Adrenal Venography Using Multi-slice Spiral Computed Tomography

  Objective  To assess the image quality of multi-slice spiral computed tomography (MSCT) for adrenal venography and describe the anatomic and morphologic features of adrenal veins.

  Methods  The abdominal MSCT images of 100 patients (M:F=54:46, 55.7±15.7 yrs old) with normal adrenal morphologies were retrospectively reviewed. The bilateral adrenal veins were displayed using maximum intensity projection (MIP) or multi-plannar reformation (MPR) software and the image quality was assessed using a 3-point grading scale (excellent, sufficient and non-diagnostic). The anatomical location, anomalies and spatial interrelationships of the renal veins and inferior vena cava (IVC) were also described.

  Results  In the evaluation of image quality with MIP or MPR images, the left adrenal vein was excellent in 97% patients, sufficient in 1%, and non-diagnostic in 2%. For the right adrenal vein, 52% were excellent, 19% were sufficient, and 29% were non-diagnostic. The left adrenal vein was always a single one, 91% of which joined the inferior phrenic vein and then drained into the left renal vein. The diameter of the left adrenal vein ranged 2.4 mm to 4.5 mm (mean:3.6±0.6 mm). The angle of the left adrenal vein and left renal vein ranged 150° to 58° (mean:121.9±16.0°). Two patients were found to have double right adrenal veins. The right adrenal vein drained into the IVC in 67 of 71 patients (94%) and into the right accessory hepatic vein in 4 patients (6%). The average diameter of the right adrenal vein ranged 1.9 mm to 4.0 mm (mean:3.2±0.5 mm). The angle of the right adrenal vein and IVC ranged 90° to 35° (mean:75.3±16.6°).

  Conclusion  MSCT venography, together with the application of MIP and MPR permits satisfying visualization of the bilateral adrenal veins, especially the left one, in most cases.