Download Imaging of the Renal System

Imaging of the Renal
System
Dr. Reshaid Al Jurayyan
Department of Radiology
OUTLINE
• Introduction
• Imaging modalities
• Anatomy
• Case scenarios
Case (1)
• Young male patient presenting with left
flank pain and hematuria, no fever and
normal WBC count.
Case (2)
• Middle aged woman presenting with
flank pain, fever and high WBC.
Case (3)
• Elderly male patient with recurrent
urinary tract infections.
Case (4)
• Young female presenting with decreased
renal function (high urea and creatinine
level).
Case (5)
• Elderly male patient with painless
hematuria and weight loss.
Case (6)
• Young male patient involved in a motor
vehicle accident with sever blunt trauma
to the abdomen.
INTRODUCTION
• What is radiology?
It is a medical specialty that employs the
use of imaging to both diagnosing and
treating diseases within the human body.
• What is the renal system?
Kidneys, ureters, urinary bladder and
urethra.
What radiological modalities
can be used to image the renal
system ?
IMAGING MODALITIES
• Conventional radiography
• Intravenous urogram (IVU)
• US
• CT
• MRI
• Nuclear medicine
Terminology
X ray : Radio-opaque (white) vs radio-lucent (black) •
US: Hyper-echoic (white) / hypo-echoic(black) •
CT: Hyper-dense (white) / hypo-dense(black) •
MRI: Hyper-signal (white) / hypo-signal •
Nuclear med.: Highuptake(black) / lowuptake
(white)
•
Conventional radiography
• First imaging
modality in most
cases.
• Cheap.
• Useful for radioopaque stones.
• Disadvantage :
radiation
Conventional radiography
Image features:
• Projectional image.
• Image contrast
determined by
tissue density.
• Good evaluation
radio-opaque
stones.
IVU
• Conventional x-ray
plus intravenous
contrast.
• Cheap.
• Recently replaced by
CT and MRI.
• Useful for radioopaque stones.
• Disadvantage :
impaired the kidney
IVU
Image features:
• Projectional image.
• Image contrast
determined by
tissue density and
IV contrast.
• Good evaluation of
collecting system
and radio-opaque
stones.
US
• Use high frequency
sound wave.
• No radiation
• Contrast between
tissue is
determined by
sound reflection.
US
Image features:
• Operator
dependant.
• Good resolution.
• Used for stone,
hydronephrosis,
focal lesion (ex.
masses).
CT
• Same basic
principle of
radiography.
• More precise.
• Costly.
• +/- IV contrast.
• Useful for trauma,
stone, tumor,
infection.
• Best in stones
CT
Image features:
• Cross sectional
images.
• Image contrast
determined by
tissue density +/contrast.
• Better evaluation of
soft tissue.
MRI
• Better evaluation of
soft tissue.
• Expensive.
• Useful for soft
tissue pathology:
tumor, infection.
MRI
Image features:
• Cross sectional
images.
• Image contrast
determine by tissue
properties.
• Excellent for soft
tissue evaluation.
Nuclear medicine
• Utilizes a gamma
camera and
radioactive isotopes.
• Good to assess
kidney function.
• Less expensive.
Nuclear medicine
Image features:
• Projectional image.
• Image contrast
by tissue uptake
and metabolism.
ANATOMY
•MRI IS NOT GOOD
IN STONES
•In MRI bones are
black
CASES
• What are the imaging modalities?
• What are the findings?
• Diagnosis?
Case (1)
• Young male patient presenting with left
flank pain and hematuria, no fever and
normal WBC count.
• Kidney stones with hydronephrosis.
• X-ray >> US >> CT
Case (2)
• Middle aged woman presenting with
flank pain, fever and high WBC.
• Inflammation (e.g. Pyelonephritis)
•US >> CT+contrast >> MRI
Case (3)
• Elderly male patient with recurrent
urinary tract infections.
• Bilateral hydronephrosis due to Prostate
enlargement.
• US
Case (4)
• Young female presenting with decreased
renal function (high urea and creatinine
level).
• Polycystic.
• US >> CT >> MRI
• Contrast is contraindicated
Case (5)
• Elderly male patient with painless
hematuria and weight loss.
• Tumor
• MRI (BEST) >> US >> CT+contrast
Case (6)
• Young male patient involved in a motor
vehicle accident with blunt trauma to the
abdomen.
• Truma
• CT (because it’s very fast)
Renal trauma grading
‫• سألت الدكتور عن األسئلة ‪:‬‬
‫يقول راح تكون األسئلة بالنظري وبتكون مثال واحد جاه حادث‬
‫وش افضل أشعة للشيء هذا؟ وكذلك خاصية األجهزة‬
‫حمد البريدي‬
THANK YOU