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