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Anatomy Imaging

Plain Radiograph (Ionizing Radiation)

KUB

Intravenous Urography

Ultrasound (No Ionizing Radiation)

Fluoroscopy

MCU

APG/ RPG

Ascending Urethrogram

CT Scan

Abdomen

KUB

Renal

Radionuclide Imaging

MRI

Angiography

KUB

Abnormality

Radio-opaque stone

Calcification

Soft Tissue Mass 

Abnormal Air Collection

Intravenous Urography

Contraindications

Dehydration

Renal Failure

Information gain

Relative Function

Any Obstruction

Level of Obstruction 

Films

Immediate

5-min

15-min

Compression/ Release

Post-Micturation  

 

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Echogenicity

Hypoechoic

Hyperechoic

Assess

Kidney Size

Stone

Dilatation of Collecting System

Fluoroscopy

Direct Visualization under Image Intensifier

Real Time

Need Contrast (Non IV)

y  Micturating Cystourethrography (MCU)

y  Antegrade (APG), Retrograde (RPG) Pyelogram

y  Ascending Urethrography

Micturating Cystourethrography (MCU)

Study Lower Urinary System

Direct Injection of contrast into Urinary Bladder (via Foleys catheter)

Patient micturates, Image taken

Information

y  Anatomy

y  Vesicoureteric Reflux

APG/ RPG

Imaging of Pelvicalyceal system

Antegrade Retrograde

Ascending Urethrogram

Injection of contrast through

a catheter to opacify Urethra

Catheter Tip at the Fossa Navicularis

Indication - Trauma

can

Excellent Internal Detail as Kidney is cut in slices

Disadvantage - Ionizing Radiation 

Preparation (same for any imaging that need IV contrast injection)

y  Fasting (at least 4 hours)

y  Exclude Allergy, contraindication for IV contrast

Protocol

y  CT KUB

y  CT Renal Perfusion, Secretion, Excretion

CT KUB

CT Renal

CT Abdomen

Radionuclide Imaging

Study Distribution of Pharmaceutical agent administered to patient

Pharmaceutical = Radioisotope/ Radionuclide + Pharmaceutical Agent

Radionuclide (Technetium 99-m)

Pharmaceutical Agent (DTPA, DMSA)

Activity Produced, Image taken using gamma camera

[99m Tc] DTPA [99m Tc] DMSA

Diethylenetriamene pentaacetate

(excreted via glomerular filtration)

Dimercaptosuccinic acid

(bound to plasma protein, cleared

via renal tubular excretion)

(specific affinity to proximal

convulated tubules, thus accumulate

in renal cortex)

Study individual kidney function 

Dynamic study

Perfusion, Secretion, Excretion phase

Plot in Renogram curve

Look for Scarring, Renal Infarction 

Static Imaging

Study Anatomy

Magnetic Resonance Imaging

Radiofrequency impulse in magnetic field

 

Structure that has Hydrogen nuclei will show signal

Based on Relaxation Time : TE (time to echo), TR (time to relax)

Sequences : T1 weighted, T2 weighted, FLAIR, STIR, PD

Signal Apperance

T1WI  T2WI  FLAIR  STIR 

Hypointense Hyperintense Suppressed Fluid

Hyperintense Hyperintense Suppressed Fat

Intermediate Intermediate Muscle

Hypointense Hypointense Tendon,

ligament

Signal void Signal void Vessel,

calcification

Etc

Angiography

Imaging of Vessel using digital subtraction technique

Diagnostic, Therapeutic

Preparation

y  Need IV Contrast (as for other imaging)

y  Bleeding Profile 

Femoral Artery Catheterization

Femoral Artery Catheterization

Renal Angiogram Renal Angiogram

Renal Aneurysm Embolization Renal Aneurysm Embolization

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Oral 

Barium Sulphate Suspension (E-z-cat) 4.9%w/v 200mls dilute with 900mls H2O

Intravenous

Iodine based contrast

Non ionic

y  Low osmolar/ LOCM (Omnipaque)

y  Iso-osmolar/ IOCM (Visipaque)

Contrast forMRI

Gadolinium DTPA

LOCM 

Precaution

Allergyto Drugs, Seafood, Iodine

Renal Impairment, Failure

Heart Problem Cardiac Arrhythmia, Heart Failure

Dehydration

Sickle cell disease

Multiple Myeloma

Gadolinium DTPA (Gd-DTPA)

Rare earth materal

Paramagnetic property

Renal Impairment

Nephrogenic fibrosing sclerosis