IMAGING MODALITIES OF THE KIDNEY - u-szeged.hu€¦ · • Kidney failure: parenchyma destruction,...
Transcript of IMAGING MODALITIES OF THE KIDNEY - u-szeged.hu€¦ · • Kidney failure: parenchyma destruction,...
IMAGING MODALITIES OF THE KIDNEYIMAGING MODALITIES OF THE KIDNEY
Dr. Nagy EndreDr. Nagy Endre
Anatomical reviewAnatomical review
Anatomical reviewAnatomical review
PyelonPyelon
Examination modalities:Examination modalities:
• plain x-ray (film, fluoroscopy, tomography)plain x-ray (film, fluoroscopy, tomography)• contrast enhanced examinations contrast enhanced examinations • catheter angiography (DSA)catheter angiography (DSA)• ultrasound (B-mode, Doppler-mode, color, duplex)ultrasound (B-mode, Doppler-mode, color, duplex)• computed tomography (CT, CTA)computed tomography (CT, CTA)• nuclear magnetic resonance imaging (MRI, MRA)nuclear magnetic resonance imaging (MRI, MRA)• x-ray-, US-, CT-, MR-guided interventionsx-ray-, US-, CT-, MR-guided interventions• nuclear medicine nuclear medicine
Plain film:Plain film:
Contrast enhanced study:Contrast enhanced study:
DSA:DSA:
Ultrasonography:Ultrasonography:
Computed tomography:Computed tomography:
MRI:MRI:
Nuclear medicine:Nuclear medicine:
Diseases of the kidneyDiseases of the kidney
• Developmental variations, disordersDevelopmental variations, disorders• Collecting system (Obstruction, stone, Collecting system (Obstruction, stone,
hydronephrosis)hydronephrosis)• Acute and chronic inflammationAcute and chronic inflammation• Circulation disorders (renovascular hypertension, Circulation disorders (renovascular hypertension,
function failure)function failure)• (Diseases of the parenchyma)(Diseases of the parenchyma)• InjuriesInjuries• Space occupying lesions (cystic, solid)Space occupying lesions (cystic, solid)
Normal variations and congenital Normal variations and congenital disorders (abnormality)disorders (abnormality)
• fusion anomalies (Bertini-columna, lobulated kidney, fusion anomalies (Bertini-columna, lobulated kidney, dromedary-kidney, horseshoe-kidney)dromedary-kidney, horseshoe-kidney)
• extrarenal pyelonextrarenal pyelon• congenital malposition (dystopy, congenital malposition (dystopy, crossed dystopy, crossed dystopy,
malrotation)malrotation)• agenesis, hypoplasiaagenesis, hypoplasia
Other genital disorders !Other genital disorders !
DystopyDystopy
Horseshoe-kidneyHorseshoe-kidney
Obstruction, stone, hydronephrosisObstruction, stone, hydronephrosis
• acute: enlarged kidney, slow perfusion and excretion, acute: enlarged kidney, slow perfusion and excretion, moderate dilatation of the pyelon, stone, other causesmoderate dilatation of the pyelon, stone, other causes
• chronic: dilated collecting system, thin parenchyma, chronic: dilated collecting system, thin parenchyma, pure excretion, stone, other causespure excretion, stone, other causes
Ureter stone, acute hydronephrosisUreter stone, acute hydronephrosis
Chronic hydronephrosisChronic hydronephrosis
Acut and chronic inflammationsAcut and chronic inflammations
• autoimmun: large/small kidney autoimmun: large/small kidney • acute pyelonephritis (acute focal bacterialacute pyelonephritis (acute focal bacterial
nephritis, etc) nephritis, etc) • emphysematous pyelonephritis: large kidney, emphysematous pyelonephritis: large kidney,
hypodensity, decreased contrast uptake, space hypodensity, decreased contrast uptake, space occupation, thikening of the renal fascia, gas in the occupation, thikening of the renal fascia, gas in the parenchymaparenchyma
• Pyonephros : hydronephrosis, thik wall of the pyelonPyonephros : hydronephrosis, thik wall of the pyelon• abscess: APN abscess: APN + + abscess cavityabscess cavity• segmental, polar, global atrophy segmental, polar, global atrophy
Calcified lesionCalcified lesion
Surgical preparateSurgical preparate
Surgical towels
Chronic inflammationChronic inflammation
Circulation and function abnormalityCirculation and function abnormality
• infarction (partial, complete): no enhancement, infarction (partial, complete): no enhancement, absence of excretionabsence of excretion
• Renal vein thrombosis: large kidney, slow Renal vein thrombosis: large kidney, slow perfusion, venous filling defect, perirenal perfusion, venous filling defect, perirenal collaterals, no excretioncollaterals, no excretion
• Renal artery stenosis, renovascular hypertensionRenal artery stenosis, renovascular hypertension• aneurysmaaneurysma• Kidney failure: parenchyma destruction, Kidney failure: parenchyma destruction,
calcification, pure excretion calcification, pure excretion (contrast material?!?)(contrast material?!?)
Kidney infarctionKidney infarction
Renal vein thrombusRenal vein thrombus
Renal artery stenosis on both sidesRenal artery stenosis on both sides
PosttraumPosttraumaticatic A-V shunt A-V shunt
Kidney injuriesKidney injuries
• blount or penetrating injuries, contusionblount or penetrating injuries, contusion• haematoma (subcapsular/perirenal), urinoma, haematoma (subcapsular/perirenal), urinoma,
parenchyma laceration, artery/vein injuries, ureter parenchyma laceration, artery/vein injuries, ureter rupturerupture
Subcapsular haematomaSubcapsular haematoma
„„Spontaneos” ruptureSpontaneos” rupture
Space occupying lesionSpace occupying lesion
cysticcystic - simple (solitaer, multiple)- simple (solitaer, multiple) - hereditary (polycystic disease)- hereditary (polycystic disease) - atipical (closed calix, diverticula, cystic tumor, - atipical (closed calix, diverticula, cystic tumor,
abscess, echinococcus, multilocular cysticabscess, echinococcus, multilocular cysticnephroma)nephroma)
• solidesolide - benign (AML, adenoma, oncocytoma, etc.)- benign (AML, adenoma, oncocytoma, etc.) - pr. malignances (RCC, TCC, Wilms-tumor)- pr. malignances (RCC, TCC, Wilms-tumor) - sec. malignances (HL, NHL, metastasis)- sec. malignances (HL, NHL, metastasis)
CystCyst
Cystic tumor in a horseshoe kidneyCystic tumor in a horseshoe kidney
AngiomyolipomaAngiomyolipoma
Hypernephroid carciomaHypernephroid carcioma(Grawitz-tumor)(Grawitz-tumor)