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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?

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Presentation on theme: "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?"— Presentation transcript:

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2 Urinary system: imaging diagnosis 唐光健

3 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?  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?

4 Urinary System Characteristics: poor natural contrast  Luminal Structure calyces, pelvic, ureter, bladder -UROGRAPHY  Parenchyma Kidney-cortex, medulla -TOMOGRAPHIC IMAGING Characteristics: poor natural contrast  Luminal Structure calyces, pelvic, ureter, bladder -UROGRAPHY  Parenchyma Kidney-cortex, medulla -TOMOGRAPHIC IMAGING

5 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  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

6 Normal Manifestations  KUB: contour of kidney -edge, density, size, position…  KUB: contour of kidney -edge, density, size, position…

7  IVP –compress the ureter, picture 15’-30’ after contrast administration minor calyx renal papilla formix ureter renal pelvic fundament major calyx-neck Vtx body Normal Manifestations bladder

8  IVP –compress the ureter, picture 15’-30’ after contrast administration minor calyx renal papilla formix ureter renal pelvic fundament major calyx-neck Vtx body Normal Manifestations

9  IVP-normal variant branching branching ampullary ampullary Normal Manifestations

10  retrograde pyelogram back flow- collecting duct BF, renal sinus BF, perivein BF, lymph duct BF  retrograde pyelogram back flow- collecting duct BF, renal sinus BF, perivein BF, lymph duct BF Normal Manifestations

11  B-mode sonography- renal sinus, renal parenchyma, renal profile…  B-mode sonography- renal sinus, renal parenchyma, renal profile… Normal Manifestations

12  CT– without /with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement… plane scan cortical phase Parenchymal phase Normal Manifestations

13  CT– without /with contrast ~cortical phase, parenchymal phase, excrete phase ~profile, density, enhancement… cortical phase Parenchymal phase Normal Manifestations excretive phase

14  Angiography– ~no routine method, with interventional therapy ~arterial ph. parenchymal ph. Veinal ph. Normal Manifestations

15 T 1 WI T 2 WI Normal Manifestations  MRI- T 1 WI higher SI with cortex T 2 WI homogeneous high SI (signal intensity)  MRI- T 1 WI higher SI with cortex T 2 WI homogeneous high SI (signal intensity)

16 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carcinoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carcinoma  Cysticinside 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

17 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

18 Renal solid malignant  renal carcinoma - neoplasm, vascularity, necrosis

19 Renal solid malignant  pathologic features correlate to imaging neoplasm-mass effect neoplastic vascularity necrosis & bleeding in side the mass  pathologic features correlate to imaging neoplasm-mass effect neoplastic vascularity necrosis & bleeding in side the mass

20  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 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 malignant

21  renal carcinoma plain film: profile change- helpless with diag.  renal carcinoma plain film: profile change- helpless with diag. Renal solid malignant

22  renal carcinoma urography: elongated & deformated pelvic-poor specification  renal carcinoma urography: elongated & deformated pelvic-poor specification Renal solid malignant

23  renal carcinoma BUS: substantial, hypo/inhomog eneous echoic  renal carcinoma BUS: substantial, hypo/inhomog eneous echoic Renal solid malignant

24  renal carcinoma CT high specific & sensitive. Staging  renal carcinoma CT high specific & sensitive. Staging plain scan With enhancemnet delay scan Renal solid malignant

25 plain scan with enhancement delay scan Renal solid malignant  renal carcinoma CT high specific & sensitive. Staging  renal carcinoma CT high specific & sensitive. Staging

26 arterial phase parenchymal phase post ia adrenalin Renal solid malignant  renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging  renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging

27 renal vein, IVC invaded by RCC Renal solid malignant  renal carcinoma CT high specific & sensitive. Staging  renal carcinoma CT high specific & sensitive. Staging

28 renal vein, IVC invaded by RCC Renal solid malignant  renal carcinoma CT high specific & sensitive. Staging  renal carcinoma CT high specific & sensitive. Staging

29 Arterial phase Parenchymal phase Renal solid malignant  renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging  renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging

30 IVC angiography post embolizing of RA Renal s solid malignant  renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging  renal carcinoma angiography: vessel shift, tumor flashing, neo-vessel. Staging

31  renal carcinoma MRI seldom use  renal carcinoma MRI seldom use Renal solid malignant

32  Renal hamartoma (angiomyolipoma) - ratio of tree elements various, bleeding often Renal solid benign

33 Renal solid malignant Angiomyolipoma  pathologic features correlate to imaging neoplasm-mass effect adipose tissue, smooth muscle, vessels hypo-developed neoplastic vessels-bleeding Angiomyolipoma  pathologic features correlate to imaging neoplasm-mass effect adipose tissue, smooth muscle, vessels hypo-developed neoplastic vessels-bleeding

34  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 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 benign

35  renal angiomyolipoma sonography: hyperechoic substantial mass mostly  renal angiomyolipoma sonography: hyperechoic substantial mass mostly Renal solid benign

36  renal angiomyolipoma CT high specific with fat density, high sensitive, bleeding might be seen  renal angiomyolipoma CT high specific with fat density, high sensitive, bleeding might be seen CT plain scan Renal solid benign with enhancement

37  renal angiomyolipoma CT high specific with fat density, high sensitive, bleeding might be seen  renal angiomyolipoma CT high specific with fat density, high sensitive, bleeding might be seen CT plain scan Renal solid benign with enhancement

38  renal angiomyolipoma CT high specific with fat density, high sensitive, bleeding might be seen  renal angiomyolipoma CT high specific with fat density, high sensitive, bleeding might be seen Coronal MPR Renal solid benign with enhancement

39 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

40 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

41 cyst  pathologic features correlate to imaging with thin, even wall, flat epithelium clear fluid inside & no blood flow cyst  pathologic features correlate to imaging with thin, even wall, flat epithelium clear fluid inside & no blood flow cystic, inside kidney- renal cyst

42  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  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 cyst

43  Urography deforming of pelvic & calculi, low specific cystic, inside kidney- renal cyst

44  BUS, high specific anechoic lesion, echo enhancement post. cystic, inside kidney- renal cyst C

45  CT : clear appearance, high sen. & spe. for calcification of the wall or septation Waterlike, no enhancement, “no wall” cystic, inside kidney- renal cyst C

46  CT : clear appearance, high sen. & spe. for calcification of the wall or septation

47 Plain scan Enhancement scan cystic, inside kidney- renal cyst C  CT : clear appearance, high sen. & spe. for calcification, differentiation with high density cyst

48  MRI, atypical signal-differentiate cystic, sig. of fluid cystic, inside kidney- renal cyst C

49 cystic, inside kidney- renal cyst Multicystic kidney

50  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  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 kidney

51  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  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 kidney

52  urography: elongation/ deformation of the pelvic cystic, inside kidney- multycystic kidney

53  BUS: renal enlargement of both sides with multi-cyst ~ diagnosed cystic, inside kidney- multycystic kidney

54  CT: manifest clear, with multi-cystic liver often cystic, inside kidney- multycystic kidney

55 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

56 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

57  KUB:useless  BUS:crescent anechoic area outside kidney adjacent kidney deform echoic if clot in hematoma  KUB:useless  BUS:crescent anechoic area outside kidney adjacent kidney deform echoic if clot in hematoma cystic, outside-sub capsule hematoma Imaging character: out of kidney, no blood perfusion, fluid inside, partial solid if clot inside

58  CT: crescent, low density, high density if clot within hematoma, no enhancement, kidney deform cystic, outside-sub capsule hematoma

59  Angiography: renal vessel compressed & shifted find source of bleeding cystic, outside-sub capsule hematoma

60 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

61 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

62  carcinoma of renal pelvis pathologies of Urinary tract wall

63  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  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 pathologies of Urinary tract wall

64  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  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 pathologies of Urinary tract wall

65  carcinoma of renal pelvis urography: filling defect, high sensitive  carcinoma of renal pelvis urography: filling defect, high sensitive pathologies of Urinary tract wall

66  carcinoma of renal pelvis CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging  carcinoma of renal pelvis CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging plain scan with enhancement delay scan pathologies of Urinary tract wall

67  carcinoma of renal pelvis CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging pathologies of Urinary tract wall

68  carcinoma of renal pelvis MRI equivalent SI in T1 & T2WI  carcinoma of renal pelvis MRI equivalent SI in T1 & T2WI T 1 WI T 2 WI STAGE pathologies of Urinary tract wall

69  carcinoma of renal pelvis urography: filling defect, high sensitive  carcinoma of renal pelvis urography: filling defect, high sensitive pathologies of Urinary tract wall

70  carcinoma of ureter CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging  carcinoma of ureter CT: slight/medial enhancement, filling defect in hydronephrostic pelvic/ureter in excrete phase Staging plain scan with enhancement delay scan pathologies of Urinary tract wall

71  carcinoma of ureter MRI equivalent SI in T1 & T2WI, hydrography  carcinoma of ureter MRI equivalent SI in T1 & T2WI, hydrography pathologies of Urinary tract wall

72 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carinoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carinoma  Cysticinside 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

73 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

74 pathologies of Urinary tract lumen - 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  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

75  KUB: renal calculi- pelvic/calix (staghorn stone) ureter calculi-? pathologies of Urinary tract lumen - lithiasis

76  Sonography: renal calculi- pelvic/calix (staghorn stone) ureter calculi-? pathologies of Urinary tract lumen - lithiasis

77  CT: high sensitive, exact positioning plane scan Enhancement scan pathologies of Urinary tract lumen - lithiasis slab MIP

78  KUB:  Urography: renal calculi- pelvic/calix ureter calculi-?  KUB:  Urography: renal calculi- pelvic/calix ureter calculi-? pathologies of Urinary tract lumen - lithiasis

79  CT: high sensitive, exact positioning plane scan Enhancement scan pathologies of Urinary tract lumen - lithiasis MIP

80  MRI: no routine, low SI both T1WI & T2WI pathologies of Urinary tract lumen - lithiasis

81  CT: high sensitive, exact positioning

82  USG: high specific but low sensitive with ureter calculi pathologies of Urinary tract lumen - lithiasis

83  CT: high sensitive, exact positioning plane scan Enhancement scan

84 Soft tissue around cal., hydronephrosis proximately pathologies of Urinary tract lumen - lithiasis

85 Soft tissue around cal., hydronephrosis proximately pathologies of Urinary tract lumen - lithiasis

86 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carinoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carinoma  Cysticinside 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

87 Renal pathologies  pathologies of Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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 Parenchymal  Solid-benign: angiomyolipoma -malignant: carninoma  Cysticinside 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

88  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  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 Inflammatory change-renal tuberculosis

89  imaging KUB (-) / calcification  imaging KUB (-) / calcification Self-resection Inflammatory change-renal tuberculosis

90  imaging Urography: edge irregular (insect bite), cavitation, pelvic/ureter deform ulcer of renal papillae  imaging Urography: edge irregular (insect bite), cavitation, pelvic/ureter deform ulcer of renal papillae cavitation Inflammatory change-renal tuberculosis

91  imaging CT sensitive with cal. but with pelvic/ureter deform  imaging CT sensitive with cal. but with pelvic/ureter deform plain CTscan enhancement Inflammatory change-renal tuberculosis

92  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT plain CTscan enhancement Inflammatory change-renal tuberculosis delayed

93  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT plain CTscan enhancement Inflammatory change-renal tuberculosis

94  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT Inflammatory change-renal tuberculosis

95  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT  imaging CT sensitive with cal. also with pelvic/ureter deform -MSCT Inflammatory change-renal tuberculosis

96 Hydronephrosis-summary

97  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  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 - summary

98  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  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 - summary

99  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  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 - summary

100 Ureteral carcinoma Hydronephrosis  urography (retrograde )

101  urography: (IVP, retro, percutaneous ) some causes can be diagnosed Hydronephrosis

102  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  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 - summary

103  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  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 - summary

104  sonography: high sensitivity and cause- diagnositic Hydronephrosis- summary

105  sonography: high sensitivity and cause- diagnositic Hydronephrosis- summary

106  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  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 - summary

107  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  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 - summary

108  CT: cause-diagnostic, sensitivity relatively high plain scan enhanced delay scan Hydronephrosis- summary

109 ureteral carcinoma  CT: cause-diagnostic, sensitivity relatively high Hydronephrosis- summary

110 retroperitoneal fibrosis  CT: cause-diagnostic, sensitivity relatively high Hydronephrosis- summary

111 retroperitoneal fibrosis  CT: cause-diagnostic, sensitivity relatively high Hydronephrosis- summary

112  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  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 - summary

113  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  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 - summary

114 retroperitoneal fibrosis  MRI: seldom used, urography partly rapalced by uro-hydrography Hydronephrosis- summary

115 Prostate: imaging diagnosis

116 Prostate-imaging anatomy Characteristics: soft-tissue, poor natural X-ray contrast  central zone-rich in muscle fiber  periphery zone-rich in loose CT & glands Characteristics: soft-tissue, poor natural X-ray contrast  central zone-rich in muscle fiber  periphery zone-rich in loose CT & glands

117 Prostate-imaging anatomy  MRI-USG-CT , not shown with plain film

118 Prostate-imaging anatomy  MRI-USG-CT , not shown with plain film T1WI T2WI

119 Prostate-imaging anatomy  MRI-USG-CT , not shown with plain film

120 Prostate-imaging anatomy  MRI-USG-CT , not shown with plain film

121 prostate  BHP benign hypertrophy of prostate sup. border 10mm over the pubis / diameter > 5cm no abnormal signal/echo/density inside  BHP benign hypertrophy of prostate sup. border 10mm over the pubis / diameter > 5cm no abnormal signal/echo/density inside

122 prostate  BHP plain CT scan with enhancement MPR

123  BHP T 1 WI T 2 WI prostate

124  prostate carcinoma low signal lesion in periphery zone in T 2 WI staging  prostate carcinoma low signal lesion in periphery zone in T 2 WI staging

125  prostate carcinoma stage B stage C prostate

126 plain CT scan with enhancement  prostate carcinoma prostate

127 MPR  prostate carcinoma prostate plain CT scan with enhancement

128 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?  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?


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