Radiologic Assessment of Native Renal Vasculature: A Multimodality Review.

Area of Science:

• Radiology
• Vascular Imaging
• Renal Pathology

Background:

• Clinically significant renal vascular variants and pathologies require accurate radiologic diagnosis.
• Renal artery and vein assessment is vital across all imaging modalities, as many conditions lack specific clinical suspicion.
• Familiarity with normal renal vascular anatomy and optimized imaging protocols is essential for effective interpretation.

Purpose of the Study:

• To review common and critical renal vascular conditions encountered in radiologic practice.
• To highlight the importance of imaging in diagnosing renal artery stenosis, fibromuscular dysplasia, aneurysms, and arteriovenous abnormalities.
• To emphasize the radiologist's role in identifying both congenital and acquired renal vascular pathologies.

Main Methods:

• Review of key imaging findings for various renal vascular conditions.
• Discussion of diagnostic criteria for renal artery stenosis using ultrasonography (US).
• Description of imaging features differentiating arteriovenous fistulas from arteriovenous malformations and identifying Nutcracker syndrome.

Main Results:

• Renal artery stenosis, often secondary to atherosclerosis or fibromuscular dysplasia, is a primary cause of hypertension.
• Fibromuscular dysplasia is linked to renal artery hypertension, aneurysms, and dissection, particularly in young women.
• Imaging can detect renal artery aneurysms, pseudoaneurysms, arteriovenous fistulas/malformations, and venous thrombi (bland or tumor), as well as leiomyosarcoma.

Conclusions:

• Accurate interpretation of renal vascular imaging is critical for diagnosing diverse pathologies, from stenosis to tumors.
• Knowledge of normal anatomy and imaging techniques aids in recognizing variants and conditions like Nutcracker syndrome.
• Radiologists are indispensable in managing renal vascular diseases, preventing potentially catastrophic outcomes from overlooked conditions.