![Page 1: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/1.jpg)
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Review anatomy of the urinary
tract
Imaging modalities
Contents
![Page 3: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/3.jpg)
The Urinary Tract
![Page 4: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/4.jpg)
Kidneys
![Page 5: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/5.jpg)
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ต าแหน่งไต
(position)
อยู่ใน retroperitoneum ระดับ T12-L3 โดยไต
ขวาจะมีระดับต ากว่าไตซ้ายเล็กน้อย
รปูรา่ง (shape) คล้ายรูปถั ว ด้านเว้าหันเข้าทาง medial
ทิศทางการวางตวั
(axis)
Long axis ของไตเอียงขนานไปกับเงาของ
psoas muscle
ขนาด (size) ยาวประมาณ 10-16 cm. กว้าง 6 cm. หนา 4
cm. หรือประมาณ 3-4 lumbar vertebral
bodies ขนาดของไตสองข้างต่างกันได้ไม่เกิน
1.5 cm.
ความหนาของ renal
cortex (cortical
thickness)
ประมาณ 1.5-2 cm.
ขอบ (outline) ขอบเรียบเสมอกัน
![Page 7: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/7.jpg)
Kidneys
1. Renal capsule
Gerota’s capsule
Adipose capsule
Fibrous capsule
2. Renal parenchyma
Cortex
Medulla
3. Renal sinus
Renal pelvis
Artery, vein lymph, nerves
Fat
![Page 8: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/8.jpg)
Renal Capsule
Renal capsule: 3 layers
I. Gerota’s capsule
II. Adipose capsule
III. Fibrous capsule
![Page 9: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/9.jpg)
Renal Capsule
Renal capsule: 3 layers
I. Gerota’s capsule
II. Adipose capsule
III. Fibrous capsule
![Page 10: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/10.jpg)
Renal Capsule
Renal capsule: 3 layers
I. Gerota’s capsule
II. Adipose capsule
III. Fibrous capsule
![Page 11: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/11.jpg)
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Renal Parenchyma
![Page 13: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/13.jpg)
Renal Sinus
![Page 14: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/14.jpg)
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Associations
![Page 16: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/16.jpg)
Renal Vessels
![Page 17: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/17.jpg)
Film KUB
![Page 18: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/18.jpg)
IVP/IVU
IVP5 MINS
![Page 19: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/19.jpg)
Ultrasound
![Page 20: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/20.jpg)
ComputedTomography
(CT scan)
![Page 21: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/21.jpg)
Magnetic resonance imaging (MRI)
![Page 22: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/22.jpg)
Ureters
![Page 23: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/23.jpg)
Ureters
![Page 24: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/24.jpg)
Film KUB IVP 10 Minutes
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Physiologic narrowing of ureterI. Ureteropelvic junction (UPJ)
II. Distal ureter that cross bifurcation of iliac vessels
III. Ureterovesical junction (UVJ)
![Page 26: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/26.jpg)
Physiologic Narrowing (1)
![Page 27: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/27.jpg)
Physiologic Narrowing (2)
![Page 28: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/28.jpg)
Physiologic Narrowing (3)
![Page 29: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/29.jpg)
Urinary Bladder
![Page 30: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/30.jpg)
Urinary Bladder
![Page 31: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/31.jpg)
Urinary Bladder
![Page 32: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/32.jpg)
Urethra
![Page 33: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/33.jpg)
Urethra
♂ ♀
![Page 34: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/34.jpg)
Urethra
![Page 35: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/35.jpg)
Normal male urethrogram
![Page 36: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/36.jpg)
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Investigations
1. Plain KUB
2. Intravenous pyelography (IVP)
3. Retrograde pyelography (RP)
4. Cystography
5. Voiding cystourethrography (VCUG)
6. Ultrasonography
7. CT scan
8. Magnetic resonance imaging
9. Renal angiogram
10. Renogram
![Page 38: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/38.jpg)
Plain KUB
![Page 39: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/39.jpg)
Plain KUB
1. Soft tissue shadow
2. Abnormal calcification
3. Free air or free fluid
4. Bony structure
![Page 40: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/40.jpg)
Soft tissue shadows:KidneysPsoas musclesUterus BladderLiver Spleen
![Page 41: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/41.jpg)
1. Position2. Shape3. Axis 4. Size5. Cortical thickness6. Outline
Soft tissue shadows:KidneysPsoas musclesUterus BladderLiver Spleen
![Page 42: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/42.jpg)
Soft tissue shadows:KidneysPsoas musclesUterus BladderLiver Spleen
![Page 43: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/43.jpg)
Soft tissue shadows:KidneysPsoas musclesUterus BladderLiver Spleen
Retroperitoneal mass?
![Page 44: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/44.jpg)
Right psoasabscess
![Page 45: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/45.jpg)
Intraperitonealmass
![Page 46: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/46.jpg)
DDx.
- Urinary tract stone
- Calcified granuloma
- Tumor
- Gallstone
- Appendicolith
- Costochondral
calcification
- Atherosclerosis
- Phlebolith
- Prostatic calculi
- Calcified uterine fibroid
?
![Page 47: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/47.jpg)
?
Example:
There is an oval-
shaped calcification at
left L1-L2
paravertebral level,
overriding lateral
margin of left psoas
muscle. These
findings are suspected of left UPJ stone.
![Page 48: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/48.jpg)
UPJ stone
![Page 49: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/49.jpg)
Calyceal stone
![Page 50: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/50.jpg)
Staghorn stone
![Page 51: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/51.jpg)
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Emphysematous pyelonephritis
![Page 54: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/54.jpg)
I. SpineII. Lower ribsIII. SacrumIV. PelvisV. Hip & SI joints
Look for…- Fracture - Congenital bony defect- Bony destruction
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สรุป: การอ่าน Plain KUB
1. Soft tissue shadow
2. Abnormal calcification
3. Free air or free fluid
4. Bony structure
![Page 57: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/57.jpg)
Intravenous Pyelography(IVP)
![Page 58: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/58.jpg)
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IVP
*** Intravenous injection of iodinated contrast medium to evaluate for renal anatomy and function
1. Standard IVP (50 mL contrast medium)
2. Double dose IVP (100 mL contrast medium)
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Factors
1. Kidney function GFR
2. Intrarenal concentration:
State of hydration, osmotic diuresis
3. Exit of contrast from kidney (collecting
system dynamics):
Rate of urine flow, volume of collecting system,
ureteral dynamics
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IVP: Preparation
Fluid restriction
Increase visualization of contrast media
Except for patients with poor renal function, DM,
multiple myeloma, trauma, young child
Bowel preparation
To clear fecal content
Not absolutely needed
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IVP: Contraindication
1. Allergy to iodinated contrast media
2. Renal insufficiency (Creatinine Clearance < 30)
… Pregnancy
Note: Cr Clearance = (140-age)xBW(kg)
72xserum Cr (mg/dl)
If female (x0.85)
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IVP: Evaluation
3 min.
5 min.
10 min.
30 min, full bladder
Post void
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Scout Film
![Page 65: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/65.jpg)
Normal Nephrogram
3 min.
![Page 66: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/66.jpg)
3 min: Nephrogram
1. Position
2. Shape
3. Axis
4. Size
5. Cortical thickness
6. Outline
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Normal Excretion
5 min.
3 min.
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5 min: Excretion
1. Minor/major calyx
2. Renal pelvis
Abnormalities- Clubbing calyx/
hydronephrosis
- Filling defect
- Anomaly
- Dense nephrogram
![Page 69: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/69.jpg)
10 min: Pelvocalyeal system and ureter
5
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Scout film
3 mins
5 mins
10 mins
Findings of UPJ obstruction
![Page 71: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/71.jpg)
Scout 5 min
10 min
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Hydronephrosis
![Page 73: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/73.jpg)
Double collecting system
![Page 74: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/74.jpg)
10 mins 30 mins
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scout 10 mins post void
Right UVJ stone causing obstruction
![Page 76: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/76.jpg)
Bilateral
hydronephrosis &
hydroureters
1. Bladder cause2. Urethra cause
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Filling Defects
![Page 78: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/78.jpg)
30 min: Full bladder
1. Size
2. Shape
3. Position
4. Architecture5. Density
![Page 79: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/79.jpg)
Irregular bladder outline
Multiple bladder
diverticulum
Bladder
trabeculation
![Page 80: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/80.jpg)
Bladder filling defects
![Page 81: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/81.jpg)
Post voiding film
1. Residual urine
2. Small tumor3. Small stone
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IVP: Indication
1. Renal and ureteric calculi
2. Colicky abdominal pain
3. Persistent or frank hematuria
4. Complicated urinary tract infection
5. Urothelial tumors
6. Abnormal US or renogram
![Page 83: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/83.jpg)
IVP
1. Unable to identify renal parenchymal
abnormality2. Need IV contrast renal failure
1. Can evaluate renal function
2. Can demonstrate urothelium
3. Can visualize the ureter
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Retrograde Pyelography(RP)
![Page 85: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/85.jpg)
Retrograde Pyelography (RP)
![Page 86: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/86.jpg)
RP: Indication
1. Poor kidney excretion
2. Evaluate pelvocalyceal system if uncertainty
from IVP
3. Unexplained hematuria
![Page 87: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/87.jpg)
RP: Contraindication
1. Urinary tract infection
![Page 88: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/88.jpg)
RP: Complication
1. Infection
2. Trauma to urethra
![Page 89: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/89.jpg)
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Cystography
![Page 91: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/91.jpg)
Retrograde Cystography
![Page 92: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/92.jpg)
Cystography: Indication
1. Evaluate size and contour of urinary bladder
2. Bladder carcinoma
3. Trauma: rupture bladder
4. Low-pressure vesicoureteral reflux
5. Vesical fistula
![Page 93: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/93.jpg)
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Voiding Cystourethrography(VCUG)
![Page 95: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/95.jpg)
Voiding Cystourethrography(VCUG)
![Page 96: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/96.jpg)
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VCUG: Indication
1. Urinary tract infection in children:
- Urethral abnormality: posterior urethral valve
- Vesicoureteral reflux (VUR)
2. Cause of urinary incontinence
![Page 98: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/98.jpg)
1. Descending (antegrade) urethrography
2. Ascending (retrograde) urethrography
Urethrography
![Page 99: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/99.jpg)
Descending Urethrography
Urethrography was performed during voiding
![Page 100: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/100.jpg)
Ascending/Retrograde Urethrography
![Page 101: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/101.jpg)
Urethral stricture at bulbous portion
![Page 102: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/102.jpg)
Urethrograpy: Indication
1. Urethral trauma
2. Urethral stricture or anomaly
![Page 103: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/103.jpg)
Ultrasonography(US)
![Page 104: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/104.jpg)
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Longitudinal
scan of right kidney
1. Liver
2. Right kidney
3. Right
diaphragm
4. Hepatorenalpouch
![Page 106: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/106.jpg)
Normal kidney
Normal renal
parenchyma,
slightly
hypoechoic
Liver parenchyma
Hepatorenal pouch, no free fluid
Normal renal fat =
hyperechoic
No dilatation of
collecting system
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Normal renal pyramids: medullatriangular-shaped, hypoechoic structures
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Renal parenchymal disease
Increased renal echogenicity
Normal kidney
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Obstruction hydronephrosis
Compressed
renal fat,
hyperechoic
Renal
parenchyma,
hypoechoic
Dilated collecting
system, anechoic
(fluid)
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Renal mass: solid / cystic
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Bladder, uterus, prostate gland
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US: Indication
1. Renal mass
2. Creatinine rising Renal disease or obstruction
3. Infection of kidney Renal abscess, perinephric abscess
4. Renal transplant patients
5. Urinary bladder lesion
6. Renal biopsy
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US-KUB
1. Cannot evaluate renal function
2. Limit evaluation of ureter
3. Operator dependent
1. No radiation
2. Can be used in pts with renal failure
3. No need to NPO
4. Image guided biopsy
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Computed Tomography(CT KUB)
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CT Renal Protocol
I. Precontrast phase
II. Corticomedullary phase (30-60 sec)
III. Nephrographic phase (60-100 sec)
IV. Excretory or delayed phase (180-300 sec)
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Non contrast
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Corticomedullary phase
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Nephrographic phase
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Excretory phase
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Ureter
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Ureter
![Page 123: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/123.jpg)
Ureter
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Ureter
![Page 125: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/125.jpg)
Ureter
![Page 126: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/126.jpg)
Ureter
![Page 127: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/127.jpg)
Bladder
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CT: Indication
1. Renal mass: diagnosis, staging
2. Tumor of urinary system
3. Renal trauma
4. Infection
5. Renal artery stenosis
6. Renal stone protocol
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CT KUB
1. Radiation
2. Contrast administration
1. Can evaluate renal function and anatomy
2. Good detail study
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Magnetic Resonance Imaging(MRI)
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Magnetic Resonance Imaging (MRI)
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MRI
1. Long scan time
2. Metallic / motion artifact
3. Not sensitive for stone or calcification
4. Expensive
1. No radiation
2. Risk of Gadolinium allergy < iodinated CM
3. Good for evaluating renal artery stenosis
![Page 133: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/133.jpg)
Renal Angiography
![Page 134: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/134.jpg)
Renal Angiography
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Renogram
![Page 136: The Urinary Tract - Srinakharinwirot Universitymed.swu.ac.th/radiology/images/stories/Education/lecture kub part 1.pdf · psoas muscle ขนาด(size) ยาวประมาณ10-16](https://reader033.vdocuments.net/reader033/viewer/2022041518/5e2c6a3bd4b935471d3c52ac/html5/thumbnails/136.jpg)
Renogram
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Summary
Normal radiographic anatomy
Kidney, Ureter, Bladder, urethra
Investigation of the KUB system
Indication
Contraindication
Complication
Interpretation
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Thank You