URINARY SYSTEM
RADIOGRAPHY
VIVEK
6B
Imaging Techniques
• Plane urinary Tract film. Kidney, Ureters and bladder(KUB).
• Intravenous urography. (IVU/EU).
• Ante grade and retrograde urethrography.
• Ultrasound.
• CT scan
• MRI
• Angiography
X-ray KUB(KIDNEY,URETERS, BLADDER)
• Indications.
• Stone diseases. Help in diagnosis and management
• Abdominal pain
• Gall bladder stones
• Position and size of kidneys and bladder
• Show the position of ureteric stent
• Preliminary examination to contrast study
• Preparation. We use laxative, the night before the test to
clear colon of solid fecal material.
• On good quality film psoas muscle should be visible
INTRAVENOUS UROGRAPHY (IVU)
• Shows anatomy and functions of the kidneys. After injection of iv
contrast, it concentrate in the kidneys. Excreted by kidneys and pass via
ureters in to the urinary bladder. we take a series of films to follow the
passage of contrast from kidneys to urinary bladder. Contrast Shows
renal parenchyma, collecting system and ureters.
• Evaluate urothelial abnormalities, haematuria, urolithiasis
• Contrast media
1. ionic (urograffin, angiograffin)
2. non-ionic(omnipaque, ultravist)
• Procedure
Patient is placed in supine position. The patient is asked to void the bladder before the procedure.
Contrast media is injected intravenously into a prominent vein in the arm. Test injection of 1ml of
contrast is given and patient observed for 5 min for any contrast reactions. Then the rest of the
contrast is rapidly injected within 30-60 seconds.
• The kidneys should be evaluated for:
- their position
- orientation
- size
- contour
- radiographic density.
Advantages
• • IVU is low cost
• • anesthesia is not needed
• • detailed anatomy of the collecting system
• • rapid overview of the entire urinary tract
• • demonstration of calcifications
Disadvantages
• • contrast material must be avoided in patients with a history of allergy, hay fever or asthma until steroid cover has been
given; those on metformin must stop this drug for 24 h before any contrast. These groups cannot safely undergo an
emergency IVU.
• • the differentiation from a phlebolith is difficult, especially when there is no ureteric dilatation proximally
• • contraindications renal insufficiency
• • contraindications hepatorenal syndrome, thyrotoxicosis, pregnancy
• • do not differentiate solid or cystic lesion
• • requires contrast medium and radiation
• • missing small stones
• Bladder Tumors
• Most malignant bladder tumors are transitional cell tumors. Transitional cell tumors may occur
simultaneously from uroepithelium anywhere from the bladder to the ureter to the kidney.
The primary tumor appears as focal thickening of the bladder wall and/or produces a filling defect in the
contrast-filled bladder
Dx: Cystoscopy(best)
There is a filling defect in the
left lateral wall of the contrast-
filled bladder (solid white
arrow) representing a bladder
tumor. The defect at the base of
the bladder (black arrow) is
caused by the prostate gland. Normal
The calyceal collecting systems
(dotted white arrows) are
normal.
Voiding/Micturating cystourethrogram
• Functional and anatomical evaluation of bladder and urethra specially posterior urethra.
• Commonly for kids with recurrent UTI
• Dx. reflux, urethral valve,uretrocele, urethral stricture and diverticula
Ultrasound
• Now a days first line investigation.
• Grey scale and Doppler
• Evaluate renal parenchyma, adrenals, bladder and prostate.
• Can differentiate between solid and cystic, hydronephrosis,shows all type of stone
• Evaluate congenital anomalies.
US
• + ve:
• Available
• No radiation
• Good anatomy
• -ve:
• Operator dependent
• Used for:
• Good for kidney stones
• Excellent for hydronephrosis
• Excellent for focal lesion e.g. cysts, masses
CT scan
• Gold standard test.
• With and with out contrast
• Standard CT technique for renal imaging.
• 5mm collimation is adequate to demonstrate kidneys.
• IV contrast differentiate pathological process from normal.
• Parenchyma,coricomedullary differentiation max at 30 seconds
• Nephrogenic phase is best seen at 70-100 seconds
• Non contrast helical CT shows any kind and small size of stone
• Hyper-densewhite (stone/bone)
• Hypo-dense grey to black (fat/fluid)
CT
• ►+ ve:
• Relatively available (more then MRI)
• Very good anatomy
• ►-ve:
• Radiation
• Some times need IV contrast (reaction)
• ►Used for:
• Excellent for kidney stones (the best)
• Excellent for hydronephrosis& masses
• Excellent for kidney trauma
MRI
• Hyper-intense (white)
• Hypo-intense (grey to black)
• MRI
• + ve:
• Excellent anatomy details
• No radiation
• -ve:
• Expensive
• Long scanning time (30 to 60 min)
• Not used to diagnosed kidney stone
• Used for:
• Excellent for masses
• Good for hydronephrosis
MRI imaging modalities mnemonic
ANGIOGRAPHY
Congenital anomalies
• Cross ectopic. Lower kidney is usually ectopic one. In 90% of
cases there is fusion of kidneys. There are increase chances of
calculus formation.
• Horse shoe kidney. Lower pole of both unite in the middle.
Prone to traume
• Pelvic kidney. Kidney is located in the pelvis. More prone to
trauma.
• Duplicate collecting system. Complete/part
THANK YOU
