Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure gradients

Eur J Radiol. 2011 Dec;80(3):648-54. doi: 10.1016/j.ejrad.2010.08.044. Epub 2010 Sep 24.


Purpose: To evaluate the diagnostic values of CT findings of nutcracker syndrome (NCS).

Methods and materials: Twenty seven subjects that underwent CT and renal venography, were divided into three groups based on the venographic renocaval pressure gradient (PG) and collateral veins of the left renal vein (LRV): non-compensated NCS patients with PG≥3 mm Hg (group 1, n=12), partially compensated NCS patients with borderline PG (1<3 mm Hg) and collateral veins (group 2, n=6), and control group with low PG (0-1 mm Hg) without collateral veins (group 3, n=9). The CT findings were analyzed with regard to abrupt narrowing of the LRV with an acute angle (beak sign), aortomesenteric angle between the superior mesenteric artery and aorta on sagittal images, and LRV diameter ratio (hilar-aortomesenteric).

Results: Beak sign of the LRV was found in 91.7% (11/12) of group 1, 50% (3/6) of group 2, and in 11.1% (1/9) of group 3 with the significant difference between groups 1 and 3 (P<.05, χ2 test). Mean values of all quantitative CT parameters differed significantly only between groups 1 and 3 (P<.05, one-way ANOVA test). For differentiating the non-compensated NCS from the control group, the beak sign showed 91.7% sensitivity and 88.9% specificity. Of the various CT parameters, the beak sign and LRV diameter ratio of ≥4.9 showed the greatest diagnostic accuracy (AUC 0.903, ROC analysis).

Conclusion: Beak sign of the LRV and CT findings can be useful in diagnosing the non-compensated NCS.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Female
  • Humans
  • Kidney / diagnostic imaging*
  • Kidney Function Tests*
  • Male
  • Manometry / methods*
  • Phlebography / methods*
  • Renal Nutcracker Syndrome / diagnosis*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Statistics as Topic
  • Tomography, X-Ray Computed / methods*
  • Young Adult