Urinary system

(Imaging)Dr. Vipan Magotra

Professor

Department of Radiodiagnoisis

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

Principles of Radiography

The underlying physical principles of conventional

radiography involve

Emitting a stream of photons from x-ray source, strike

body tissue.

Photons with varying amount of energy exit the patient

body and fall on image receptor/film, thus produce an

image

X-ray KUBIndications.

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

KIDNEYS

URETERS

URINARY

BLADDER

URETHRA

Conventional plain film of the abdomen is called a KUB

(Kidneys, Ureters, Bladder)

Good evaluation of radio-opaque stones

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

.

Scout film

+/- abd preparation.

Inject bolus of contrast

Nephrogenic phase in first minute

Pyelogenic phase after 5 minutes

Supine,oblique,prone upright and

post void film are taken

Prone films to see distal ureters

This is KUB taken post intravenous contrast injection

KUB IVU

This is KUB taken post intravenous contrast injection

• 5 min post IV is nephrogram

This is KUB taken post intravenous contrast injection

Also called IVP (intravenous pyelogram)

Demonstrates both function and structure of the renal system

•Function ---→ Filtration

•Structure ---→ Contrast filled collecting system

Indications:

•Urolithiasis / calculus

•Pyelonephritis

•Hydronephrosis

•Trauma

•Tumour

•Renal hypertension

•Congenital abnormality

Contra-Indications: (relative)

•History of Allergy

•Asthma

•Cardiovascular disease

•Sickle cell disease

•Diabetes mellitus

Voiding/Micturating

cystourethrogramFunctional and anatomical evaluation of

bladder and urethra specially posterior

urethra.

Commonly for kids with recurrent UTI

Dx.reflux,urethralvalve,uretrocele,urethral

stricture and diverticula

Scout film

Pediatric 6-8F catheter

For adult standard catheter

Films during filling the bladder

Oblique films

Post void films

You can see normal bladder film

8-16 F Foleys catheter.

Fill balloon with2cc of

contrast

Inject 50% of contrast in to

the bladder

Take films in oblique

position

Some resistance at the

membranous urethra and

sphincter.

Retrograde urethrogram

Ascending urethgram

in female

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.

Ultrasound

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-dense→ white

(stone/bone)

Hypo-dense grey to

black (fat/fluid)

Arterial

Venous Excretion

Non-contrast = Cortical

= Parenchymal

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

ANGIOGRAPHY

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

Congenital anomalies

Anamolies