Imaging%20of%20the%20Renal%20System

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Imaging of the Renal System

• Dr. Dima Jamjoom
• Department of Radiology

Same slides but with Dr.Dimas notes. (Dark
Red) Good luck ??????? ???? ?? ???? ??? ???? ???
????? ??? ???? ?
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OUTLINE

• Introduction
• Imaging modalities
• Anatomy
• Cases

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INTRODUCTION

• What is radiology?
• It is a medical specialty that employs the use
  of imaging to both diagnose and treat disease
  within the human body.
• What is the renal system?
• Kidneys, ureters, urinary bladder and urethra.

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IMAGING MODALITIES

• Conventional radiography
• Intravenous urogram (IVU)
• US
• CT
• MRI
• Nuclear medicine

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Terminology
This slide is taken from the boys slide, I
think its the only difference between the
Female/Male slides.

• 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)

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Conventional radiography Plain X-Ray

• First imaging modality. meaning that a patient
  complains of symptoms renal disease, we start by
  X-ray
• Cheap.
• Useful for radio-opaque stones. But its limited,
  usually used only for this purpose. radio-opaque
  stones will appear white.

Note that there are stones which are not
radio-opaque and are diagnosed by US and CT.
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Conventional radiography

• Image features
• Projectional image.
• Image contrast determined by tissue density.
• Good evaluation radio-opaque stones.

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IVU same as plain x-ray but we give the patient
contrast

• Conventional x-ray plus intravenous contrast.
• Cheap.
• Recently replaced by CT and MRI.
• Useful for radio-opaque stones.

Contrast ???? ?????? ??? ?????? it will
appear white in the x-Ray.
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IVU

• Image features
• Projectional image.
• Image contrast determined by tissue density and
  IV contrast.
• Good evaluation of collecting system and
  radio-opaque stones. the doctor said it is used
  also for hydronephrosis which is dilatation of
  the collecting system.

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US

• Use high frequency sound wave.
• Contrast between tissue is determined by sound
  reflection.

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US

• Image features
• Operator dependant. Meaning that if the
  practitioner is good, then images will be good if
  not then the images will be bad.
• Projectional image.
• Good resolution.
• Used for stone, hydronephrosis, focal lesion.

Fluid black. Fat White.
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CT

• Same basic principle of radiography.
• More precise.
• Costly.
• /- contrast.( we can do it with or without
  contrast)
• Useful for trauma, stone, tumor, infection.

If patient suspected with stones, then the gold
standard is CT without contrast.
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CT
Non-contrast CT

• Image features
• Cross sectional images.
• Image contrast determined by tissue density /-
  contrast.
• Better evaluation of soft tissue.

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MRI

• Better evaluation of soft tissue.
• Expensive. time consumer, takes 30-45 mins
• Useful for soft tissue pathology tumor,
  infection.

If we are suspecting renal tumors, then MRI is
the best.
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MRI

• Image features
• Cross sectional images.
• Image contrast determine by tissue properties.
• Excellent for soft tissue evaluation.

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Nuclear medicine

• Utilizes a gamma camera and radioactive
  isotopes.
• Functional test. Meaning that the Anatomy wont
  appear clear as the CT and MRI but gives us an
  idea about the function of the kidneys.
• Less expensive.
• Useful for obstruction and split function.

???? ???? ?????? ??? ??????
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Nuclear medicine

• Image features
• Projectional image.
• Image contrast by tissue uptake and metabolism.

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ANATOMY
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Plain x-ray Kidneys size is about 3 and half
vertebral bodies including the vertebral discs.
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IVU
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US
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CT
The doctor talked in details about the fasciae
and everything in this picture.
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• CT with contrast ,
• Aorta we can see it in the right because we
  gave contrast.

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(No Transcript)
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MRI
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(No Transcript)
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CASES
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• What are the imaging modalities?
• What are the findings?
• Diagnosis?

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Case (1)

• Young male patient presenting with left flank
  pain and hematuria, no fever and normal WBC count.

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This is IVU we can see dilatation of the
collecting system ( hydronephrosis).. Stones
causing hydronephrosis. Renal pelvis is a bet
dilated
This is Plain X-ray without contrast, we can see
radio-opaque stones in the left kidney.
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Note the dilatation on this side ( Hydronephrosis
)
Same patient but with CT and US, stones will be
white by ultrasound.
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Case (2)

• Middle aged woman presenting with flank pain,
  fever and high WBC.

We expect infection.
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CT
Kidneys are white except some areas which is
darker, this is the focal infection (
pyleonephritis )
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Case (3)

• Elderly male patient with recurrent urinary tract
  infections.

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Renal pelvis is dilated. its dark because it
contains fluid
us
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Nuclear, collecting system is dilated. (normally
the isotope will be less in the kidneys with
time) but in this case still there is isotope in
the kidneys.
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Case (4)

• Young female presenting with decreased renal
  function (high urea and creatinine level).

Renal failure.
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• US
• Kidneys are not seen, its replaced by cysts
  which are dark.

This is congenital ( autosomal dominant
polycystic kidney disease.)
MRI of same patient. No kidneys, replaced by
cysts.
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gross
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Case (5)

• Elderly male patient with painless hematuria and
  weight loss.

tumor
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MRI, we see a mass
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Case (6)

• Young male patient involved in a motor vehicle
  accident with blunt trauma to the abdomen.

Trauma, cases of trauma CT
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CT
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Renal trauma grading

1. bleeding beneath the renal capsule, contusion.
   (?????)
2. Ulceration less than 2 cm not involving the
   collecting system ( ???? ???? ??? ?? ????? )
3. more than 2 cm but also not involving the
   collecting system
4. Extending to collecting system or if there is(
   thrombus ) , injury to blood supply.
5. Shattered kidney, multiple injuries , or ???
   ????? ?????? ????? ?????

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References

• Stephanie Ryan, Anatomy for Diagnostic imaging,
  2nd Edition.
• Jamie Weir, Peter Abraham, Imaging Atlas of
  Human Anatomy 3rd Edition.
• Peter Armstrong, diagnostic imaging,
• 5th Edition.

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THANK YOU