imaging of the renal system dr. dima jamjoom department of radiology same slides but with...
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Imaging of the Imaging of the Renal SystemRenal System
Dr. Dima JamjoomDepartment of Radiology
Same slides but with Dr.Dima’s notes. (Dark Red)Good luck
اجتهاد شخصي إن أصبت فمن الله وان أخطأت فمن نفسي
OUTLINEOUTLINE
• Introduction• Imaging modalities• Anatomy• Cases
INTRODUCTIONINTRODUCTION
• What is radiology? It is a medical specialty that employs
the use of imaging to both diagnose and treat disease within the human body.
• What is the renal system? Kidneys, ureters, urinary bladder and
urethra.
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)
This slide is *taken from the boys slide*, I think it’s the only difference between the
Female/Male slides .
Conventional radiography= Plain X-Ray• First imaging
modality. meaning that a patient complains of symptoms renal disease, we start by X-ray
• Cheap.• Useful for radio-
opaque stones. But it’s limited, usually used only for this purpose. *radio-opaque stones will appear white.*
Note that there are stones which are not radio-
opaque and are diagnosed by US and CT.
Conventional radiography
Image features:• Projectional image.• Image contrast
determined by tissue density.
• Good evaluation radio-opaque stones.
IVU= same as plain x-ray but we give the patient
contrast
• Conventional x-ray plus intravenous contrast.
• Cheap.• Recently replaced
by CT and MRI. • Useful for radio-
opaque stones.Contrast : + الوريد عبر نحقنها itمادة
will appear white in the x-Ray.
IVUImage features:• Projectional image.• Image contrast
determined by tissue density and IV contrast.
• Good evaluation of collecting system and radio-opaque stones. + the doctor said it is used also for hydronephrosis which is dilatation of the collecting system.
US
• Use high frequency sound wave.
• Contrast between tissue is determined by sound reflection.
USImage features:• Operator
dependant. Meaning that if the practitioner is good, then images will be good if not then the images will be bad.
• Projectional image.• Good resolution.• Used for stone,
hydronephrosis, focal lesion.
Fluid = black.Fat = White.
CT• Same basic
principle of radiography.
• More precise.• Costly.• +/- contrast.( we can
do it with or without contrast)
• Useful for trauma, stone, tumor, infection.
If patient suspected with stones, then
the gold standard is CT without contrast.
CT
Image features:
• Cross sectional images.
• Image contrast determined by tissue density +/- contrast.
• Better evaluation of soft tissue.
Non-contrast CT
MRI
• Better evaluation of soft tissue.
• Expensive. + time consumer, takes 30-45 mins
• Useful for soft tissue pathology: tumor, infection.
If we are suspecting renal tumors, then MRI is the
best.
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*.
• Functional test. Meaning that the Anatomy won’t appear clear as the CT and MRI but gives us an idea about the function of the kidneys.
• Less expensive.• Useful for: obstruction
and split function. مشعة * مادةعبر نحقنها
الوريد
Nuclear medicine
Image features:• Projectional image.
• Image contrast by tissue uptake and metabolism.
ANATOMYANATOMY
Plain x-ray
Kidneys size is about 3 and half vertebral
bodies including the
vertebral discs.
IVU
US
CT
The doctor talked in details about the fasciae and
everything in this picture.
CT with contrast, •*Aorta* : we can see it
in the right because we gave contrast .
MRI
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.
This is Plain X-ray without contrast, we can see radio-
opaque stones in the left kidney.
This is IVU we can see dilatation of the collecting system ( hydronephrosis).. Stones
causing hydronephrosis. *Renal pelvis is a bet dilated*
Same patient but with CT and US, stones will be
white by ultrasound.
Note the dilatation on this side ( Hydronephrosis )
Case (2)
• Middle aged woman presenting with flank pain, fever and high WBC.
We expect infection.
CT
Kidneys are white except some areas which is darker, this
is the focal infection ( pyleonephritis )
Case (3)
• Elderly male patient with recurrent urinary tract infections.
us Renal pelvis is dilated. * it’s dark because it contains fluid*
Nuclear, collecting system is dilated. (normally the isotope will be less in the kidneys with time) but in this case still there is
isotope in the kidneys.
Case (4)
• Young female presenting with decreased renal function (high urea and creatinine level).
Renal failure.
US •Kidneys are not seen, it’s replaced by cysts which are dark .
MRI of same patient.No kidneys, replaced
by cysts.
This is congenital ( autosomal dominant
polycystic kidney disease.)
gross
Case (5)
• Elderly male patient with painless hematuria and weight loss.
tumor
MRI, we see a mass
Case (6)
• Young male patient involved in a motor vehicle accident with blunt trauma to the abdomen.
Trauma, cases of trauma = CT
CT
Renal trauma grading.1bleeding beneath the
renal capsule, contusion . دائرة)(
.2Ulceration less than 2 cm + not involving the
collecting system ألسر ) = طويل شوي مو دائرة )
.3more than 2 cm but also not involving the collecting system
.4Extending to collecting system or if there is( thrombus ) , injury to blood supply.
.5Shattered kidney, multiple injuries , or اذا
انقطع البلود سبالي تماما
ReferencesReferences
• Stephanie Ryan, “Anatomy for Diagnostic imaging”, 2nd Edition.
• Jamie Weir, Peter Abraham, “Imaging Atlas of Human Anatomy” 3rd Edition.
• Peter Armstrong, “diagnostic imaging”, 5th Edition.
THANK YOUTHANK YOU