Radiology of urology
- 1. Urinary system (Imaging) Dr. Vipan Magotra Professor Department of Radiodiagnoisis THE RADIOLOGY OF URINARY TRACT ISHIKA KAKANI 81A
- 2. Imaging Techniques ➢ Plane urinary Tract film. Kidney, Ureters and bladder(KUB). ➢ Intravenous urography. (IVU/EU). ➢ Ante grade and retrograde urethrography. ➢ Ultrasound. ➢ CT scan ➢ MRI ➢ Angiography
- 3. Principles of Radiography The underlying physical principles of conventional radiography involve Emitting a stream of photons from x-ray source, strike body tissue. Photons with varying amount of energy exit the patient body and fall on image receptor/film, thus produce an image
- 4. X-ray KUB Indications. Stone diseases. Help in diagnosis and management Abdominal pain Gall bladder stones Position and size of kidneys and bladder Show the position of ureteric stent Preliminary examination to contrast study
- 5. KIDNEYS URETERS URINARY BLADDER URETHRA Conventional plain film of the abdomen is called a KUB (Kidneys, Ureters, Bladder) Good evaluation of radio-opaque stones
- 9. Preparation. We use laxative, the night before the test to clear colon of solid fecal material. On good quality film psoas muscle should be visible
- 10. INTRAVENOUS UROGRAPHY (IVU). Shows anatomy and functions of the kidneys. After injection of iv contrast, it concentrate in the kidneys. Excreted by kidneys and pass via ureters in to the urinary bladder. we take a series of films to follow the passage of contrast from kidneys to urinary bladder. Contrast Shows renal parenchyma, collecting system and ureters. Evaluate urothelial abnormalities,haematuria,urolithiasis . Scout film +/- abd preparation. Inject bolus of contrast Nephrogenic phase in first minute Pyelogenic phase after 5 minutes Supine,oblique,prone upright and post void film are taken Prone films to see distal ureters
- 11. This is KUB taken post intravenous contrast injection KUB IVU
- 12. This is KUB taken post intravenous contrast injection • 5 min post IV is nephrogram
- 13. This is KUB taken post intravenous contrast injection Also called IVP (intravenous pyelogram) Demonstrates both function and structure of the renal system •Function ---→ Filtration •Structure ---→ Contrast filled collecting system Indications: •Urolithiasis / calculus •Pyelonephritis •Hydronephrosis •Trauma •Tumour •Renal hypertension •Congenital abnormality Contra-Indications: (relative) •History of Allergy •Asthma •Cardiovascular disease •Sickle cell disease •Diabetes mellitus
- 14. Voiding/Micturating cystourethrogram Functional and anatomical evaluation of bladder and urethra specially posterior urethra. Commonly for kids with recurrent UTI Dx.reflux,urethralvalve,uretrocele,urethral stricture and diverticula Scout film Pediatric 6-8F catheter For adult standard catheter Films during filling the bladder Oblique films Post void films You can see normal bladder film
- 15. 8-16 F Foleys catheter. Fill balloon with2cc of contrast Inject 50% of contrast in to the bladder Take films in oblique position Some resistance at the membranous urethra and sphincter. Retrograde urethrogram Ascending urethgram in female
- 16. Now a days first line investigation. Grey scale and Doppler Evaluate renal parenchyma, adrenals, bladder and prostate. Can differentiate between solid and cystic, hydronephrosis,shows all type of stone Evaluate congenital anomalies. Ultrasound
- 18. US + ve: Available No radiation Good anatomy - ve: Operator dependent Used for: Good for kidney stones Excellent for hydronephrosis Excellent for focal lesion e.g. cysts, masses
- 19. CT scan Gold standard test. With and with out contrast Standard CT technique for renal imaging. 5mm collimation is adequate to demonstrate kidneys. IV contrast differentiate pathological process from normal. Parenchyma,coricomedullary differentiation max at 30 seconds Nephrogenic phase is best seen at 70-100 seconds Non contrast helical CT shows any kind and small size of stone
- 20. Hyper-dense→ white (stone/bone) Hypo-dense grey to black (fat/fluid)
- 21. Arterial Venous Excretion Non-contrast = Cortical = Parenchymal
- 23. CT: ► + ve: ▪ Relatively available (more then MRI) ▪ Very good anatomy ► - ve: ▪ Radiation ▪ Some times need IV contrast (? reaction) ► Used for: ▪ Excellent for kidney stones (the best) ▪ Excellent for hydronephrosis & masses ▪ Excellent for kidney trauma
- 24. MRI
- 25. Hyper-intense (white) Hypo-intense (grey to black)
- 26. MRI + ve: Excellent anatomy details No radiation - ve: Expensive Long scanning time (30 to 60 min) Not used to diagnosed kidney stone Used for: Excellent for masses Good for hydronephrosis
- 27. ANGIOGRAPHY
- 28. Cross ectopic. Lower kidney is usually ectopic one. In 90% of cases there is fusion of kidneys. There are increase chances of calculus formation. Horse shoe kidney. Lower pole of both unite in the middle. Prone to traume Pelvic kidney. Kidney is located in the pelvis. More prone to trauma. Duplicate collecting system. Complete/part Congenital anomalies
- 30. Anamolies