urinary system: imaging diagnosis 唐光健 questions to think of which diagnostic imaging modality...
TRANSCRIPT
Urinary system:imaging
diagnosis
Urinary system:imaging
diagnosis
唐光健唐光健
Questions to think of Questions to think of
Which diagnostic imaging modality is the most
suitable for the urinary system and why?
What urinary diseases are suitable for imaging
examination?
What imaging method should be chosen with
different sort of disease considered clinically?
What information we expect to get from the
imaging?
Which diagnostic imaging modality is the most
suitable for the urinary system and why?
What urinary diseases are suitable for imaging
examination?
What imaging method should be chosen with
different sort of disease considered clinically?
What information we expect to get from the
imaging?
Urinary SystemUrinary SystemCharacteristics:
poor natural contrast Luminal Structure
calyces, pelvic, ureter, bladder
-UROGRAPHY
Parenchyma
Kidney-cortex, medulla
-TOMOGRAPHIC IMAGING
Characteristics:
poor natural contrast Luminal Structure
calyces, pelvic, ureter, bladder
-UROGRAPHY
Parenchyma
Kidney-cortex, medulla
-TOMOGRAPHIC IMAGING
Imaging modalities:Imaging modalities: plane film （ KUB ） -limited effective Urography
Intravenous pyelography IVPRetrograde pyelographyCystographyUrethrography -show morphous of the lumen indirectly
-overall view of the urinary tract -affected by the renal function & lumen constructi
on Ultrasonography USG
-real time, convenient, low cost, available -good characteristic of stone, fluid
CT Computed Tomography -high resolution of high density & low density
-contrast enhancement MRI Magnetic Resonant Imaging
-good contrast of soft tissues
plane film （ KUB ） -limited effective Urography
Intravenous pyelography IVPRetrograde pyelographyCystographyUrethrography -show morphous of the lumen indirectly
-overall view of the urinary tract -affected by the renal function & lumen constructi
on Ultrasonography USG
-real time, convenient, low cost, available -good characteristic of stone, fluid
CT Computed Tomography -high resolution of high density & low density
-contrast enhancement MRI Magnetic Resonant Imaging
-good contrast of soft tissues
Normal ManifestationsNormal ManifestationsKUB: contour of kidney
-edge, density, size, position…
KUB: contour of kidney-edge, density, size, position…
IVP –compress the ureter, picture 15’-30’ after contrast administration
IVP –compress the ureter, picture 15’-30’ after contrast administration
minor calyxminor calyx
renalpapillarenalpapilla
formixformix
ureterureter
renal pelvic renal pelvic
fundamentfundament
major calyx-neckmajor calyx-neck
VtxVtx
bodybody
Normal ManifestationsNormal Manifestations
bladderbladder
IVP –compress the ureter, picture 15’-30’ after contrast administration
IVP –compress the ureter, picture 15’-30’ after contrast administration
minor calyxminor calyx
renalpapillarenalpapilla
formixformix
ureterureter
renal pelvic renal pelvic
fundamentfundament
major calyx-neckmajor calyx-neck
VtxVtx
bodybody
Normal ManifestationsNormal Manifestations
IVP-normal variant IVP-normal variant
branchingbranching
ampullaryampullary
Normal ManifestationsNormal Manifestations
retrograde pyelogramback flow-collecting duct BF, renal sinus BF,
perivein BF, lymph duct BF
retrograde pyelogramback flow-collecting duct BF, renal sinus BF,
perivein BF, lymph duct BF
Normal ManifestationsNormal Manifestations
B-mode sonography-renal sinus, renal parenchyma, renal profile…
B-mode sonography-renal sinus, renal parenchyma, renal profile…
Normal ManifestationsNormal Manifestations
CT– without/with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement…
CT– without/with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement…
plane scanplane scan
cortical phasecortical phase
Parenchymal phaseParenchymal phase
Normal ManifestationsNormal Manifestations
CT– without/with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement…
CT– without/with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement…
cortical phasecortical phase
Parenchymal phaseParenchymal phase
Normal ManifestationsNormal Manifestations
excretive phaseexcretive phase
Angiography– ~no routine method, with interventional therapy ~arterial ph. parenchymal ph. Veinal ph.
Angiography– ~no routine method, with interventional therapy ~arterial ph. parenchymal ph. Veinal ph.
Normal ManifestationsNormal Manifestations
T1WIT1WI
T2WIT2WI
Normal ManifestationsNormal ManifestationsMRI- T1WI higher SI with cortex
T2WI homogeneous high SI (signal intensity)
MRI- T1WI higher SI with cortex
T2WI homogeneous high SI (signal intensity)
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carcinoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carcinoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
Renal solid malignantRenal solid malignant
renal carcinoma - neoplasm, vascularity, necrosis
renal carcinoma - neoplasm, vascularity, necrosis
Renal solid malignantRenal solid malignant
pathologic features correlate to imaging neoplasm-mass effect neoplastic vascularity necrosis & bleeding in side the mass
pathologic features correlate to imaging neoplasm-mass effect neoplastic vascularity necrosis & bleeding in side the mass
renal carcinoma - neoplasm, vascularity, common with necrosis
plain film: profile change-helpless with diag. urography: elongated & deformed pelvic- poor spec
ification BUS: substantial, hypo/inhomogeneous echoic angiography: vessel shift, tumor flashing, neo-vesse
l. Staging CT high specific & sensitive. Staging MRI Seldom used
renal carcinoma - neoplasm, vascularity, common with necrosis
plain film: profile change-helpless with diag. urography: elongated & deformed pelvic- poor spec
ification BUS: substantial, hypo/inhomogeneous echoic angiography: vessel shift, tumor flashing, neo-vesse
l. Staging CT high specific & sensitive. Staging MRI Seldom used
Renal solid malignantRenal solid malignant
renal carcinoma
plain film: profile change-helpless with diag.
renal carcinoma
plain film: profile change-helpless with diag.
Renal solid malignantRenal solid malignant
renal carcinoma urography: elo
ngated & deformated pelvic-poor specification
renal carcinoma urography: elo
ngated & deformated pelvic-poor specification
Renal solid malignantRenal solid malignant
renal carcinoma
BUS: substantial, hypo/inhomog eneous echoic
renal carcinoma
BUS: substantial, hypo/inhomog eneous echoic
Renal solid malignantRenal solid malignant
renal carcinomaCT high specific & sensitive. Staging
renal carcinomaCT high specific & sensitive. Staging
plain scanplain scan
With enhancemnetWith enhancemnet
delay scandelay scan
Renal solid malignantRenal solid malignant
plain scanplain scan with
enhancement
with enhancement
delay scandelay scan
Renal solid malignantRenal solid malignant renal carcinoma
CT high specific & sensitive. Staging
renal carcinomaCT high specific & sensitive. Staging
arterial phasearterial phase
parenchymal phaseparenchymal phase post ia adrenalin post ia adrenalin
Renal solid malignantRenal solid malignant renal carcinoma
angiography: vessel shift, tumor flashing, neo-vessel. Staging
renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging
renal vein, IVC invaded by RCCrenal vein, IVC invaded by RCC
Renal solid malignantRenal solid malignant renal carcinoma
CT high specific & sensitive. Staging
renal carcinomaCT high specific & sensitive. Staging
renal vein, IVC invaded by RCCrenal vein, IVC invaded by RCC
Renal solid malignantRenal solid malignant renal carcinoma
CT high specific & sensitive. Staging
renal carcinomaCT high specific & sensitive. Staging
Arterial phaseArterial phase Parenchymal phaseParenchymal phase
Renal solid malignantRenal solid malignant renal carcinoma
angiography: vessel shift, tumor flashing, neo-vessel. Staging
renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging
IVC angiographyIVC angiography post embolizing of RApost embolizing of RA
Renal s solid malignantRenal s solid malignant renal carcinoma
angiography: vessel shift, tumor flashing, neo-vessel. Staging
renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging
renal carcinoma
MRI seldom use
renal carcinoma
MRI seldom use
Renal solid malignantRenal solid malignant
Renal hamartoma (angiomyolipoma) - ratio of tree elements various, bleeding often
Renal hamartoma (angiomyolipoma) - ratio of tree elements various, bleeding often
Renal solid benignRenal solid benign
Renal solid malignantRenal solid malignant
Angiomyolipomapathologic features correlate to imagi
ng neoplasm-mass effect adipose tissue, smooth muscle, vessels hypo-developed neoplastic
vessels-bleeding
Angiomyolipomapathologic features correlate to imagi
ng neoplasm-mass effect adipose tissue, smooth muscle, vessels hypo-developed neoplastic
vessels-bleeding
renal angiomyolipoma plain film: profile change-helpless with diag. urography: elongated & deformed pelvic-poor specifi
cation
sonography: hyperechoic substantial mass mostly CT: high specific with fat density, high sensitive, bleedi
ng might be seen MRI inhomogeneous signal, signal of fat & old bleedi
ng
renal angiomyolipoma plain film: profile change-helpless with diag. urography: elongated & deformed pelvic-poor specifi
cation
sonography: hyperechoic substantial mass mostly CT: high specific with fat density, high sensitive, bleedi
ng might be seen MRI inhomogeneous signal, signal of fat & old bleedi
ng
Renal solid benignRenal solid benign
renal angiomyo
lipoma
sonography:
hyperechoi
c substantia
l mass most
ly
renal angiomyo
lipoma
sonography:
hyperechoi
c substantia
l mass most
ly
Renal solid benignRenal solid benign
renal angiomyolipoma CT high specific with fat density, high sensitive,
bleeding might be seen
renal angiomyolipoma CT high specific with fat density, high sensitive,
bleeding might be seenCT plain scanCT plain scan
Renal solid benignRenal solid benign
with enhancement
with enhancement
renal angiomyolipoma CT high specific with fat density, high sensitive,
bleeding might be seen
renal angiomyolipoma CT high specific with fat density, high sensitive,
bleeding might be seen
CT plain scanCT plain scan
Renal solid benignRenal solid benign
with enhancement
with enhancement
renal angiomyolipoma CT high specific with fat density, high sensitive,
bleeding might be seen
renal angiomyolipoma CT high specific with fat density, high sensitive,
bleeding might be seen
Coronal MPR Coronal MPR
Renal solid benignRenal solid benign
with enhancement
with enhancement
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
cyst pathologic features correlate to imaging with thin, even wall, flat epithelium clear fluid inside & no
blood flow
cyst pathologic features correlate to imaging with thin, even wall, flat epithelium clear fluid inside & no
blood flow
cystic, inside kidney-renal cyst cystic, inside kidney-renal cyst
plain film: profile changing urography: pelvix & calix deforming, no specific BUS ： anechoic lesion, high specific CT ： clear appearance, high sen. & spe. for calcification of the wall or septation MRI ： cystic, signal of fluids,
different diagnosis needed if signal be non-specific
plain film: profile changing urography: pelvix & calix deforming, no specific BUS ： anechoic lesion, high specific CT ： clear appearance, high sen. & spe. for calcification of the wall or septation MRI ： cystic, signal of fluids,
different diagnosis needed if signal be non-specific
cystic, inside kidney-renal cyst cystic, inside kidney-renal cyst
Urography Urography
deforming of pelvic & calculi, low specific deforming of pelvic & calculi, low specific
cystic, inside kidney-renal cyst cystic, inside kidney-renal cyst
BUS, high specific BUS, high specific
anechoic lesion, echo enhancement post.
anechoic lesion, echo enhancement post.
cystic, inside kidney-renal cyst C cystic, inside kidney-renal cyst C
CT ： clear appearance, high sen. & spe. for calcification of the wall or septation
CT ： clear appearance, high sen. & spe. for calcification of the wall or septation
Waterlike, no enhancement, “no wall”Waterlike, no enhancement, “no wall”
cystic, inside kidney-renal cyst C cystic, inside kidney-renal cyst C
cystic, inside kidney-renal cyst C cystic, inside kidney-renal cyst C CT ： clear appearance, high sen. & spe. fo
r calcification of the wall or septation CT ： clear appearance, high sen. & spe. fo
r calcification of the wall or septation
Plain scanPlain scan
Enhancement scanEnhancement scan
cystic, inside kidney-renal cyst C cystic, inside kidney-renal cyst C CT ： clear appearance, high sen. & spe. for calc
ification, differentiation with high density cyst CT ： clear appearance, high sen. & spe. for calc
ification, differentiation with high density cyst
MRI, atypical signal-
differentiate
MRI, atypical signal-
differentiate
cystic, sig. of fluidcystic, sig. of fluid
cystic, inside kidney-renal cyst C cystic, inside kidney-renal cyst C
cystic, inside kidney-renal cyst cystic, inside kidney-renal cyst
Multicystic kidneyMulticystic kidney
plain film: enlargement & shift of renal shadow
urography: elongation/deformation of the pelvic
BUS: renal enlargement of both sides with multi-cyst ~ diagnosed
CT: manifest clear, with multi-cystic liver often
plain film: enlargement & shift of renal shadow
urography: elongation/deformation of the pelvic
BUS: renal enlargement of both sides with multi-cyst ~ diagnosed
CT: manifest clear, with multi-cystic liver often
cystic, inside kidney-multycystic kidney cystic, inside kidney-multycystic kidney
plain film: enlargement & shift of renal shadow
urography: elongation/deformation of the pelvic
BUS: renal enlargement of both sides with multi-cyst ~ diagnosed
CT: manifest clear, with multi-cystic liver often
plain film: enlargement & shift of renal shadow
urography: elongation/deformation of the pelvic
BUS: renal enlargement of both sides with multi-cyst ~ diagnosed
CT: manifest clear, with multi-cystic liver often
cystic, inside kidney-multycystic kidney cystic, inside kidney-multycystic kidney
urography: elongation/deformation of the pelvic
urography: elongation/deformation of the pelvic
cystic, inside kidney-multycystic kidney cystic, inside kidney-multycystic kidney
BUS: renal
enlargement of
both sides
with multi-
cyst ~
diagnosed
BUS: renal
enlargement of
both sides
with multi-
cyst ~
diagnosed
cystic, inside kidney-multycystic kidney cystic, inside kidney-multycystic kidney
CT: manifest clear, with multi-cystic liver often CT: manifest clear, with multi-cystic liver often
cystic, inside kidney-multycystic kidney cystic, inside kidney-multycystic kidney
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
KUB: useless BUS: crescent anechoic area outside kidney
adjacent kidney deformechoic if clot in hematoma
KUB: useless BUS: crescent anechoic area outside kidney
adjacent kidney deformechoic if clot in hematoma
cystic, outside-sub capsule hematoma cystic, outside-sub capsule hematoma
Imaging character: out of kidney, no blood
perfusion, fluid inside, partial solid if clot
inside
Imaging character: out of kidney, no blood
perfusion, fluid inside, partial solid if clot
inside
CT: crescent, low density, high density if clot within hematoma, no enhancement, kidney deform
CT: crescent, low density, high density if clot within hematoma, no enhancement, kidney deform
cystic, outside-sub capsule hematoma cystic, outside-sub capsule hematoma
Angiography: renal vessel compressed & shifted
find source of bleeding
Angiography: renal vessel compressed & shifted
find source of bleeding
cystic, outside-sub capsule hematoma cystic, outside-sub capsule hematoma
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
carcinoma of renal pelvis carcinoma of renal pelvis
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of renal pelvis - neoplasm, often small, seldom necrosis
plain film: helpless urography: filling defect, high sensitive sonography: hypoechoic substantial mass in pelvic/
ureter CT: slight/medial enhancement, filling defect in hyd
ronephrostic pelvic/ureter in excrete phase Staging MRI equivalent SI in T1 & T2WI
carcinoma of renal pelvis - neoplasm, often small, seldom necrosis
plain film: helpless urography: filling defect, high sensitive sonography: hypoechoic substantial mass in pelvic/
ureter CT: slight/medial enhancement, filling defect in hyd
ronephrostic pelvic/ureter in excrete phase Staging MRI equivalent SI in T1 & T2WI
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of renal pelvis - neoplasm, often small, seldom necrosis
plain film: helpless urography: filling defect, high sensitive sonography: hypoechoic substantial mass in pelvic/
ureter CT: slight/medial enhancement, filling defect in hyd
ronephrostic pelvic/ureter in excrete phase Staging MRI equivalent SI in T1 & T2WI
carcinoma of renal pelvis - neoplasm, often small, seldom necrosis
plain film: helpless urography: filling defect, high sensitive sonography: hypoechoic substantial mass in pelvic/
ureter CT: slight/medial enhancement, filling defect in hyd
ronephrostic pelvic/ureter in excrete phase Staging MRI equivalent SI in T1 & T2WI
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of renal pelvis
urography: filling defect, high sensitive
carcinoma of renal pelvis
urography: filling defect, high sensitive
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of renal pelvis CT: slight/medial enhancement, filling defect in hy
dronephrostic pelvic/ureter in excrete phase Staging
carcinoma of renal pelvis CT: slight/medial enhancement, filling defect in hy
dronephrostic pelvic/ureter in excrete phase Staging
plain scanplain scan
with enhancement
with enhancement
delay scandelay scan
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of renal pelvis CT: slight/medial enhancement, filling defect in hy
dronephrostic pelvic/ureter in excrete phase Staging
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of renal pelvis MRI equivalent SI in T1 & T2WI
carcinoma of renal pelvis MRI equivalent SI in T1 & T2WI
T1WIT1WIT2WIT2WI
STAGESTAGE
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of renal pelvis
urography: filling defect, high sensitive
carcinoma of renal pelvis
urography: filling defect, high sensitive
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of ureter CT: slight/medial enhancement, filling defect in hy
dronephrostic pelvic/ureter in excrete phase Staging
carcinoma of ureter CT: slight/medial enhancement, filling defect in hy
dronephrostic pelvic/ureter in excrete phase Staging
plain scanplain scan
with enhancement
with enhancement
delay scandelay scan
pathologies of Urinary tract wallpathologies of Urinary tract wall
carcinoma of ureter MRI equivalent SI in T1 & T2WI, hydrography
carcinoma of ureter MRI equivalent SI in T1 & T2WI, hydrography
pathologies of Urinary tract wallpathologies of Urinary tract wall
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carinoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carinoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
90% X-ray positive, diagnose considering clinical data
KUB: renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
CT: high sensitive, exact positioning
USG: high specific but low sensitive with ureter calculi
90% X-ray positive, diagnose considering clinical data
KUB: renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
CT: high sensitive, exact positioning
USG: high specific but low sensitive with ureter calculi
KUB: renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
KUB: renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
Sonography:
renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
Sonography:
renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
CT: high sensitive, exact positioningCT: high sensitive, exact positioning
plane scanplane scan
Enhancement scanEnhancement scan
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
slab MIPslab MIP
KUB: Urography:
renal calculi-pelvic/calix ureter calculi-?
KUB: Urography:
renal calculi-pelvic/calix ureter calculi-?
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
CT: high sensitive, exact positioningCT: high sensitive, exact positioning
plane scanplane scan
Enhancement scanEnhancement scan
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
MIPMIP
MRI: no routine, low SI both T1WI & T2WI MRI: no routine, low SI both T1WI & T2WI
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
CT: high sensitive, exact positioningCT: high sensitive, exact positioning
USG:
high specific but low sensitive with ureter calculi
USG:
high specific but low sensitive with ureter calculi
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
CT: high sensitive, exact positioningCT: high sensitive, exact positioning
plane scanplane scan
Enhancement scanEnhancement scan
Soft tissue around cal., hydr
onephrosis proximatelySoft tissue around cal., hydr
onephrosis proximately
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
Soft tissue around cal., hydr
onephrosis proximatelySoft tissue around cal., hydr
onephrosis proximately
pathologies of Urinary tract lumen-lithiasis
pathologies of Urinary tract lumen-lithiasis
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carinoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carinoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
Renal pathologiesRenal pathologies
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
pathologies of ParenchymalSolid -benign: angiomyolipoma
-malignant: carninoma Cystic inside kidney: renal cyst
outside kidney: sub capsule hematoma pathologies of Urinary tract
of the wall –transitional cell carcinomaof the lumen –calculus
Inflammatory change-tuberculosis Hydronephrosis –differentiate diagnosis
nephropyelitis renal papilla ulcer necrosis, cavitation pyonephrosiscalcification, renal self-resectionimaging
KUB: ( － ) /calcification Urography: edge irregular (insect bite), cavitation,
pelvic/ureter deform CT: sensitive with cal. but pelvic/ureter deform MRI insensitive
diag. – consider clinical data
nephropyelitis renal papilla ulcer necrosis, cavitation pyonephrosiscalcification, renal self-resectionimaging
KUB: ( － ) /calcification Urography: edge irregular (insect bite), cavitation,
pelvic/ureter deform CT: sensitive with cal. but pelvic/ureter deform MRI insensitive
diag. – consider clinical data
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
imaging KUB （－） / calcification
imaging KUB （－） / calcification
Self-resectionSelf-resection
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
imaging Urography: edge irregular (insect bite), cavitation, pelvic/ur
eter deform
ulcer of renal papillae
imaging Urography: edge irregular (insect bite), cavitation, pelvic/ur
eter deform
ulcer of renal papillae
cavitationcavitation
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
imaging CT sensitive with cal. but with pelvic/ureter deform
imaging CT sensitive with cal. but with pelvic/ureter deform
plain CTscanplain CTscan
enhancementenhancement
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
plain CTscanplain CTscan
enhancementenhancement
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
delayeddelayed
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
plain CTscanplain CTscan
enhancementenhancement
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
imaging CT sensitive with cal. also with pelvic/ureter deform
-MSCT
Inflammatory change-renal tuberculosisInflammatory change-renal tuberculosis
Hydronephrosis-summary Hydronephrosis-summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/ureter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/ureter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
Ureteral carcinoma Ureteral carcinoma
HydronephrosisHydronephrosis
urography (retrograde )urography (retrograde )
urography: (IVP, retro, percutaneous ) some causes can be diagnosed
urography: (IVP, retro, percutaneous ) some causes can be diagnosed
HydronephrosisHydronephrosis
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
sonography: high s
ensitivity and cause-diagnositic
sonography: high s
ensitivity and cause-diagnositic
Hydronephrosis-summaryHydronephrosis-summary
sonography: high s
ensitivity and cause-diagnositic
sonography: high s
ensitivity and cause-diagnositic
Hydronephrosis-summaryHydronephrosis-summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly replaced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly replaced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
CT: cause-diagnostic, sensitivity relatively high CT: cause-diagnostic, sensitivity relatively high
plain scanplain scan
enhancedenhanced
delay scandelay scan
Hydronephrosis-summaryHydronephrosis-summary
ureteral carcinoma ureteral carcinoma
CT: cause-diagnostic, sensitivity relatively high CT: cause-diagnostic, sensitivity relatively high
Hydronephrosis-summaryHydronephrosis-summary
retroperitoneal fibrosisretroperitoneal fibrosis
CT: cause-diagnostic, sensitivity relatively high CT: cause-diagnostic, sensitivity relatively high
Hydronephrosis-summaryHydronephrosis-summary
retroperitoneal fibrosisretroperitoneal fibrosis
CT: cause-diagnostic, sensitivity relatively high CT: cause-diagnostic, sensitivity relatively high
Hydronephrosis-summaryHydronephrosis-summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Obstruction of the urinary tract- malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis… imaging-various dilatation of pelvis/uriter
plain film: renal shadow enlarged, no cause be diagnosis except calculi of urinary tract
urography: some causes can be diagnosed sonography: high sensitivity and cause-diagnositic CT: cause-diagnostic, sensitivity relatively high MRI: seldom used, urography partly rapalced by uro-
hydrography
Hydronephrosis - summary Hydronephrosis - summary
retroperitoneal fibrosisretroperitoneal fibrosis
MRI: seldom used, urography partly rapalced by uro-hydrography
MRI: seldom used, urography partly rapalced by uro-hydrography
Hydronephrosis-summaryHydronephrosis-summary
Prostate:imaging
diagnosis
Prostate:imaging
diagnosis
Prostate-imaging anatomyProstate-imaging anatomy
Characteristics:soft-tissue, poor natural X-ray contrast
central zone-rich in muscle fiber periphery zone-rich in loose CT & glands
Characteristics:soft-tissue, poor natural X-ray contrast
central zone-rich in muscle fiber periphery zone-rich in loose CT & glands
Prostate-imaging anatomyProstate-imaging anatomy
MRI-USG-CT ， not shown with plain filmMRI-USG-CT ， not shown with plain film
Prostate-imaging anatomyProstate-imaging anatomy
MRI-USG-CT ， not shown with plain filmMRI-USG-CT ， not shown with plain film
T1WI T2WI
Prostate-imaging anatomyProstate-imaging anatomy
MRI-USG-CT ， not shown with plain filmMRI-USG-CT ， not shown with plain film
Prostate-imaging anatomyProstate-imaging anatomy
MRI-USG-CT ， not shown with plain filmMRI-USG-CT ， not shown with plain film
prostate prostate
BHP benign hypertrophy of prostate
sup. border 10mm over the pubis / diam
eter > 5cm
no abnormal signal/echo/density inside
BHP benign hypertrophy of prostate
sup. border 10mm over the pubis / diam
eter > 5cm
no abnormal signal/echo/density inside
prostate prostate
BHP BHP
plain CT scanplain CT scan
with enhancement
with enhancement
MPRMPR
BHP BHP
T1WIT1WI
T2WIT2WI
prostate prostate
prostate prostate
prostate carcinoma
low signal lesion in periphery
zone in T2WI
staging
prostate carcinoma
low signal lesion in periphery
zone in T2WI
staging
prostate carcinoma prostate carcinoma
stage Bstage B
stage Cstage C
prostate prostate
plain CT scanplain CT scan
with enhancement
with enhancement
prostate carcinoma prostate carcinoma
prostate prostate
MPRMPR
prostate carcinoma prostate carcinoma
prostate prostate
plain CT scanplain CT scan
with enhancement
with enhancement
Questions after lecture Questions after lecture
How to chose imaging exam for the patient with gross hematuria (how to determine the method and purpose of next exam according to the result of pre-exam)?
What is the pathologic underlying of the various manifestations of renal carcinoma with different imaging method?
What imaging method is the first chosen for the prostate exam?
How to chose imaging exam for the patient with gross hematuria (how to determine the method and purpose of next exam according to the result of pre-exam)?
What is the pathologic underlying of the various manifestations of renal carcinoma with different imaging method?
What imaging method is the first chosen for the prostate exam?