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KUB

KUB. Bone Kidney outline Psoas shadow Calcification: mesenteric calcification, phlebolith, arterial plaque, renal cyst calcification GI shadow. Excretory urography(DIP,RSP). the basic radiologic study of the UT 전처치 과거 : 수분섭취 제한 , 금식 최근 : 조영제 개선 , 대량투여

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KUB

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  1. KUB • Bone • Kidney outline • Psoas shadow • Calcification: mesenteric calcification, phlebolith, arterial plaque, renal cyst calcification • GI shadow

  2. Excretory urography(DIP,RSP) • the basic radiologic study of the UT • 전처치 과거: 수분섭취 제한, 금식 최근: 조영제 개선, 대량투여 소아, 노인, DM, MM, azotemia환자는 전처치 안함 • 촬영방법 정맥주사 후 3-5분, 10-15분, 25분에 촬영 복부에 압박 24시간 delay, oblique, tomography, postvoiding film

  3. Excretory urography • 조영제 methylglutamine, iothalamate, sod. diatrizoate, methylglutamine cliatrizoate등을 흔히 쓰나 최근 metrizamide 등의 비이온화 조영제를 주로 쓴다. • 조영제의 부작용 vasomotor collapse: nausea, febrile sensation anaphylactic Rx: flushing, urticaria, bronchial edema vagal Rx: hypotension, bradycardia renal failure: DM, MM

  4. Retrograde pyelography(RGP) • Cystoscope을 넣고 ureteral catheter를 통해 조영제를 주입 • 적응증 inappropriate IVP 조영제에 부작용

  5. Antegrade pyelography(AGP) • 적응증 RGP failed or CIx Nephrostomy state • 요관 폐색 부위의 진단에 도움

  6. Retrograde cystography • 무균적으로 방광에 카테타를 삽입한 후 25-30%의 조영제를 200-300ml 주입 • 잔뇨, 게실, 방광천공 등이 의심되면 postvoiding 사진 • Ix bladder rupture bladder tumor, stone, diverticulum • Christmas tree app. Pear-shaped bladder Pie-in-the- sky

  7. Voiding cystourethrogram(VCU) • vesicoureteral reflux • urethra evaluation

  8. Retrograde urethrography • urethra evaluation(anatomic) • Ix urethral injury urethral stricture urethral diverticulum urethral stone

  9. Chain cystourethrography

  10. Vasography • investigation of male sterility • 무정자증의 남성불임 환자에서 고환 생검에서 정자생산이 정상인 경우

  11. Angiography • US, CT와 DSA의 사용 증가로 arteriography의 사용이 줄어들고 있다. • renovascular disease kidney donor renal tumor(embolization) renal trauma • Arterial phase Nephrogram phase Venous phase

  12. Utrasonography • 장점: non-invasive, no radiation excellent spatial & temporal resolution flexibility for imaging in many planes • 단점: cannot travel through air & skilled operator • DDx of renal mass (cystic or solid) Transrectal US(TRUS) Scrotal US Penile duplex US

  13. CT scan • expensive but cost effective • Hounsfield unit • 장점 1)X선 흡수계수의 사소한 차이를 알 수 있다. 2)단층영상을 얻을 수 있다. • 단점 1) 다양한 각도의 영상을 얻는데 한계 2) 연부조직의 해상도가 낮고 동태적 검사에 부적합 3) 병리조직학적 구분에 한계가 있다. 4) 조영제를 사용하여야 한다. • 적응증: 부신, 신종물, 신외상, 신이식, 선천성기형, 방광암, 후복막강 및 전립선암의 병기 결정 등

  14. MRI • 조직의 자기성을 이용하여 영상을 얻는다. • 장점 1)no radiation 2)no contrast media, no bowel preparation 3)great flexibility for imaging in many planes 4)better information about soft tissue • 단점 1) expensive, longer time than CT 2) metallic hazard(magnetic field) • 적응증: 부신, 신, 방광, 전립선

  15. 핵의학 검사

  16. Kidney • Function (1) glomerular function(GFR) - iothalamate, 51Cr-EDTA - 99mTc-DTPA (2) tubular function (RBF) - 131I-,121I-hippuran, 99mTc-MAG-3 - 99mTc-DMSA

  17. Renal imaging • cortical imaging : 99mTc-DMSA • excretory imaging: 99mTc-DTPA, 99mTc-MAG-3

  18. Indications • upper UT obstruction 99mTc-DTPA diuretic renal scan • chronic PN in children(renal scarring in VUR) 99mTc-DMSA • renal transplantation: 131I-hippuran • renovascular hypertension • functional renal mass quantification • space occupying renal lesions

  19. 기타 • Bladder: VUR • Testis scan 99mTc-sodium pertechnetate DDx: testicular torsion & epididymitis • Adrenal scintigraphy cortex: Cushing's synd.- NP59 medulla: pheochromocytoma- 123I-MIBG • Bone scan

  20. 비뇨기계 기계와 사용법 • catheter is a foreign body • the leading cause of nosocomial UTI • the most common predisposing factor in gram-negative sepsis in hospital

  21. 경요도적 시술(Transurethral procedures) • size: 3F = 1mm (external diameter) • Latex, silicone, polyethylene, polyvinyl chloride • Foley, Pezzer, Malecot, Coude, Nelaton, Robinson

  22. 경요도적 시술(Transurethral procedures) • Cxs of catheterization 1) UTI 2) urethritis, epididymitis 3) urethral stricture 4) stone formation • Risk patients 1) prior to delivery or post-partum 2) the elderly or debilitated 3) diabetic patients

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