1. Urinary system (Imaging)
Radiological anatomy

3. Imaging Techniques
Plane urinary Tract film. Kidney, Ureters and bladder(KUB).
Intravenous urography. (IVU/EU).
Ante grade and retrograde urethrography.
Ultrasound.
CT scan
MRI
Angiography

4. Principles of Radiography
The underlying physical principles of conventional radiography involve Emitting a stream of photons from x-ray source, strike body tissue. Photons with varying amount of energy exit the patient body and fall on image receptor/film, thus produce an image

5. Indications.
Stone diseases. Help in diagnosis and management
Abdominal pain
Gall bladder stones
Position and size of kidneys and bladder
Show the position of ureteric stent
Preliminary examination to contrast study
X-ray KUB

7. Preparation. We use laxative, the night before the test to clear colon of solid fecal material.
On good quality film psoas muscle should be visible

8. INTRAVENOUS UROGRAPHY (IVU).
Shows anatomy and functions of the kidneys. After injection of iv contrast, it concentrate in the kidneys. Excreted by kidneys and pass via ureters in to the urinary bladder. we take a series of films to follow the passage of contrast from kidneys to urinary bladder. Contrast Shows renal parenchyma, collecting system and ureters.
Evaluate urothelial abnormalities,haematuria,urolithiasis.
Scout film
+/- abd preparation.
Inject bolus of contrast
Nephrogenic phase in first minute
Pyelogenic phase after 5 minutes
Supine,oblique,prone upright and post void film are taken
Prone films to see distal ureters

9. Voiding/Micturating cystourethrogram
Functional and anatomical evaluation of bladder and urethra specially posterior urethra.
Commonly for kids with recurrent UTI
Dx.reflux,urethralvalve,uretrocele,urethral stricture and diverticula
Scout film
Pediatric 6-8F catheter
For adult standard catheter
Films during filling the bladder
Oblique films
Post void films
You can see normal bladder film

10. Retrograde urethrogram
8-16 F Foleys catheter.
Fill balloon with2cc of contrast
Inject 50% of contrast in to the bladder
Take films in oblique position
Some resistance at the membranous urethra and sphincter.
Ascending urethgram in female

11. Ultrasound Now a days first line investigation. Grey scale and Doppler
Evaluate renal parenchyma, adrenals, bladder and prostate.
Can differentiate between solid and cystic, hydronephrosis,shows all type of stone
Evaluate congenital anomalies.

12. CT scan Gold standard test. With and with out contrast
Standard CT technique for renal imaging.
5mm collimation is adequate to demonstrate kidneys.
IV contrast differentiate pathological process from normal.
Parenchyma,coricomedullary differentiation max at 30 seconds
Nephrogenic phase is best seen at seconds
Non contrast helical CT shows any kind and small size of stone

13. MRI

14. ANGIOGRAPHY

15. Congenital anomalies
Cross ectopic. Lower kidney is usually ectopic one. In 90% of cases there is fusion of kidneys. There are increase chances of calculus formation.
Horse shoe kidney. Lower pole of both unite in the middle. Prone to traume
Pelvic kidney. Kidney is located in the pelvis. More prone to trauma.
Duplicate collecting system. Complete/part

17. Anamolies

18. Nephrolithiasis Symptomatic/asymptomatic. Flank pain hematuria.
Calcium phosphate stones are opaque on plane x-rays
Uric acid and xanthine stones are radiolucent.
All renal calculi have high attenuation(Opaque) on CT
Sensitivity is 97% and specefity is 96%
Can cause hydronephrosis, hydro ureter and renal
enlargement

19. Kidney and ureteric stones

20. CT images of renal abscess with and with out contrast

21. Renal cystic diseases Very common. 50% of patient over the age of 50
Associated with many syndromes
Asymptomatic
Rarely cause hematuria or become infected
Smooth thin wall, sharp demarcation from surrounding parenchyma.
Water attenuation on CT, non enhancing
Simple cyst are with out septation or calcification
Could be inherited like autosomal dominant or recessive
Simple cyst in kidney on u/s and CT

22. Renal cell carcinoma Most common malignancy 85%
Associated with smoking, family history, age, von hippel Lindau, dialysis, phenacetin and acquired cystic diseases
Present with wet loss,hematuria,pain,mass,fever and anemia
Variable from complex cyst to large heterogeneous mass
Generally enhancing
May have calcification hemorrhage and central necrosis

23. Wilms tumor Commonest kidney tumor in children.
Peak incidence at 3-4 years of age
85% occur before years

24. Hydronephrosis
Distension and dilation of the renal pelvis and calyces.
It is usually caused by obstruction to the free flow of urine from the kidney.
If obstruction is at lower level, there is dilation of ureters and pelvis of kidney.
Untreated , initially it cause enlargement of kidney, but finally it leads to atrophy.