imaging of genitourinary system
TRANSCRIPT
mag ng o en our nary ys em
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
rasoun
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