The role of CT angiography in the evaluation of pediatric renovascular hypertension
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PICTORIAL ESSAY
The role of CT angiography in the evaluation of pediatric renovascular hypertension Jessica Kurian & Monica Epelman & Kassa Darge & Kevin Meyers & Els Nijs & Jeffrey C. Hellinger
Received: 28 June 2012 / Revised: 30 September 2012 / Accepted: 15 October 2012 / Published online: 4 December 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract Historically, the evaluation of renovascular hypertension has been accomplished by US, renal scintigraphy and digital subtraction angiography. Based on its high accuracy reported in adults renal CT angiography (CTA) with pediatric-appropriate low radiation dose techniques has become an important tool in the workup of renovascular hypertension in children. Renal CTA has several advantages
CME activity This article has been selected as the CME activity for the current month. Please visit the SPR Web site at www.pedrad.org on the Education page and follow the instructions to complete this CME activity. J. Kurian : M. Epelman (*) : K. Darge : E. Nijs : J. C. Hellinger Department of Radiology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA e-mail: [email protected] M. Epelman e-mail: [email protected] K. Meyers Division of Nephrology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Present Address: J. Kurian The Children’s Hospital at Montefiore, 111 East 210th St., Bronx, NY 10467, USA Present Address: M. Epelman Department of Radiology, Nemours Children’s Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA Present Address: J. C. Hellinger New York Cardiovascular Institute and Lenox Hill Radiology, New York, NY, USA
over more conventional imaging modalities, including rapid and non-invasive acquisition, high resolution and easy reproducibility. Additionally, in our experience high-quality renal CTA can be performed using low-dose radiation exposures and can be acquired without sedation in most instances. This article illustrates by examples the usefulness of renal CTA for diagnosis of childhood renovascular hypertension and provides an overview of renal CTA findings in the most common childhood renovascular diseases. Keywords Renovascular hypertension . Renal artery stenosis . CT angiography
Introduction In children, secondary hypertension is more common than in adults [1], and the odds of detecting a secondary cause of hypertension are inversely proportional to the age of the child and directly related to the severity of blood pressure elevation [2]. The precise incidence of pediatric secondary hypertension caused by renovascular disease is estimated to account for 5–25% of cases [1, 3]. Conversely, in adults renovascular hypertension is found only in approximately 1% of patients with hypertension and is usually secondary to atherosclerosis [1, 3]. Renovascular disease is the third most common cause of pediatric hypertension, following coarctation of the aorta and renal parenchymal disease [4].
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