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Urinary system: imaging diagnosis. 唐光健. Questions to think of. Which diagnostic imaging modality is the most suitable for the urinary system and why? What urinary diseases are suitable for imaging examination?

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questions to think of
Questions to think of
  • Which diagnostic imaging modality is the most suitable for the urinary system and why?
  • What urinary diseases are suitable for imaging examination?
  • What imaging method should be chosen with different sort of disease considered clinically? What information we expect to get from the imaging?
urinary system
Urinary System

Characteristics:

poor natural contrast

  • Luminal Structure
    • calyces, pelvic, ureter, bladder -UROGRAPHY
  • Parenchyma
    • Kidney-cortex, medulla -TOMOGRAPHIC IMAGING
imaging modalities
Imaging modalities:
  • plane film(KUB)-limited effective
  • Urography
    • Intravenous pyelography IVP
    • Retrograde pyelography
    • Cystography
    • Urethrography -show morphous of the lumen indirectly -overall view of the urinary tract -affected by the renal function & lumen construction
  • Ultrasonography USG-real time, convenient, low cost, available -good characteristic of stone, fluid
  • CT Computed Tomography -high resolution of high density & low density -contrast enhancement
  • MRI Magnetic Resonant Imaging -good contrast of soft tissues
normal manifestations
Normal Manifestations
  • KUB: contour of kidney

-edge, density, size, position…

normal manifestations1
Normal Manifestations
  • IVP –compress the ureter, picture 15’-30’ after contrast administration

renalpapilla

Vtx

body

formix

major calyx-neck

fundament

minor calyx

renal pelvic

ureter

bladder

normal manifestations2
Normal Manifestations
  • IVP –compress the ureter, picture 15’-30’ after contrast administration

renalpapilla

Vtx

body

formix

major calyx-neck

fundament

minor calyx

renal pelvic

ureter

normal manifestations3
Normal Manifestations
  • IVP-normal variant

branching

ampullary

normal manifestations4
Normal Manifestations
  • retrograde pyelogram

back flow-collecting duct BF, renal sinus BF,

perivein BF, lymph duct BF

normal manifestations5
Normal Manifestations
  • B-mode sonography-

renal sinus, renal parenchyma, renal profile…

normal manifestations6
Normal Manifestations
  • CT– without/with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement…

Parenchymal phase

cortical phase

plane scan

normal manifestations7
Normal Manifestations
  • CT– without/with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement…

Parenchymal phase

excretive phase

cortical phase

normal manifestations8
Normal Manifestations
  • Angiography– ~no routine method, with interventional therapy ~arterial ph. parenchymal ph. Veinal ph.
normal manifestations9
Normal Manifestations
  • MRI- T1WI higher SI with cortex

T2WI homogeneous high SI (signal intensity)

T2WI

T1WI

renal pathologies
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carcinoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
renal pathologies1
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
renal solid malignant
Renal solid malignant
  • renal carcinoma - neoplasm, vascularity, necrosis
renal solid malignant1
Renal solidmalignant
  • pathologic features correlate to imaging
    • neoplasm-mass effect
    • neoplastic vascularity
    • necrosis & bleeding in side the mass
renal solid malignant2
Renal solidmalignant
  • renal carcinoma - neoplasm, vascularity, common with necrosis
    • plain film: profile change-helpless with diag.
    • urography: elongated & deformed pelvic- poor specification
    • BUS: substantial, hypo/inhomogeneous echoic
    • angiography: vessel shift, tumor flashing, neo-vessel. Staging
    • CT high specific & sensitive. Staging
    • MRI Seldom used
renal solid malignant3
Renal solidmalignant
  • renal carcinoma
    • plain film: profile change-helpless with diag.
renal solid malignant4
Renal solidmalignant
  • renal carcinoma
    • urography: elongated & deformated pelvic-poor specification
renal solid malignant5
Renal solidmalignant
  • renal carcinoma
    • BUS: substantial, hypo/inhomog eneous echoic
renal solid malignant6
Renal solidmalignant
  • renal carcinoma
    • CT high specific & sensitive. Staging

plain scan

delay scan

With enhancemnet

renal solid malignant7
Renal solidmalignant
  • renal carcinoma
    • CT high specific & sensitive. Staging

delay scan

plain scan

with enhancement

renal solid malignant8
Renal solidmalignant

parenchymal phase

  • renal carcinoma
    • angiography: vessel shift, tumor flashing, neo-vessel. Staging

post ia adrenalin

arterial phase

renal solid malignant9
Renal solidmalignant
  • renal carcinoma
    • CT high specific & sensitive. Staging

renal vein, IVC invaded by RCC

renal solid malignant10
Renal solidmalignant
  • renal carcinoma
    • CT high specific & sensitive. Staging

renal vein, IVC invaded by RCC

renal solid malignant11
Renal solidmalignant
  • renal carcinoma
    • angiography: vessel shift, tumor flashing, neo-vessel. Staging

Arterial phase

Parenchymal phase

renal s solid malignant
Renal s solidmalignant
  • renal carcinoma
    • angiography: vessel shift, tumor flashing, neo-vessel. Staging

post embolizing of RA

IVC angiography

renal solid malignant12
Renal solidmalignant
  • renal carcinoma
    • MRI seldom use
renal solid benign
Renal solidbenign
  • Renal hamartoma (angiomyolipoma)- ratio of tree elements various, bleeding often
renal solid malignant13
Renal solidmalignant

Angiomyolipoma

  • pathologic features correlate to imaging
    • neoplasm-mass effect
    • adipose tissue, smooth muscle, vessels
    • hypo-developed neoplastic vessels-bleeding
renal solid benign1
Renal solidbenign
  • renal angiomyolipoma
    • plain film: profile change-helpless with diag.
    • urography: elongated & deformed pelvic-poor specification
    • sonography: hyperechoic substantial mass mostly
    • CT: high specific with fat density, high sensitive, bleeding might be seen
    • MRI inhomogeneous signal, signal of fat & old bleeding
renal solid benign2
Renal solidbenign
  • renalangiomyolipoma
    • sonography: hyperechoic substantial mass mostly
renal solid benign3
Renal solidbenign

CT plain scan

  • renalangiomyolipoma
    • CT high specific with fat density, high sensitive, bleeding might be seen

with enhancement

renal solid benign4
Renal solidbenign
  • renalangiomyolipoma
    • CT high specific with fat density, high sensitive, bleeding might be seen

with enhancement

CT plain scan

renal solid benign5
Renal solidbenign
  • renalangiomyolipoma
    • CT high specific with fat density, high sensitive, bleeding might be seen

with enhancement

Coronal MPR

renal pathologies2
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
renal pathologies3
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
cystic inside kidney renal cyst
cystic, inside kidney-renal cyst

cyst

  • pathologic features correlate to imaging
  • with thin, even wall,
  • flat epithelium
  • clear fluid inside & no blood flow
cystic inside kidney renal cyst1
cystic, inside kidney-renal cyst
  • plain film: profile changing
  • urography: pelvix & calix deforming, no specific
  • BUS: anechoic lesion, high specific
  • CT: clear appearance, high sen. & spe. for calcification of the wall or septation
  • MRI:cystic, signal of fluids, different diagnosis needed if signal be non-specific
cystic inside kidney renal cyst2
cystic, inside kidney-renal cyst
  • Urography

deforming of pelvic & calculi, low specific

cystic inside kidney renal cyst c
cystic, inside kidney-renal cyst C
  • BUS, high specific

anechoic lesion, echo enhancement post.

cystic inside kidney renal cyst c1
cystic, inside kidney-renal cyst C
  • CT: clear appearance, high sen. & spe. for calcification of the wall or septation

Waterlike, no enhancement, “no wall”

cystic inside kidney renal cyst c2
cystic, inside kidney-renal cyst C
  • CT: clear appearance, high sen. & spe. for calcification of the wall or septation
cystic inside kidney renal cyst c3
cystic, inside kidney-renal cyst C
  • CT: clear appearance, high sen. & spe. for calcification, differentiation with high density cyst

Enhancement scan

Plain scan

cystic inside kidney renal cyst c4
cystic, inside kidney-renal cyst C
  • MRI, atypical signal-differentiate

cystic, sig. of fluid

cystic inside kidney multycystic kidney
cystic, inside kidney-multycystic kidney
  • plain film: enlargement & shift of renal shadow
  • urography: elongation/deformation of the pelvic
  • BUS: renal enlargement of both sides with multi-cyst ~ diagnosed
  • CT: manifest clear, with multi-cystic liver often
cystic inside kidney multycystic kidney1
cystic, inside kidney-multycystic kidney
  • plain film: enlargement & shift of renal shadow
  • urography: elongation/deformation of the pelvic
  • BUS: renal enlargement of both sides with multi-cyst ~ diagnosed
  • CT: manifest clear, with multi-cystic liver often
cystic inside kidney multycystic kidney2
cystic, inside kidney-multycystic kidney
  • urography: elongation/deformation of the pelvic
cystic inside kidney multycystic kidney3
cystic, inside kidney-multycystic kidney
  • BUS: renal enlargement of both sides with multi-cyst ~ diagnosed
cystic inside kidney multycystic kidney4
cystic, inside kidney-multycystic kidney
  • CT: manifest clear, with multi-cystic liver often
renal pathologies4
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
renal pathologies5
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cystoutside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
cystic outside sub capsule hematoma
cystic, outside-sub capsule hematoma

Imaging character: out of kidney, no blood perfusion, fluid inside, partial solid if clot inside

  • KUB: useless
  • BUS: crescent anechoic area outside kidney adjacent kidney deform echoic if clot in hematoma
cystic outside sub capsule hematoma1
cystic, outside-sub capsule hematoma
  • CT: crescent, low density, high density if clot within hematoma, no enhancement, kidney deform
cystic outside sub capsule hematoma2
cystic, outside-sub capsule hematoma
  • Angiography: renal vessel compressed & shifted find source of bleeding
renal pathologies6
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
renal pathologies7
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
slide61

pathologies of Urinary tract wall

  • carcinoma of renal pelvis
slide62

pathologies of Urinary tract wall

  • carcinoma of renal pelvis - neoplasm, often small, seldom necrosis
    • plain film: helpless
    • urography: filling defect, high sensitive
    • sonography: hypoechoic substantial mass in pelvic/ureter
    • CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging
    • MRI equivalent SI in T1 & T2WI
slide63

pathologies of Urinary tract wall

  • carcinoma of renal pelvis - neoplasm, often small, seldom necrosis
    • plain film: helpless
    • urography: filling defect, high sensitive
    • sonography: hypoechoic substantial mass in pelvic/ureter
    • CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging
    • MRI equivalent SI in T1 & T2WI
slide64

pathologies of Urinary tract wall

  • carcinoma of renal pelvis
    • urography: filling defect, high sensitive
slide65

pathologies of Urinary tract wall

  • carcinoma of renal pelvis
    • CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging

with enhancement

plain scan

delay scan

slide66

pathologies of Urinary tract wall

  • carcinoma of renal pelvis
    • CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging
slide67

pathologies of Urinary tract wall

  • carcinoma of renal pelvis
    • MRI equivalent SI in T1 & T2WI

T2WI

T1WI

STAGE

slide68

pathologies of Urinary tract wall

  • carcinoma of renal pelvis
    • urography: filling defect, high sensitive
slide69

pathologies of Urinary tract wall

  • carcinoma of ureter
    • CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging

delay scan

with enhancement

plain scan

slide70

pathologies of Urinary tract wall

  • carcinoma of ureter
    • MRI equivalent SI in T1 & T2WI, hydrography
renal pathologies8
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carinoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
renal pathologies9
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
pathologies of urinary tract lumen lithiasis
pathologies of Urinary tractlumen- lithiasis
  • 90% X-ray positive, diagnose considering clinical data
  • KUB: renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
  • CT: high sensitive, exact positioning
  • USG: high specific but low sensitive with ureter calculi
pathologies of urinary tract lumen lithiasis1
pathologies of Urinary tractlumen- lithiasis
  • KUB: renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
pathologies of urinary tract lumen lithiasis2
pathologies of Urinary tractlumen- lithiasis
  • Sonography: renal calculi-pelvic/calix (staghorn stone) ureter calculi-?
pathologies of urinary tract lumen lithiasis3
pathologies of Urinary tractlumen- lithiasis
  • CT: high sensitive, exact positioning

Enhancement scan

slab MIP

plane scan

pathologies of urinary tract lumen lithiasis4
pathologies of Urinary tractlumen- lithiasis
  • KUB:
  • Urography: renal calculi-pelvic/calix ureter calculi-?
pathologies of urinary tract lumen lithiasis5
pathologies of Urinary tractlumen- lithiasis
  • CT: high sensitive, exact positioning

Enhancement scan

MIP

plane scan

pathologies of urinary tract lumen lithiasis6
pathologies of Urinary tractlumen- lithiasis
  • MRI: no routine, low SI both T1WI & T2WI
pathologies of urinary tract lumen lithiasis7
pathologies of Urinary tractlumen- lithiasis
  • CT: high sensitive, exact positioning
pathologies of urinary tract lumen lithiasis8
pathologies of Urinary tractlumen- lithiasis
  • USG: high specific but low sensitive with ureter calculi
pathologies of urinary tract lumen lithiasis9
pathologies of Urinary tractlumen- lithiasis
  • CT: high sensitive, exact positioning

plane scan

Enhancement scan

pathologies of urinary tract lumen lithiasis10
pathologies of Urinary tractlumen- lithiasis

Soft tissue around cal., hydronephrosis proximately

pathologies of urinary tract lumen lithiasis11
pathologies of Urinary tractlumen- lithiasis

Soft tissue around cal., hydronephrosis proximately

renal pathologies10
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carinoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
renal pathologies11
Renal pathologies
  • pathologies of Parenchymal
    • Solid -benign: angiomyolipoma -malignant: carninoma
    • Cystic inside kidney: renal cyst outside kidney: sub capsule hematoma
  • pathologies of Urinary tract
    • of the wall –transitional cell carcinoma
    • of the lumen –calculus
  • Inflammatory change-tuberculosis
  • Hydronephrosis –differentiate diagnosis
slide87

Inflammatory change-renal tuberculosis

  • nephropyelitis  renal papilla ulcer  necrosis, cavitation  pyonephrosiscalcification, renal self- resection
  • imaging
    • KUB: (-) /calcification
    • Urography: edge irregular (insect bite), cavitation, pelvic/ureter deform
    • CT: sensitive with cal. but pelvic/ureter deform
    • MRI insensitive
  • diag. – consider clinical data
slide88

Inflammatory change-renal tuberculosis

  • imaging
    • KUB (-) / calcification

Self-resection

slide89

Inflammatory change-renal tuberculosis

  • imaging
    • Urography: edge irregular (insect bite), cavitation, pelvic/ureter deform

ulcer of renal papillae

cavitation

slide90

Inflammatory change-renal tuberculosis

plain CTscan

  • imaging
    • CT sensitive with cal. but with pelvic/ureter deform

enhancement

slide91

Inflammatory change-renal tuberculosis

  • imaging
    • CT sensitive with cal. also with pelvic/ureter deform-MSCT

enhancement

delayed

plain CTscan

slide92

Inflammatory change-renal tuberculosis

  • imaging
    • CT sensitive with cal. also with pelvic/ureter deform-MSCT

enhancement

plain CTscan

slide93

Inflammatory change-renal tuberculosis

  • imaging
    • CT sensitive with cal. also with pelvic/ureter deform-MSCT
slide94

Inflammatory change-renal tuberculosis

  • imaging
    • CT sensitive with cal. also with pelvic/ureter deform-MSCT
hydronephrosis summary1
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis summary2
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis summary3
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/ureter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis
Hydronephrosis
  • urography (retrograde )

Ureteral carcinoma

hydronephrosis1
Hydronephrosis
  • urography: (IVP, retro, percutaneous ) some causes can be diagnosed
hydronephrosis summary4
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis summary5
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis summary6
Hydronephrosis-summary
  • sonography: high sensitivity and cause-diagnositic
hydronephrosis summary7
Hydronephrosis-summary
  • sonography: high sensitivity and cause-diagnositic
hydronephrosis summary8
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis summary9
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly replaced by uro- hydrography
hydronephrosis summary10
Hydronephrosis-summary
  • CT: cause-diagnostic, sensitivity relatively high

delay scan

plain scan

enhanced

hydronephrosis summary11
Hydronephrosis-summary
  • CT: cause-diagnostic, sensitivity relatively high

ureteral carcinoma

hydronephrosis summary12
Hydronephrosis-summary
  • CT: cause-diagnostic, sensitivity relatively high

retroperitoneal fibrosis

hydronephrosis summary13
Hydronephrosis-summary
  • CT: cause-diagnostic, sensitivity relatively high

retroperitoneal fibrosis

hydronephrosis summary14
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis summary15
Hydronephrosis - summary
  • Obstruction of the urinary tract-malformation, calculi, tuberculosis, inflammation, compression from outside-retroperitoneal fibrosis…
    • imaging-various dilatation of pelvis/uriter
      • plain film: renal shadow enlarged,no cause be diagnosis except calculi of urinary tract
      • urography: some causes can be diagnosed
      • sonography: high sensitivity and cause-diagnositic
      • CT: cause-diagnostic, sensitivity relatively high
      • MRI: seldom used, urography partly rapalced by uro- hydrography
hydronephrosis summary16
Hydronephrosis-summary
  • MRI: seldom used, urography partly rapalced by uro-hydrography

retroperitoneal fibrosis

prostate imaging anatomy
Prostate-imaging anatomy

Characteristics:

soft-tissue,

poor natural X-ray contrast

  • central zone-rich in muscle fiber
  • periphery zone-rich in loose CT & glands
prostate imaging anatomy1
Prostate-imaging anatomy
  • MRI-USG-CT,not shown with plain film
prostate imaging anatomy2
Prostate-imaging anatomy
  • MRI-USG-CT,not shown with plain film

T1WI

T2WI

prostate imaging anatomy3
Prostate-imaging anatomy
  • MRI-USG-CT,not shown with plain film
prostate imaging anatomy4
Prostate-imaging anatomy
  • MRI-USG-CT,not shown with plain film
prostate
prostate
  • BHP benign hypertrophy of prostate
    • sup. border 10mm over the pubis / diameter > 5cm
    • no abnormal signal/echo/density inside
prostate1
prostate
  • BHP

MPR

with enhancement

plain CT scan

prostate2
prostate
  • BHP

T2WI

T1WI

prostate3
prostate
  • prostate carcinoma
    • low signal lesion in periphery zone in T2WI
    • staging
prostate4
prostate
  • prostate carcinoma

stage C

stage B

prostate5
prostate
  • prostate carcinoma

with enhancement

plain CT scan

prostate6
prostate
  • prostate carcinoma

plain CT scan

MPR

with enhancement

questions after lecture
Questions after lecture
  • How to chose imaging exam for the patient with gross hematuria (how to determine the method and purpose of next exam according to the result of pre-exam)?
  • What is the pathologic underlying of the various manifestations of renal carcinoma with different imaging method?
  • What imaging method is the first chosen for the prostate exam?