ct urographyfrom seeing to understanding
TRANSCRIPT
CT UROGRAPHYFROM SEEING TO UNDERSTANDING
Dr. Hazem Abu Zeid YousefLecturere of Radiodiagnosis
Faculty of MedicineAssiut University
Although all imaging modalities play an important role in imaging the urinary tract, CT urography represents the most comprehensive imaging examination of the urinary tract. It provides a single noninvasive examination of the kidneys, ureters, and bladder in one test. As a result, CT urography is the current modality of choice for evaluation of painless gross or microscopic hematuria. CT urography allows for identification of stones, renal parenchymal masses, and urothelial abnormalities.
APPROACHES TO CTU For a CT examination to allow for
comprehensive urinary tract imaging, it must be able to adequately detect urinary tract calculi, renal masses, and renal collecting system, bladder, and ureteral abnormalities.
TECHNIQUES OF CTU
• SINGLE BOLUS 3 OR 4 PHASES TECHNIQUE
• SPLIT BOLUS TECHNIQUE
• SALINE HYDRATION
• IV DIURETICS.
Due to the radiation intensive nature of MDCTU, some investigators have suggested that this study be performed only on patients who are preidentified by urologists as being at a high risk for having urinary tract pathology, especially transitional cell carcinoma. When these restrictions are enforced, MDCTU is generally performed on patients more than 40 years of age and patients with at least one of the following: a history of transitional cell carcinoma (and who are therefore likely to have recurrences or metachronous tumors), positive urine cytology, previous equivocal imaging studies, and persistent symptoms (e.g., ongoing hematuria).
In contrast, others suggest performing MDCTU as a screening test on any patient who presents with hematuria. According to these authors, MDCTU is already in a position to replace EU completely. Regardless of the differing recommendations as to when MDCTU should be performed, all investigators are extremely enthusiastic about its potential. Even those advocating limited use have stated that with a few additional radiation-restricting modifications in CT hardware and changes in CT technique, MDCTU is poised to make EU obsolete in the very near future.
CASE (1)
NON ENHANCED CT SHOWING BILATERAL RENAL PELVIS CALCULI WITH MARKED PYELITIS.
ENHANCED CT SHOWING GOOD ENHANCEMENT.
CASE (2)
THICK SLAP MIPBILATERAL RENAL AND UB STONES
CORONAL IMAGESSHOWING MARKED PYELITIS OF THE LEFT KIDNEY
CASE (5)
CURVED REFORMATLOWER URETERIC STONE
CAUSING MILD HYDRONEPHROSIS
DOUBLE DENSITY VR IMAGETHE STONE IS DEMONSTRATED
AGAINST THE UNDERLYINGBONE
CASE (2)
OBSTRUCTED INFECTED KIDNEYENLARGED LEFT KIDNEY WITH MARKED STRANDING OF THE
PERINEPHRIC FAT AND OBSTRUCTING PELVIC CALCULUS
BOSNIOAK TYPE II CYST WITH THIN CALCIFIED RIM AND INTRACYSTIC SEPTUM
(THANKS FOR THE SUBMILLEMETRIC SLICE THICKNESS)
MALIGNANT LOWER POLAR LEFT RENAL MASS WITH ENHANCING MALIGNANT THROMBUS WITHIN THE IVC
AND SECONDARY VARICOSITIES OF THE LEFT TESTICULAR VEIN.
CASE (1)
PRE AND POST CONTRAST MIP IMAGESTUBULAR DILATATION WITH TINY
CALCULI WITHIN THE DILATED TUBULES(MEDULLARY SPONGE KIDNEY)
URETERS
AS A RULE;MALIGNANT URETERIC NEOPLASMS CHARACTERISTICALLY CAUSE DILATATION OF THE URETER BOTH PROXIMAL AND DISTAL TO THE LESION.