Urinary Tract Urinary Tract

Dr. Nasr A. Mohammed Dr. Nasr A. Mohammed

FIBMSFIBMS

Imaging techniques Imaging techniques Basic examinationsBasic examinations

-Ultrasound.-Ultrasound.

-Intravenous Urography IVU.-Intravenous Urography IVU.

-Computed Tomography CT.-Computed Tomography CT.

-Radionuclide examination.-Radionuclide examination.

Other investigationsOther investigations

investigations limited to selected patients investigations limited to selected patients Magnetic Resonance Imaging MRI.Magnetic Resonance Imaging MRI. Arteriography.Arteriography. Direct puncture of collecting systemDirect puncture of collecting system Catheterization.Catheterization.

-Anatomical-Anatomical USUS CTCT MRIMRI

-Functional-FunctionalRadionuclide Radionuclide

-both-both IVU IVU

Type of information they provideType of information they provide

ULTRASOUNDULTRASOUND Is the first line investigationIs the first line investigation

Non invasive , no radiation, no contarst…..Non invasive , no radiation, no contarst…..

The main uses of ultrasound : The main uses of ultrasound :

renal symptomsrenal symptoms

renal sizerenal size

hydronephrosishydronephrosis

renal masses renal masses

bladder and prostate bladder and prostate

Normal renal Ultrasound Normal renal Ultrasound

Outline …….smooth Outline …….smooth Renal paranchymaRenal paranchymaRenal sinus ..cental partRenal sinus ..cental partRenal pyramidsRenal pyramidsSize …… difference <1.5 cm Size …… difference <1.5 cm

Small kindeysSmall kindeys Unilateral but may be bilateral :Unilateral but may be bilateral :

chronic infection ( including TB) chronic infection ( including TB)

obstructive atrophyobstructive atrophy

RAS RAS

HypoplasticHypoplastic Always bilateral :Always bilateral :

Chronic glomerulonephritisChronic glomerulonephritis

Hypertensive nephropathyHypertensive nephropathy

DM, DM,

collagen vascular diseasecollagen vascular disease

Enlarged kidneysEnlarged kidneys Always unilateral …….compensatory hypertophyAlways unilateral …….compensatory hypertophy May be unilateral or bilateral :May be unilateral or bilateral :

bifid collecting systembifid collecting system

renal mass renal mass

hydronephrosishydronephrosis

lymphoma ( masses or just enlargement)lymphoma ( masses or just enlargement)

renal vein thrombosesrenal vein thromboses Always bilateral :Always bilateral :

PCK (polycystic disease) PCK (polycystic disease)

AGN (acute glomerulonephritis)AGN (acute glomerulonephritis)

amyloidosisamyloidosis

Ureters ……..usually not visualizedUreters ……..usually not visualized

Urinary bladder Urinary bladder

examined in distended state ….thin walls examined in distended state ….thin walls

following micturition….. For residual vol. following micturition….. For residual vol.

UrographyUrography

Use of IV iodinated contrastUse of IV iodinated contrast

IVUIVU CT UrographyCT UrographyDetails of PCS Renal calculi detection (all types)Details of PCS Renal calculi detection (all types)

Ureteric injury HematuriaUreteric injury Hematuria

Acute ureteric colic Renal massAcute ureteric colic Renal mass

Staging and follow up of CAStaging and follow up of CA

Renal vascular anatomyRenal vascular anatomy

renal trauma renal trauma

Intravenous urogramIntravenous urogram Plain film ; Plain film ;

identify calcification: identify calcification:

-stone-stone

-diffuse or focal nephroclacinosis -diffuse or focal nephroclacinosis After contrast injection :After contrast injection :

--KidneysKidneys

position ( mormally left higher than Right) position ( mormally left higher than Right)

outline : outline :

indentation : fetal lobulation , scarindentation : fetal lobulation , scar

bulge : mass or cyst bulge : mass or cyst

renal length …… 10-16 cm renal length …… 10-16 cm

- - CalicesCalices : :

distribution (distributed and symmetrical ) distribution (distributed and symmetrical )

shape :shape :

normal …. Cupped normal …. Cupped

dilatation…….clubbed ( from obstructiondilatation…….clubbed ( from obstruction

or destruction ) or destruction )

Renal plevis and uretersRenal plevis and ureters : :

shape : funnel shaped shape : funnel shaped

dilatation :dilatation :

-obstruction -obstruction

filling defect : calculi, blood clot , tumor …. filling defect : calculi, blood clot , tumor ….

stricture : PUJ, tumor , infectionstricture : PUJ, tumor , infection

compression : compression :

LN LN

pelvic masspelvic mass

- reflux- reflux

- normal variant - normal variant

Bladder Bladder

Outline : central and smooth Outline : central and smooth Indentation Indentation

( smooth indentation by prostate or uterus ) ( smooth indentation by prostate or uterus ) after voiding should be empty . after voiding should be empty .

CT urography CT urography

CT KUB : before contrast CT KUB : before contrast

for detection of calcification for detection of calcification

Contrast :Contrast :

early …. Cortical phaseearly …. Cortical phase

then …..nephrogram then …..nephrogram

delay… urographic phasedelay… urographic phase

MRI MRI

Indication : Indication :

for selected patient as :- for selected patient as :-

renal artery stenosisrenal artery stenosis

tumor extension to IVC tumor extension to IVC

Disadvantage : Disadvantage :

calcification is not visible on MRIcalcification is not visible on MRI

Radionuclide examination Radionuclide examination

Renogram ( DTPA ) Renogram ( DTPA )

Renal morphology (DMSA scan) Renal morphology (DMSA scan)

Voiding cystography Voiding cystography

Special techniques Special techniques

Retrograde and antegrade pyelographyRetrograde and antegrade pyelography

Micturating cystogram Micturating cystogram

UrethrographyUrethrography

Renal arteriographyRenal arteriography

Questions?Questions?