GU imaging Flashcards
common indications to image the renal tract
categories for renal tract symptoms
- pain in lumbar region when micturating
- changes to urine and flow of urine
- palpable lump
what is visible on a KUB
- kidney size, location and morphology
- calcifications
- potential pathologies/ incidental findings
- spinal disease
- Metastases
common clinical indications x-ray
- Haematuria (macroscopic {can be seen} or microscopic [only seen under microscope})
- ? stones
- post surgery (stents)
- loin pain
- dysuria
intravenous urogram (IVU) common indications
- renal colic
- haematuria
- recurrent UTI
- Suspected urinary tract pathology
potential findings on x-ray
- duplex kidney
- horseshoe kidney
benefits and uses of ultrasound
effective in evaluating:
- renal size
- masses
- renal obstruction
- bladder residual volumes
- function of vessels using doppler
disadvantages of ultrasound
- cant be used for air related studies
- can be nonspecific - can see abnormality, but what it is may be difficult
- non replicable - images wont look the same if redone
ultrasound common indications
- renal mass
- rena; cysts
- infections
- UTI
- haematuria
- obstruction
ultrasound patient prep
- patient needs full bladder (1hr b4 scan start drinking water 500-1000mls
- patient shouldn’t empty the bladder b4 examination
renal ultrasound technique - kidneys (which transducer is used?)
3-7 MHz curvilinear transducer - more frequency and high penetration
Renal ultrasound technique
- scanned in supine longitudinally
- in oblique coronal plane
- A transverse view is included, so all aspects are visualised
for renal ultrasound paeds are scanned…
in prone postion
US guided biopsy - after care
- patient is advised not to drive
- no heavy lifting or strenuous exercise
- pain killers are allowed to be taken, however not aspirin
- Attend emergency department if they experience severe back pain, blood/clots in the urine or feel faint
CT renal imaging
renal stone tumours perineal collection loin mass staging and follow up of renal carcinomas CT angiography - renal arteries
CT KUB allows detection of
ureteral wall oedema
perinephric oedema
hydronephrosis
renal sinus infiltration
CT IVU Technique
- patient is supine
- scanogram is done
- initial scan is non-contrast
- patient is injected with 70 MLS of contrast at 2-4mls/s
- 10 minutes after contrast injection, another 30mls is injected and 1mm slices are taken from the top of the kidneys to the base of the bladder
renal mass imaging
- patient is supine
- scanogram is done
- non-enhanced scan from diaphragm to lower poles of kidneys
- patient is injected with ‘low osmolar contrast’
- contrast-enhanced scan is taken. 30 second
other renal scans
- scanning for trauma
- penetrating wounds
renal trauma scan
- patient is supine
- ABDO-PELVIS CT
- scanogram - from diaphragm - symphysis pubis
- 100 mls of IV contrast 2-4mls/s
- 60 -70 sec delay
CT Guided biopsy patient prep
bloods- eGFR, INR
- written consent
- contrast enhanced CT prior to biopsy
- site entry and trajectory is then planned using previous CT
- patient position is dependant on mass location
CT Biopsy technique
- patient positioned onto table
- unenhanced scan 5-7mm slice thickness through kidneys
- the slice depicting the mass is selected
- limited scan through the mass is repeated
- needle entry point is determined
CT biopsy technique (during)
- local anaesthetic is administered
- angle of approach is determined
- needle is then advanced
- sample is acquired and processed
- the sample is rolled onto a saline soaked gauze
- is then assessed for glomeruli
- then placed into formalin saline solution
CT Biopsy patient aftercare
- patient needs to stay flat on back for 6 hrs
- close monitoring is done
CT biopsy potential complications
- could induce further bleeding in the renal system
- pain
- could induce sepsis
- tumour seeding (breaking up tumour - could induce it to another area if dropped in body)
MRI in GU imaging
- not commonly used as 1st choice
- used in prostatic and endometrial imaging
- renal masses
- urinary tract obstruction
- congenital anomalies
- visualisation of renal arteries
MRI prep
- safety questionnaire
- contrast check
- consent
mri technique
- T2 weighted sequence used ( good for fluid filled structures) e.g. renal cysts
- T1 shows tumours well with gadalinium enhancement
