Imaging of the Renal System Dr. Reshaid Al Jurayyan Department of Radiology.

Imaging of the Imaging of the Renal SystemRenal System

Dr. Reshaid Al JurayyanDepartment of Radiology

OUTLINEOUTLINE

• Introduction• Imaging modalities• Anatomy• Case scenarios

Case (1)

• Young male patient presenting with left flank pain and hematuria, no fever and normal WBC count.

Case (2)

• Middle aged woman presenting with flank pain, fever and high WBC.

Case (3)

• Elderly male patient with recurrent urinary tract infections.

Case (4)

• Young female presenting with decreased renal function (high urea and creatinine level).

Case (5)

• Elderly male patient with painless hematuria and weight loss.

Case (6)

• Young male patient involved in a motor vehicle accident with sever blunt trauma to the abdomen.

INTRODUCTIONINTRODUCTION

• What is radiology? It is a medical specialty that employs

the use of imaging to both diagnosing and treating diseases within the human body.

• What is the renal system? Kidneys, ureters, urinary bladder and

urethra.

What What radiological radiological modalities modalities can be used can be used

to image the to image the renal renal systemsystem ??

IMAGING MODALITIESIMAGING MODALITIES

• Conventional radiography• Intravenous urogram (IVU)• US• CT• MRI• Nuclear medicine

Terminology

•X ray : Radio-opaque (white) vs radio-lucent (black)

•US: Hyper-echoic (white) / hypo-echoic(black)

•CT: Hyper-dense (white) / hypo-dense(black)

•MRI: Hyper-signal (white) / hypo-signal

•Nuclear med.: Highuptake(black) / lowuptake (white)

Conventional radiography

• First imaging modality in most cases.

• Cheap.• Useful for radio-

opaque stones.• Disadvantage :

radiation

Conventional radiography

Image features:• Projectional image.• Image contrast

determined by tissue density.

• Good evaluation radio-opaque stones.

IVU• Conventional x-ray

plus intravenous contrast.

• Cheap.• Recently replaced by

CT and MRI. • Useful for radio-

opaque stones.• Disadvantage :

impaired the kidney

IVU

Image features:• Projectional

image.• Image contrast

determined by tissue density and IV contrast.

• Good evaluation of collecting system and radio-opaque stones.

US

• Use high frequency sound wave.

• No radiation • Contrast between

tissue is determined by sound reflection.

US

Image features:• Operator

dependant.• Good resolution.• Used for stone,

hydronephrosis, focal lesion (ex. masses).

CT• Same basic

principle of radiography.

• More precise.• Costly.• +/- IV contrast.• Useful for trauma,

stone, tumor, infection.

• Best in stones

CT

Image features:

• Cross sectional images.

• Image contrast determined by tissue density +/- contrast.

• Better evaluation of soft tissue.

MRI

• Better evaluation of soft tissue.

• Expensive.• Useful for soft

tissue pathology: tumor, infection.

MRI

Image features:• Cross sectional

images.• Image contrast

determine by tissue properties.

• Excellent for soft tissue evaluation.

Nuclear medicine

• Utilizes a gamma camera and radioactive isotopes.

• Good to assess kidney function.

• Less expensive.

Nuclear medicine

Image features:• Projectional image.

• Image contrast by tissue uptake and metabolism.

ANATOMYANATOMY

•MRI IS NOT GOOD IN STONES

•In MRI bones are black

CASESCASES

• What are the imaging modalities?• What are the findings?• Diagnosis?

Case (1)

• Young male patient presenting with left flank pain and hematuria, no fever and normal WBC count.

• Kidney stones with hydronephrosis.• X-ray >> US >> CT

Case (2)

• Middle aged woman presenting with flank pain, fever and high WBC.

• Inflammation (e.g. Pyelonephritis)

•US >> CT+contrast >> MRI

Case (3)

• Elderly male patient with recurrent urinary tract infections.

• Bilateral hydronephrosis due to Prostate enlargement.

• US

Case (4)

• Young female presenting with decreased renal function (high urea and creatinine level).

• Polycystic.• US >> CT >> MRI• Contrast is contraindicated

Case (5)

• Elderly male patient with painless hematuria and weight loss.

• Tumor• MRI (BEST) >> US >> CT+contrast

Case (6)

• Young male patient involved in a motor vehicle accident with blunt trauma to the abdomen.

• Truma• CT (because it’s very fast)

Renal trauma grading

األسئلة : • عن الدكتور سألتجاه واحد مثال وبتكون بالنظري األسئلة تكون راح يقولخاصية وكذلك هذا؟ للشيء أشعة افضل وش حادث

األجهزة

البريدي حمد

THANK YOUTHANK YOU