Journal of pediatric urology · 2026
Investigating the availability of new anatomical measurements in the diagnosis of anterior nutcracker syndrome.
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Kekeç Şenay Demir, Avcı Begüm, Parmaksız Gönül, Gezer Hasan Özkan, Yalçın Çiğdem, Noyan Aytül
Аннотация
BACKGROUND: Nutcracker Syndrome (NCS) results from compression of the left renal vein (LRV), most commonly between the superior mesenteric artery (SMA) and the abdominal aorta. Diagnosing NCS in children remains challenging due to nonspecific symptoms, anatomical variability, and lack of standardized criteria.
OBJECTIVE: To observe the usability of new and more practical measurements in diagnosing anterior NCS in pediatric patients.
METHODS: This retrospective study included 23 children with NCS and 45 controls who underwent abdominal CT for unrelated reasons. Eight anatomical parameters were measured. ROC analysis was used to assess diagnostic performance.
RESULTS: In correlation analysis, a positive and good level of relationship was found between AP1 and AP1/AP2, while a negative and strong relationship was found between AP1 and TA/AP, between AP2 and AP1/AP2, between AP1/AP2 and TA/AP. Also for the AP2, AP3 measurements, the cut-off values were found to be significantly higher in the control group compared to the NCS patients (p < 0.05).
CONCLUSION: The AP1/AP2 ratios, along with AP2 and Ap3 measurements, are promising anatomical indicators for the diagnosis of pediatric NCS. These midline-based parameters may eventually be adapted for use in ultrasound, offering a non-invasive alternative to CT. Further validation in larger pediatric cohorts is warranted.
OBJECTIVE: To observe the usability of new and more practical measurements in diagnosing anterior NCS in pediatric patients.
METHODS: This retrospective study included 23 children with NCS and 45 controls who underwent abdominal CT for unrelated reasons. Eight anatomical parameters were measured. ROC analysis was used to assess diagnostic performance.
RESULTS: In correlation analysis, a positive and good level of relationship was found between AP1 and AP1/AP2, while a negative and strong relationship was found between AP1 and TA/AP, between AP2 and AP1/AP2, between AP1/AP2 and TA/AP. Also for the AP2, AP3 measurements, the cut-off values were found to be significantly higher in the control group compared to the NCS patients (p < 0.05).
CONCLUSION: The AP1/AP2 ratios, along with AP2 and Ap3 measurements, are promising anatomical indicators for the diagnosis of pediatric NCS. These midline-based parameters may eventually be adapted for use in ultrasound, offering a non-invasive alternative to CT. Further validation in larger pediatric cohorts is warranted.