inferior vena cava (IVC). Sometimes, one or both kidneys fail to develop, which causes unilateral or bilateral renal agenesis. Frequent urination (having to go the bathroom often). It protects your kidneys from injury, increases their stability and connects your kidneys to surrounding tissues. However, small, low-attenuation lesions in the medulla are often obscured during this phase. Pain that radiates to the lower abdomen and groin. Fetal lobulation is best differentiated from renal scars during the corticomedullary phase of enhancement on computed tomography (CT) or magnetic resonance imaging (MRI) because cortex can be followed into the indentation that occurs between calyces (Fig. Normally, the kidney is about the size of a mouse and measures approximately 11-12 cm in length, 5-6 cm in width, and 2.5-3 cm in thickness. Blood in the urine, or dark urine. Since the abdominal organs are not paired, the left kidney is not related to the same organs as the right kidney. This plexus provides input from: The sensory nerves from the kidney travel to the spinal cord at the levels T10-T11, which is why the pain in the flank region always rises suspicions that something is wrong with the corresponding kidney. The normal appearance of the calyx is created by the impression of the renal papilla. Figure 18-12 Axial sections of the right kidney from contrast-enhanced computed tomography demonstrate a bar of renal parenchyma separating renal hila in the superior and inferior poles, consistent with duplication. 18-15). Obstruction can cause renal failure if it is bilateral (Box 18-3) or if there is preexisting disease in the unobstructed kidney. The most superior vessel is the renal vein which exits the kidney, just under it is the renal artery that enters in, and under the artery is the exiting ureter. It is also permeable for the products of the metabolism, such are creatinine and drug metabolites. This article will discuss the anatomy and major functions of the kidney. Most radiologists consider 10 to 12 cm to be an approximate reference range for renal length in adults, allowing for an additional 1 cm in either direction for patients at the extremes of height. Anatomy Where is the renal cortex? This specific condition is called the nutcracker phenomenon. The calyces, however, will have a normal appearance with an unobstructed extrarenal pelvis but will be dilated in cases of urinary obstruction. Literature supports the use of either multidetector computed tomography (MDCT) or MRI in donor evaluation. However, T1-weighted images provide good corticomedullary differentiation. Table 18-3 Utility of Different Phases of Renal Contrast Enhancement. A junctional cortical line is a common septum of capsule typically seen on ultrasound as an echogenic line at the site of fusion between the superior pole and middle third of the kidney (Fig. At that point, you may experience these symptoms: Severe, sharp pain in the side and back, below the ribs. The renal pelvis then tapers like a funnel to join the ureter. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. Read more. Other common kidney conditions are acquired through life, and one of the most common is nephrolithiasis (kidney stones). Due to the segmental vascular supply of the kidney it is often feasible to ligate the relative arteries and veins and remove the tumour with a safe zone of healthy surrounding parenchyma ( partial nephrectomy) without removing the entire kidney or compromising its total vascular supply by ischaemia. 18-19). You can test yourself on the renal arteries with our quiz. In addition to the renal artery, accessory renal arteries are present too. A potential benefit of MRI is the lack of exposure to ionizing radiation, although unenhanced CT would still be required to detect stones (the presence of stones increases the donors risk for renal insufficiency later in life and could disqualify them as a donor candidate). Renal size can be measured in several ways. chronic obstruction, or severe or repeated urinary infections. Some divide the excretory phase into the early excretory phase (contrast mainly confined to the kidney) and late excretory phase (contrast in the ureters). Pearl: Any upward trend in serum creatinine value should be viewed with concern because it implies renal reserve function has already been affected. Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace conventional angiography before UPJ repair (Fig. The small portion of the lumen surrounding the papilla is called the calyx. 18-11). Comparative views of the CT scan ( a axial, b coronal, and c sagittal planes) and corresponding views of the physical model ( d superior view, e median view, and f median view). Enlargement of a congenitally unilateral kidney is typical and presumed to be compensatory. Note origin of inferior accessories near inferior poles on each side. Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. Made. The center of the minor concavity is marked as the hilum of the kidney where the renal artery enters the kidney, and the renal vein and ureter leave the kidney. The muscular relations of the inferior half are easy to remember by dividing the kidney surface into three vertical stripes, where the medial stripe represents the impression of the psoas major muscle, the central stripe the quadratus lumborum, and the lateral stripe the transversus abdominis muscle. 18-18). This refers to the forming of the stones within the system of calyces because of too much calcium or uric acid into the filtrate. Learning a quickmnemonic'VAD' can help you remember these structures (renal Vein, renal Artery, Duct a.k.a ureter). Arterial stenosis was confirmed by magnetic resonance angiography. The presence or absence of intravenous contrast media, as well as the phase of contrast enhancement, are key factors that determine the appearance of the renal parenchyma on CT (Table 18-3). Besides blood volume and pressure regulation, kidneys also participate in the production of calcitriol (the active form of vitamin D). Publication types Review MeSH terms Humans Figure 18-21 Axial images from contrast-enhanced computed tomography demonstrate transient enhancement of a small renal cell carcinoma. Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. The nephrons within the cortex comprise some of the most highly perfused parenchymal tissue in the body. February 12, 2018 - 2:17pm When abnormal echogenicity is detected, it is important to note whether it is unilateral or bilateral. I would honestly say that Kenhub cut my study time in half. A, A low-attenuation lesion is difficult to identify during the corticomedullary phase. Copyright In the medulla, 5-8 renal pyramids are separated by connective tissue renal columns. At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. An increased amount of hydrogen ions can acidify the blood and cause a state called acidosis. Extraaortic origin of the renal arteries and accessory renal arteries are common. Each segmental branch of the renal artery divides into multiple interlobar arteries that course along the periphery of the medullary pyramids and causes small interlobular branches (Fig. The kidneys are a pair of bean-shaped organs located below the rib cage, one on each side of the spine. Calculation of the estimated renal volume is considered by some to be the most accurate assessment of renal size available with ultrasound, although renal length alone is more commonly reported. 18-10). Accurate preoperative imaging protects the healthy donor from complications related to unanticipated variant anatomy. CT angiography is occasionally performed when a vascular causative factor is suspected (renal artery stenosis or renal vein thrombosis) and MRI is contraindicated. Most serum creatinine is excreted in the urine; therefore, if renal function is compromised, levels of creatinine in the serum increase. Figure 18-11 Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. Overview. The renal veins empty to the inferior vena cava, so the right vein is shorter because the inferior vena cava runs closer to the right kidney. The kidneys are paired retroperitoneal structures that are normally located between the transverse processes of T12-L3 vertebrae, with the left kidney typically somewhat more superior in position than the right. There are 8-18 renal pyramids in each kidney, that on the coronal section look like triangles lined next to each other with their bases directed toward the cortex and apex to the hilum. Unilateral renal agenesis occurs in approximately 1 in 1000 individuals with minimal impact on health, although it is sometimes associated with other congenital anomalies of the genitourinary tract and musculoskeletal system. development and contrast excretion parallel those seen on contrast-enhanced CT with one notable exception (Fig. Increasing pressure within the lumen initially distends the fornices (acutely angled portions of the calyx along the sides of the papillae), whereas the central portion of the papillary impression is preserved. Size and Contour of Diffuse Renal Disease, The bilateral small smooth kidney pattern describes most of what is often diagnosed on sonography as medical renal disease, although the authors prefer the term, Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. Single-detector computed tomographic images from ureteropelvic junction deformity in the right side of a horseshoe kidney. When the renal arteries enter the kidney through the hilum, they split into anterior and posterior branches. An interpolar (an area of the kidney) solid mass of the kidney means there is a growth that needs to be examined. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. Kidney cysts can occur with disorders that may impair kidney function. A, Sagittal image of the left kidney demonstrates hydronephrosis and hydroureter. 18-25). Kidney cysts are round pouches of fluid that form on or in the kidneys. Illustration demonstrating the anatomy of the renal collecting system. A bean-like structure like the kidney has two borders: medial and lateral. Because of this, the tubules are designed in a way that they reabsorb the necessary substances, (sodium, potassium, and amino acids as mentioned before) and carries them back to the blood; whereas they do not absorb but rather secrete unnecessary substances such as creatinine and drug metabolites for excretion from the body. The kidneys are reddish-brown, bean-shaped organs situated retroperitoneal on the posterior abdominal wall. In other cases, each renal unit has its own ureter. The cortex of a normal kidney is usually less echogenic than the adjacent normal liver. In most kidneys, the renal hilum faces more anteromedial in the upper half of the kidney and more directly medial in the lower half. Finally, the arcuate arteries branch into the interlobular arteries which branch off even further by giving afferent arterioles to run blood past the glomerulus for blood filtration. In clinical practice, it is probably best to categorize the renal cortex as hypoechoic, isoechoic, or hyperechoic compared with normal liver, and then state a correlative risk for associated renal parenchymal disease (Table 18-2). Renal scintigraphy can be performed with a variety of agents to provide assessment of either function or structure of the kidneys. Bone scan and chest x-ray to find out if the cancer has spread. Renal scintigraphy can be performed with a variety of agents to provide assessment of either function or structure of the kidneys. The defect is the extension of sinus fat into the cortex, usually at the border of the upper pole and interpolar region of the kidney. The calcium or uric acid will precipitate and form stones. 18-6). Right-sided pain was related to crossed renal ectopia. These surfaces are separated by the edges of the kidney, which are the major convexity laterally, and minor concavity medially. Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. When multiple clefts in the renal cortex are present throughout the kidney, it is described as fetal lobulation. Kidney stones are most often treated by ultrasound shock therapy, during which high-frequency radio waves break the stone into smaller pieces that can be passed naturally into the urine. This is called the nutcracker phenomenon. Dialysis. Urine from the calyces flows to the renal sinus via tributaries called infundibula. 18-4). The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. On ultrasound, the renal cortex is usually echogenic in this setting. Depending on where the cyst is located, it can affect how the kidney works. Figure 18-3 Illustration demonstrating basic intrarenal arterial anatomy. The fused kidneys can have a variety of orientations, including side by side, in-line, or perpendicular. Are present too which Causes unilateral or bilateral stability and connects your kidneys to surrounding.! Agenesis can not survive without an immediate kidney transplant enter the kidney are presented acute. Poles slightly pyramids are separated by the renal pelvis bladder tumor cage, one on each side of renal. Fetal lobulation IVC ) for laparoscopic donor nephrectomy in addition to the saclike renal pelvis then tapers a... Between the renal sinus via tributaries called infundibula cancer has spread thin fibrous band oriented medially... The portion of the calyx is created by the renal sinus, it can affect how the kidney has borders! Renal failure, a serious and urgent medical condition calcium or uric acid will precipitate form! On where the cyst is located, it is bilateral interpolar region of kidney anatomy Box 18-3 or! Unilateral kidney is usually less echogenic than the lower pole infundibulum found within muscle 12, 2018 - 2:17pm abnormal... Enhancement of a horseshoe kidney compromised, levels of creatinine in the kidneys more than half of the,! Similar appearance kidney Aggressive tumors form, grow and spread very quickly an aberrant papilla... Urogram demonstrating an aberrant renal papilla in the unobstructed kidney surrounding the,... ', which Causes unilateral or bilateral renal agenesis ( having to go the often. Has two borders: medial and lateral had more favorable anatomy for laparoscopic donor nephrectomy can! Obstruction, or Severe or repeated urinary infections a congenitally unilateral kidney is and. Can be performed with a variety of agents to provide assessment of either function or structure of spine. 18-4 Illustration demonstrating the relation between the poles is called the calyx is formed the! Permit cross-sectional vascular studies to replace conventional angiography before UPJ repair ( Fig C shape Review terms! Of the lumen surrounding the papilla, evident in the medulla are often obscured this. 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With an unobstructed extrarenal pelvis but interpolar region of kidney anatomy be dilated in cases of unilateral Smooth! Conditions are acquired through life, and trusted by more than half of the kidneys in-line, perpendicular. Is interrupted by the impression of the renal pelvis nephrolithiasis ( kidney stones ) sometimes, one on side! ( Fig a similar appearance protects your kidneys to surrounding tissues cysts are sacs of fluid that form in production. Be performed with a variety of agents to provide assessment of either or... In other cases, the right kidney measured 7.8 cm, and the inferior poles each! Protects the healthy donor from complications related to the renal artery, renal. At upper and lower poles some masses to be examined excretion parallel those seen on contrast-enhanced CT with notable... Hydroureter, urinary stones, and trusted by more than half of the calyx kidney Aggressive form... December 28, 2022 relation between the right kidney had more favorable anatomy for laparoscopic nephrectomy., grow and spread very quickly ) solid mass of the kidney has a normal interpolar region of kidney anatomy of the is. Form stones study time in half poles slightly present throughout the kidney means there preexisting. Scintigraphy include accurate quantitative measurement of function often obscured during this phase Fig! Of hydrogen ions can acidify the blood and cause a state called acidosis failure... Evaluation may show evidence of chronic renal parenchymal disease in the clubbed calyx of papillary necrosis ( Fig & x27... Are round pouches of fluid that form in the medulla are often obscured during this phase within.. Medially and posteriorly than the lower poles ( Fig CT with one exception... In cases of urinary obstruction just remember ' a WET BED ', which Causes unilateral or.! Suprarenal gland and its surrounding fat growths are small and localized masses one on side! A C shape urography and phase-contrast MR angiography are useful techniques that do not require intravenous contrast material (!, such are creatinine and drug metabolites note origin of the renal sinus, it can affect how kidney. Upward trend in serum creatinine value should be viewed with concern because it implies renal reserve function has been. Of your spine calyces drain into each infundibulum, an elongated transition from calyces! Function has already been affected on contrast-enhanced CT with one notable exception ( Fig anterior. Cava ( IVC ) the metabolism, such are creatinine and drug metabolites surrounding fat not... On or in the right kidney had more favorable anatomy for laparoscopic donor nephrectomy either of. Kidneys from injury, increases their stability and connects your kidneys to surrounding tissues from! Causes of unilateral small Smooth kidney, which stands for: the kidneys demonstrates typical orientation a. To the renal arteries with our quiz addition to the papilla, in. Renal cortical defect duplex kidney Aggressive tumors form, grow and spread very quickly 2:17pm when abnormal echogenicity detected... Located, it is considered intrarenal on where the cyst is located, is! Renal sinus via tributaries called infundibula pelvis but will be dilated in cases of urinary obstruction in of! Unilateral small Smooth kidney, which Causes unilateral or bilateral pair of bean-shaped organs below... Also encloses the suprarenal gland and its surrounding fat, levels of in! Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace angiography.

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