Transcript calculus of urinary tract

DIAGNOSTIC IMAGING
OF URINARY TRACT
Radiology Department of Ruijin Medical College
Affiliated to Shanghai Jiaotong University Medical School
骨关节系统影像学
瑞金临床医学院
医学影像学教研室
INTRODUCTION
 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
Plain Film of the Abdomen (KUB)
 Including both sides of kidney, area of
ureter and bladder.
 To show contour, size, shape of the
above organs and psoas muscles
margin.
 To demonstrate stone and calcification
of urinary tract
KUB
METHODS OF EXAMINATION
Intravenous Urography (IVU)
 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)
METHODS OF EXAMINATION
Intravenous Urography (IVU)
 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
-C
+C
I.V.U.
I.V.U.
METHODS OF EXAMINATION
Retrograde Urography
 To be used when IVU has been unsatisfactory or
inconclusive.
 To show the morphology of urinary tract only.
Retrograde Urography
METHODS OF EXAMINATION
Renal Angiography
 abdominal aortography.
 Selective renal arteriography.
Renal Angiography
Renal Angiography
METHODS OF EXAMINATION
CT
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
CT
Plain Scans
METHODS OF EXAMINATION
CT
Contrast enhanced Scans
 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
CT
Contrast enhanced Scans
METHODS OF EXAMINATION
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
KUB
I.V.U.
R.U.
US
Angio
CT
NORMAL IMAGING OF URINARY TRACT
KUB & IVU
Kidney
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
NORMAL IMAGING OF URINARY TRACT
KUB & IVU
Ureter
long:
25~30cm
width:
3~5mm
physiological narrowings:
⑴ pelvi-ureteral junction
⑵ iliac vessels
⑶ entry of bladder
NORMAL IMAGING OF URINARY TRACT
KUB & IVU
Bladder
shape: round or oval
capacity: 200~350ml
I.V.U.
NORMAL IMAGING OF URINARY TRACT
CT
Plain Scans
Kidney
⑴ renal parenchyma: soft tissue density, 30~50Hu
⑵ pelvis: water density, 10~20Hu
⑶ renal sinus: fat density, -60~-100Hu
Ureter
soft tissue density
Bladder
water density when fully distended
NORMAL IMAGING OF URINARY TRACT
CT
Contrast Enhanced Scans
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
NORMAL IMAGING OF URINARY TRACT
CT
Contrast Enhanced Scans
Ureter and Bladder:
⑴ bladder wall enhanced on early scans
⑵ filling with the contrast medium on delayed scans
NORMAL IMAGING OF URINARY TRACT
MRI
Plain Scans
 The signal intensity of renal cortex on T1WI is
than that of renal medulla
higher
 The signal intensity of renal cortex and medulla on
T2WI are all higher
 The signal intensity of ureter and bladder are low on
T1WIand higher on T2WI
NORMAL IMAGING OF URINARY TRACT
MRI
Contrast Enhanced Scans
Renal parenchyma and bladder wall show
enhancement
CALCULUS OF URINARY TRACT
 Radiopaque(calcium) in 90% of patient
 Radiolucent(urate) in 10% of patient
CALCULUS OF URINARY TRACT
Renal Calculus
 round, horny, morula
 lie in the calyces or pelvis
 hydronephrosis
 CT: high density, 200~1000Hu
CALCULUS OF URINARY TRACT
Ureteral calculus
 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
CALCULUS OF URINARY TRACT
Calculus of Urinary bladder
 round, oval, laminited, concentric circles shaped
 CT: high density
 MRI: low signal on T1WI and T2WI
Calculus of Urinary bladder
TUBERCULOSIS OF URINARY TRACT
 Secondary infection
 Hematogenous dissemination
TUBERCULOSIS OF URINARY TRACT
Pathology
TB bacilli
renal cortex infection
medullary destruction
caseous necrosis
abscess (calcification)
pelvicalyceal destruction
ureter and bladder TB
TUBERCULOSIS
TUBERCULOSIS OF URINARY TRACT
Auto-resection of kidney
Diffused calcification of caseous foci,
or whole kidney + loss of renal function
Auto-resection of kidney
TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
KUB:
⑴ normal (early stage )
⑵ calcification
TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
IVU:
⑴ calyceal destruction
⑵ abscess and cavity formation
⑶ pyonephrosis
⑷ diffuse fibrotic contraction and calcification
⑸ auto-resection of kidney
Renal Tuberculosis
TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
Plain CT scans:
⑴ high density (calcification)
⑵ low density areas (abscess or cavity)
⑶ CT values: 20~40Hu(abscess)
TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
Contrast-enhanced CT scans:
⑴ low density areas without enhancement.
⑵ contrast media is demonstrable within the abscess.
⑶ pelvicalyceal enlargement
TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
MRI:
⑴ low signal on T1WI
⑵ high signal on T2WI
TUBERCULOSIS OF URINARY TRACT
Ureteral Tuberculosis
KUB:
calcification
IVU:
⑴ stricture
⑵ shorten
⑶ beading
TUBERCULOSIS OF URINARY BLADDER
IVU:
Small bladder
Contracted bladder
TUMORS OF URINARY TRACT
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
Renal Carcinoma
TUMORS OF URINARY TRACT
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
TUMORS OF URINARY TRACT
Renal Carcinoma
Contrast-enhanced CT scans:
⑴ inhomogeneous enhancement
⑵ peripheral enhancement
⑶ non-enhanced necrotic areas in the tumor
Renal Carcinoma
TUMORS OF URINARY TRACT
Renal Carcinoma
MRI:
(1) Plain scans: inhomogeneous signals on T1WI and
T2WI
(2)
Contrast-enhanced
enhancement
scans:
inhomogeneous
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
variable
Angioleimyolipoma
KUB and IVU
 kidney enlarged
 pelvicalyceal compression
 calcification in 20% of patients
Angioleimyolipoma
CT
 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
Angioleimyolipoma
MRI
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
Transitional cell carcinoma (80~90%)
KUB: normal
IVU : filling defect within the pelvis
CT:
⑴ mass of renal sinus
⑵ enhancement
⑶ filling defect on delayed contrast CT imaging
MRI:
⑴ mass of renal sinus
⑵ enhancement
Renal Pelvic Carcinoma
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
Carcinoma of the Urinary Bladder
RENAL CYST
Simple Renal cyst
 Single or multiple
 KUB: normal or bulging contour
 IVU: pelvicalyceal compression
RENAL CYST
Simple Renal cyst
CT:
⑴ round ⑵ clear margin ⑶ homogeneous low density ⑷
CT values: 6~18Hu ⑹ nonenhancement
MRI: ⑴ low signal on T1WI
⑵ high signal on T2WI
⑶ nonenhancement
Simple Renal cyst
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
RENAL AND URETERAL DYSPLASIA
Double pelvis and ureter
Solitary kidey
Horse-shoe kidney
Ectopic kidney
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