diagnostic imaging of urinary tract radiology department of ruijin medical college affiliated to...
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DIAGNOSTIC IMAGING
OF URINARY TRACT
DIAGNOSTIC IMAGING
OF URINARY TRACT
Radiology Department of Ruijin Medical CollegeAffiliated to Shanghai Jiaotong University Medical School
骨关节系统影像学骨关节系统影像学
瑞金临床医学院瑞金临床医学院
医学影像学教研室医学影像学教研室
INTRODUCTION INTRODUCTION
Including both kidney, ureter, bladder and urethra.
Lack of natural contrast.
Need various kinds of contrast examination.
Use of CT, USG,MRI.
Including both kidney, ureter, bladder and urethra.
Lack of natural contrast.
Need various kinds of contrast examination.
Use of CT, USG,MRI.
METHODS OF EXAMINATION METHODS OF EXAMINATION
Plain Film of the Abdomen (KUB) Plain Film of the Abdomen (KUB)
Including both sides of kidney, area of
ureter and bladder.
To show contour, size, shape of the ab
ove organs and psoas muscles margin.
To demonstrate stone and calcification
of urinary tract
Including both sides of kidney, area of
ureter and bladder.
To show contour, size, shape of the ab
ove organs and psoas muscles margin.
To demonstrate stone and calcification
of urinary tract
KUB
Intravenous Urography (IVU) Intravenous Urography (IVU)
METHODS OF EXAMINATION METHODS OF EXAMINATION
Preparation: 1. sensitivity test of iodine.
2.preparation of intestinal tract
(fast 8~12h, catharsis)
Contrast medium: 1.Urografin (泛影葡胺 )
2. Iopamidol (碘必乐 )
3. Iopromide (碘普罗胺 )
Preparation: 1. sensitivity test of iodine.
2.preparation of intestinal tract
(fast 8~12h, catharsis)
Contrast medium: 1.Urografin (泛影葡胺 )
2. Iopamidol (碘必乐 )
3. Iopromide (碘普罗胺 )
Technique: 1.intravenous instillation of contrast medium
(100ml) should be over in 5~10minutes
2. films are taken at 3,5,10,15,25(KUB)
minutes
Display: 1.excretory function of kidney
2.morphology of urinary tract
Technique: 1.intravenous instillation of contrast medium
(100ml) should be over in 5~10minutes
2. films are taken at 3,5,10,15,25(KUB)
minutes
Display: 1.excretory function of kidney
2.morphology of urinary tract
Intravenous Urography (IVU) Intravenous Urography (IVU)
METHODS OF EXAMINATION METHODS OF EXAMINATION
-C +C
I.V.U.
I.V.U.
Retrograde Urography Retrograde Urography
METHODS OF EXAMINATION METHODS OF EXAMINATION
To be used when IVU has been unsatisfactory or
inconclusive.
To show the morphology of urinary tract only.
To be used when IVU has been unsatisfactory or
inconclusive.
To show the morphology of urinary tract only.
Retrograde Urography Retrograde Urography
Renal Angiography Renal Angiography
METHODS OF EXAMINATION METHODS OF EXAMINATION
abdominal aortography.
Selective renal arteriography.
abdominal aortography.
Selective renal arteriography.
Renal Angiography Renal Angiography
Renal Angiography Renal Angiography
CT CT
METHODS OF EXAMINATION METHODS OF EXAMINATION
Plain Scans Plain Scans
patient preparation :
⑴ oral contrast mediun administration for bowel and bladder filling
⑵ 1~2%, 500ml of urografin for kidney CT
⑶ 1~2%, 1000ml of urografin for bladder CT
⑷ the bladder must be fully distended
Slice thickness and intervals: 5~10mm
Scanning method: sequential CT scans
Scanning ranges: upper pole of kidney→ureter→bladder
patient preparation :
⑴ oral contrast mediun administration for bowel and bladder filling
⑵ 1~2%, 500ml of urografin for kidney CT
⑶ 1~2%, 1000ml of urografin for bladder CT
⑷ the bladder must be fully distended
Slice thickness and intervals: 5~10mm
Scanning method: sequential CT scans
Scanning ranges: upper pole of kidney→ureter→bladder
CT CT Plain Scans Plain Scans
Contrast enhanced Scans Contrast enhanced Scans CT CT
METHODS OF EXAMINATION METHODS OF EXAMINATION
Contrast medium: 60~100ml, 1.5~2.5ml/s
Intravascular administration: bolus injection
Scanning:
⑴Sequential CT scans: start at 15~20s after injection
⑵Delayed CT scans: can be performed at 5~10min. after injection to show filling the pelvis, ureter and bladder with contrast medium
Contrast medium: 60~100ml, 1.5~2.5ml/s
Intravascular administration: bolus injection
Scanning:
⑴Sequential CT scans: start at 15~20s after injection
⑵Delayed CT scans: can be performed at 5~10min. after injection to show filling the pelvis, ureter and bladder with contrast medium
Contrast enhanced Scans Contrast enhanced Scans CT CT
MRI MRI
Plain Scans:
⑴ transverse T1WI (T1-Weighted imaging) + T2WI
(T2-Weighted imaging) with SE (spin-echo sequences)
⑵ coronal T1WI with SE
Contrast enhanced scans:
⑴ contrast medium: Gd-DTPA, 0.1~0.2mmol/kg
⑵ scanning sequences: T1WI with SE
MRU (MR urography):
to demonstrate the obstruction of urinary tract
Plain Scans:
⑴ transverse T1WI (T1-Weighted imaging) + T2WI
(T2-Weighted imaging) with SE (spin-echo sequences)
⑵ coronal T1WI with SE
Contrast enhanced scans:
⑴ contrast medium: Gd-DTPA, 0.1~0.2mmol/kg
⑵ scanning sequences: T1WI with SE
MRU (MR urography):
to demonstrate the obstruction of urinary tract
METHODS OF EXAMINATION METHODS OF EXAMINATION
KUB I.V.U.R.U.
Angio CT
US
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
KUB & IVU KUB & IVU
Kidney Kidney
1. position: T11~12 to L1~2
2. size: 11~13×5~6×2~3cm (3×6×12cm)
1. position: T11~12 to L1~2
2. size: 11~13×5~6×2~3cm (3×6×12cm)
Contour: smooth
Minor calyces: 10~14
Major calyces: 2~4
Pelvis: trumpet , branch, ampulla
Contour: smooth
Minor calyces: 10~14
Major calyces: 2~4
Pelvis: trumpet , branch, ampulla
Ureter Ureter
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
KUB & IVU KUB & IVU
long: 25~30cm
width: 3~5mm
physiological narrowings: ⑴ pelvi-ureteral junction
⑵ iliac vessels
⑶ entry of bladder
long: 25~30cm
width: 3~5mm
physiological narrowings: ⑴ pelvi-ureteral junction
⑵ iliac vessels
⑶ entry of bladder
Bladder Bladder
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
KUB & IVU KUB & IVU
shape: round or oval
capacity: 200~350ml
shape: round or oval
capacity: 200~350ml
I.V.U.
CT CT
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
Plain Scans Plain Scans
Kidney ⑴ renal parenchyma: soft tissue density, 30~50Hu
⑵ pelvis: water density, 10~20Hu
⑶ renal sinus: fat density, -60~-100Hu
Uretersoft tissue density
Bladderwater density when fully distended
Kidney ⑴ renal parenchyma: soft tissue density, 30~50Hu
⑵ pelvis: water density, 10~20Hu
⑶ renal sinus: fat density, -60~-100Hu
Uretersoft tissue density
Bladderwater density when fully distended
Contrast Enhanced Scans Contrast Enhanced Scans CT CT
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
Kidney: ⑴ 1′after injection: cortical enhancement
⑵ 2′after injection: medullary enhancement
⑶ 5~10′after injection: parenchyma enhancement and filling the pelvis with contrast medium
Kidney: ⑴ 1′after injection: cortical enhancement
⑵ 2′after injection: medullary enhancement
⑶ 5~10′after injection: parenchyma enhancement and filling the pelvis with contrast medium
Contrast Enhanced Scans Contrast Enhanced Scans CT CT
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
Ureter and Bladder: ⑴ bladder wall enhanced on early scans
⑵ filling with the contrast medium on delayed scans
MRI MRI
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
Plain Scans Plain Scans
The signal intensity of renal cortex on T1WI is higher
than that of renal medulla
The signal intensity of renal cortex and medulla on T2
WI are all higher
The signal intensity of ureter and bladder are low on T
1WIand higher on T2WI
The signal intensity of renal cortex on T1WI is higher
than that of renal medulla
The signal intensity of renal cortex and medulla on T2
WI are all higher
The signal intensity of ureter and bladder are low on T
1WIand higher on T2WI
MRI MRI
NORMAL IMAGING OF URINARY TRACT NORMAL IMAGING OF URINARY TRACT
Contrast Enhanced Scans Contrast Enhanced Scans
Renal parenchyma and bladder wall show
enhancement
Renal parenchyma and bladder wall show
enhancement
CALCULUS OF URINARY TRACT CALCULUS OF URINARY TRACT
Radiopaque(calcium) in 90% of patient
Radiolucent(urate) in 10% of patient
Radiopaque(calcium) in 90% of patient
Radiolucent(urate) in 10% of patient
Renal Calculus Renal Calculus
CALCULUS OF URINARY TRACT CALCULUS OF URINARY TRACT
round, horny, morula
lie in the calyces or pelvis
hydronephrosis
CT: high density, 200~1000Hu
round, horny, morula
lie in the calyces or pelvis
hydronephrosis
CT: high density, 200~1000Hu
Ureteral calculus Ureteral calculus
CALCULUS OF URINARY TRACT CALCULUS OF URINARY TRACT
grain of rice size, jujube core shaped
long axis parallel to the ureter
often stay in the sites of narrowness
hydroureter or hydronephrosis above the stone
CT: high density, 200~1000Hu
grain of rice size, jujube core shaped
long axis parallel to the ureter
often stay in the sites of narrowness
hydroureter or hydronephrosis above the stone
CT: high density, 200~1000Hu
Ureteral calculus Ureteral calculus
Calculus of Urinary bladder Calculus of Urinary bladder
CALCULUS OF URINARY TRACT CALCULUS OF URINARY TRACT
round, oval, laminited, concentric circles shaped
CT: high density
MRI: low signal on T1WI and T2WI
round, oval, laminited, concentric circles shaped
CT: high density
MRI: low signal on T1WI and T2WI
Calculus of Urinary bladder Calculus of Urinary bladder
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
Secondary infection
Hematogenous dissemination
Secondary infection
Hematogenous dissemination
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
PathologyPathology
TB bacilli TB bacilli
renal cortex infection renal cortex infection
medullary destruction medullary destruction
caseous necrosis caseous necrosis
abscess (calcification) abscess (calcification)
pelvicalyceal destruction pelvicalyceal destruction
ureter and bladder TB ureter and bladder TB
TUBERCULOSISTUBERCULOSIS
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
Auto-resection of kidney Auto-resection of kidney
Diffused calcification of caseous foci,
or whole kidney + loss of renal function
Diffused calcification of caseous foci,
or whole kidney + loss of renal function
Auto-resection of kidney Auto-resection of kidney
Renal Tuberculosis Renal Tuberculosis
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
KUB:
⑴ normal (early stage )
⑵ calcification
KUB:
⑴ normal (early stage )
⑵ calcification
Renal Tuberculosis Renal Tuberculosis
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
IVU:
⑴ calyceal destruction
⑵ abscess and cavity formation
⑶ pyonephrosis
⑷ diffuse fibrotic contraction and calcification
⑸ auto-resection of kidney
IVU:
⑴ calyceal destruction
⑵ abscess and cavity formation
⑶ pyonephrosis
⑷ diffuse fibrotic contraction and calcification
⑸ auto-resection of kidney
Renal Tuberculosis Renal Tuberculosis
Plain CT scans:
⑴ high density (calcification)
⑵ low density areas (abscess or cavity)
⑶ CT values: 20~40Hu(abscess)
Plain CT scans:
⑴ high density (calcification)
⑵ low density areas (abscess or cavity)
⑶ CT values: 20~40Hu(abscess)
Renal Tuberculosis Renal Tuberculosis
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
Contrast-enhanced CT scans:
⑴ low density areas without enhancement.
⑵ contrast media is demonstrable within the abscess.
⑶ pelvicalyceal enlargement
Contrast-enhanced CT scans:
⑴ low density areas without enhancement.
⑵ contrast media is demonstrable within the abscess.
⑶ pelvicalyceal enlargement
Renal Tuberculosis Renal Tuberculosis
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
MRI:
⑴ low signal on T1WI
⑵ high signal on T2WI
MRI:
⑴ low signal on T1WI
⑵ high signal on T2WI
Renal Tuberculosis Renal Tuberculosis
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT
Ureteral Tuberculosis Ureteral Tuberculosis
KUB:
calcification
IVU:
⑴ stricture
⑵ shorten
⑶ beading
KUB:
calcification
IVU:
⑴ stricture
⑵ shorten
⑶ beading
TUBERCULOSIS OF URINARY BLADDER TUBERCULOSIS OF URINARY BLADDER
IVU:
Small bladder
Contracted bladder
IVU:
Small bladder
Contracted bladder
TUMORS OF URINARY TRACT TUMORS OF URINARY TRACT
Renal Carcinoma Renal Carcinoma
KUB:
⑴ kidney enlarged, local protrusion
⑵ calcification in 10% of patients
IVU:
⑴ renal contour: bulging
⑵ calyces and pelvis:
compression
narrowing
dissociation
destruction
KUB:
⑴ kidney enlarged, local protrusion
⑵ calcification in 10% of patients
IVU:
⑴ renal contour: bulging
⑵ calyces and pelvis:
compression
narrowing
dissociation
destruction
Renal Carcinoma Renal Carcinoma
Plain CT scans:
⑴ mass (20~50Hu)
⑵ calcification
⑶ the tumor may be hypodense or isodense in comparison to the surrounding structures
Plain CT scans:
⑴ mass (20~50Hu)
⑵ calcification
⑶ the tumor may be hypodense or isodense in comparison to the surrounding structures
TUMORS OF URINARY TRACT TUMORS OF URINARY TRACT
Renal Carcinoma Renal Carcinoma
Contrast-enhanced CT scans:
⑴ inhomogeneous enhancement
⑵ peripheral enhancement
⑶ non-enhanced necrotic areas in the tumor
Contrast-enhanced CT scans:
⑴ inhomogeneous enhancement
⑵ peripheral enhancement
⑶ non-enhanced necrotic areas in the tumor
TUMORS OF URINARY TRACT TUMORS OF URINARY TRACT
Renal Carcinoma Renal Carcinoma
Renal Carcinoma Renal Carcinoma
MRI:
(1) Plain scans: inhomogeneous signals on T1WI and T2WI
(2) Contrast-enhanced scans: inhomogeneous enhancement
MRI:
(1) Plain scans: inhomogeneous signals on T1WI and T2WI
(2) Contrast-enhanced scans: inhomogeneous enhancement
TUMORS OF URINARY TRACT TUMORS OF URINARY TRACT
Renal Carcinoma Renal Carcinoma
Angioleimyolipoma Angioleimyolipoma
Benign tumor of the kidney
The tumor is histologically comprised of blood vessels,
smooth muscle, and fat tissue.
The proprtions of the conponents in the tumor are vari
able
Benign tumor of the kidney
The tumor is histologically comprised of blood vessels,
smooth muscle, and fat tissue.
The proprtions of the conponents in the tumor are vari
able
KUB and IVU KUB and IVU
Angioleimyolipoma Angioleimyolipoma
kidney enlarged
pelvicalyceal compression
calcification in 20% of patients
kidney enlarged
pelvicalyceal compression
calcification in 20% of patients
CT CT
Angioleimyolipoma Angioleimyolipoma
Fatty components of the tumor:
⑴ much lower dentisy
⑵ CT values:-40to-120Hu
⑶ non-enhancement
The vascular and muscular structeres of the tumor:
enhancement
Calcification: high density
Fatty components of the tumor:
⑴ much lower dentisy
⑵ CT values:-40to-120Hu
⑶ non-enhancement
The vascular and muscular structeres of the tumor:
enhancement
Calcification: high density
MRI MRI
Angioleimyolipoma Angioleimyolipoma
Fatty components:
⑴ high signal on T1WI and T2WI
⑵ much lower signal on STIR
Other components:
inhomogeneous signal on T1WI and T2WI
Fatty components:
⑴ high signal on T1WI and T2WI
⑵ much lower signal on STIR
Other components:
inhomogeneous signal on T1WI and T2WI
Renal Pelvic Carcinoma Renal Pelvic Carcinoma
Transitional cell carcinoma (80~90%) Transitional cell carcinoma (80~90%)
KUB: normal
IVU : filling defect within the pelvis
CT: mass of renal sinus⑴
⑵ enhancement
⑶ filling defect on delayed contrast CT imaging
MRI: mass of renal sinus ⑴
⑵ enhancement
KUB: normal
IVU : filling defect within the pelvis
CT: mass of renal sinus⑴
⑵ enhancement
⑶ filling defect on delayed contrast CT imaging
MRI: mass of renal sinus ⑴
⑵ enhancement
Renal Pelvic Carcinoma Renal Pelvic Carcinoma
Carcinoma of the Urinary Bladder Carcinoma of the Urinary Bladder
Papillary carcinoma of the epithelium of the urinary tract
Mass protruding on the bladder wall
KUB: normal
IVU: filling defect within the bladder
CT and MRI:
⑴ mass in the bladder
⑵ enhancement
⑶ invasion of surrounding structures
⑷ demonstrate metastatic lymph nodes
Papillary carcinoma of the epithelium of the urinary tract
Mass protruding on the bladder wall
KUB: normal
IVU: filling defect within the bladder
CT and MRI:
⑴ mass in the bladder
⑵ enhancement
⑶ invasion of surrounding structures
⑷ demonstrate metastatic lymph nodes
Carcinoma of the Urinary Bladder Carcinoma of the Urinary Bladder
RENAL CYST RENAL CYST
Simple Renal cyst Simple Renal cyst
Single or multiple
KUB: normal or bulging contour
IVU: pelvicalyceal compression
Single or multiple
KUB: normal or bulging contour
IVU: pelvicalyceal compression
RENAL CYST RENAL CYST
Simple Renal cyst Simple Renal cyst
CT:
⑴ round clear margin homogeneous low density ⑵ ⑶ ⑷CT values: 6~18Hu nonenhancement⑹
MRI: low signal on T1WI⑴
⑵ high signal on T2WI
⑶ nonenhancement
CT:
⑴ round clear margin homogeneous low density ⑵ ⑶ ⑷CT values: 6~18Hu nonenhancement⑹
MRI: low signal on T1WI⑴
⑵ high signal on T2WI
⑶ nonenhancement
Simple Renal cyst Simple Renal cyst
Polycystic Renal Disease in Adults Polycystic Renal Disease in Adults
Genetic disease
Accompanied with polycystic hepatic disease in 30~60% of patients
KUB: enlargment of both kidney
IVU: pelvicalyceal compression, shift, dissociation-- “spider feet”
CT and MRI:
⑴ multiple cysts in various sizes
⑵ nonenhancement
Genetic disease
Accompanied with polycystic hepatic disease in 30~60% of patients
KUB: enlargment of both kidney
IVU: pelvicalyceal compression, shift, dissociation-- “spider feet”
CT and MRI:
⑴ multiple cysts in various sizes
⑵ nonenhancement
RENAL AND URETERAL DYSPLASIA RENAL AND URETERAL DYSPLASIA
Double pelvis and ureter
Solitary kidey
Horse-shoe kidney
Ectopic kidney
Double pelvis and ureter
Solitary kidey
Horse-shoe kidney
Ectopic kidney
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