Urinary system (Imaging)
Radiological anatomy
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
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
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
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
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
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
Retrograde urethrogram
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.
Ascending urethgram in
female
Ultrasound
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.
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 70100 seconds
Non contrast helical CT shows any
kind and small size of stone
MRI
ANGIOGRAPHY
Congenital anomalies
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
Anamolies
Nephrolithiasis
•
•
•
•
Symptomatic/asymptomatic. Flank pain hematuria.
Calcium phosphate stones are opaque on plane x-rays
Uric acid and xanthine stones are radiolucent.
All renal calculi have high attenuation(Opaque) on CT
Sensitivity is 97% and specefity is 96%
Can cause hydronephrosis, hydro ureter and renal
enlargement
Kidney and ureteric stones
CT images of renal
abscess with and
with out contrast
Renal cystic diseases
Very common. 50% of patient over the
age of 50
Associated with many syndromes
Asymptomatic
Rarely cause hematuria or become
infected
Smooth thin wall, sharp demarcation
from surrounding parenchyma.
Water attenuation on CT, non enhancing
Simple cyst are with out septation or
calcification
Could be inherited like autosomal
dominant or recessive
Simple cyst in kidney on u/s and CT
Renal cell carcinoma
Most common malignancy 85%
Associated with smoking, family history,
age, von hippel Lindau, dialysis,
phenacetin and acquired cystic diseases
Present with wet
loss,hematuria,pain,mass,fever and
anemia
Variable from complex cyst to large
heterogeneous mass
Generally enhancing
May have calcification hemorrhage and
central necrosis
Wilms tumor
Commonest kidney tumor in children.
Peak incidence at 3-4 years of age
85% occur before years
Hydronephrosis
Distension and dilation of the renal pelvis and
calyces.
It is usually caused by obstruction to the free flow
of urine from the kidney.
If obstruction is at lower level, there is dilation of
ureters and pelvis of kidney.
Untreated , initially it cause enlargement of
kidney, but finally it leads to atrophy.