Imaging Flashcards
US - pros
1st line for hematuria good info about renal parenchyma excellent for hydronephrosis + renal stones renal & bladder anatomy blood flow (doppler) no iv contrast
US- cons
poor ureteral anatomy
operator-dependent
patient factors
CT KUB pros
best for renal calculi
identifying stones - can even seen uric acid (not on X-ray)
renal edema, Collecting system, perirenal edema and inflammation
fast
renal stones, masses, renal trauma
rule out AAA, appendicitis
CT KUB cons
no functional information
expensive
MRI pros
soft tissue/vasculature
contrast less nephrotoxic
allergy to CT contrast
MRI cons
long exam time
CI: pacemakers, metal
IV pyelogram pros
X-rays before and after contrast
renal obstruction, malignancy, injury to collecting system, congenital abnormalities
functional/anatomical
presence of stones, obstructions, congenital abnormalities
sensitive for TCC
IV pyelogram cons
slow several hours if obs present nephrotoxic contrast invasive less sensitive for RCC mostly replaced by CT used in pregnancy
CT + contrast pros
"one stop shop" for hematuria good for renal masses good for stones renal masses, infarcts, abscesses functional info better evaluation of parenchyma than non-contrast
3 phases:
1) non-contrast
2) nephrographic - contrast in parenchyma
3) delayed - contrast in renal calyx (excreted)
enhancement within masses = solid mass, not a cyst
CT + contrast cons
can obstruct stones with contrast
contrast is nephrotoxic
higher radiation dose than CT-KUB
Retrograde pyelogram pros
when CT contrast required but allergic
Retrograde pyelogram cons
invasive cystoscopy
Radiographic features of cysts
differentiate from solids using CT, US, MRI
Radiographic features of solid masses - benign
oncocytoma: stellate central scar on CT
- difficult to differentiate from malignant masses
angiomyolipoma - fat on CT
Radiographic features - RCC
US shows solid mass, Doppler - blood flow CT/MRI : - characterize - enhancement wiht IV contrast - spread often enhance with contrast invade renal vein, up into IVC
Radiographic features - TCC
US
- may show mass in bladder
- may show hydronephrosis if obstruction present
- won’t show mass in ureters
- Doppler for blood flow
CT-IVP/retrograde pyelogram/cystoscopy
- evaluate renal pelvis, ureters and bladder
Radiographic features - lymphoma
multiple, bilateral lesions in kidney
Radiographic features - calculi
KUB plain film - show based on Ca content
US: bright echogenic with acoustic shadow
high density focus on CT KUB
Calcium calculi on imaging
75%
radio-opaque on KUB, CT KUB
Ca-oxalate/phosphate
Calcium struvite imaging
15%
radioopaque on KUB and CT KUB
“infective stones”
Cystine calculi imagining
2%
less-radioopaque on KUB
Uric acid stone imaging
10%
radiolucent, opaque on CT KUB
Xanthine stone imagining
rare
radiolucent, opaque on CT KUB
Indinovir stone imagining
HIV antiretroviral
radiolucent on KUB and CT KUB
Matrix stone imagining
radiolucent
opaque on CT KUB
infection stone
