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year 2 renal > Imaging of the Urinary System > Flashcards

Imaging of the Urinary System Flashcards

1
Q

Anatomical overview

Each kidney is about ______ cm long

The kidneys are slightly ______ in men than in women

They increase in size up to the age of 20 years and become _______ again in later life

Each kidney weighs 120-170 grams

Renal blood flow ____ cc/min

A

10- 12

larger

smaller

1200

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2
Q

Ureters:

______ cm long

3-8 mm in diameter

_ points of narrowing

___

______ ____

__ _______

Passes on the medial edge of ____ muscles which separate it from the tip of the transverse processes

A

25-30

3

PUJ

Pelvic brim

VU junction

psoas

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3
Q

Bladder:

Pyramidal structure with its base _________ and apex behind the ________

Extra-_______

_______ is a triangular area between the ureteric and urethral orifices

A

posteriorly

symphysis

peritoneal

Trigone

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4
Q

what are indications of renal imaging?

A

Renal colic and renal stone disease - Diagnosis and follow up

Hematuria

Suspected renal mass

UTIs

Hypertension

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5
Q

What are different imaging techniques?

A

Plain film

Contrast studies:

  • IVU
  • Pyelography: antegrade, retrograde, ileal conduit
  • Cystography

Ultrasound +/- contrast

CT and CTU

MR and MRU

Isotope scans

PET-CT

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6
Q

what are the advantages of plain films?

A

Cheap and readily available

Functional and anatomical information (IVU)

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7
Q

what are the disadvantages of plain films?

A

Low sensitivity and specificity for urological diseases

Radiation

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8
Q

what is shown here?

A

KUB
Urethral stone

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9
Q

What is shown here?

A

IVU
Stone left ureter

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10
Q

What is shown here?

A

IVU showing bladder tumour

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11
Q

what are some other contrast studies?

A

Pyelography - Injection of contrast into the ureters

Micturating cystourethrography - Vesico-ureteric reflux and its grade

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12
Q

what are the advantages of US?

A

Cheap and readily available

No radiation

Contrast is not nephrotoxic

Real time imaging

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13
Q

what are the disadvantages of US?

A

Limited by body habitus and gas

Poor visualisation of ureters

Operator dependant

No functional information

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14
Q

what is shown here?

A

Ultrasound
normal right kidney

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15
Q

what is shown here?

A

Horseshoe kidney
US and CT

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16
Q

what is shown here?

A

Ureterocele

a congenital abnormality found in the ureter. In this condition the distal ureter balloons at its opening into the bladder, forming a sac-like pouch

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17
Q

what is shown here?

A

Megaureter

medical anomaly whereby the ureter is abnormally dilated

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18
Q

what is shown here?

A

Renal tumour

19
Q

What is shown here?

A

Urothelial tumours

20
Q

What is shown here?

A

Doppler US
Normal

21
Q

what is shown here?

A

Renal artery stenosis

22
Q

what are the advantages of CT?

A

Currently the imaging modality of choice for detection of renal stones, staging renal tumours, investigation of hematuria

Good spatial resolution with capability of multi planar reformat

23
Q

what are the disadvantages of CT?

A

Radiation dose

Cost

Contrast resolution less than MR

Contrast reaction and nephrotoxicity

24
Q

What is shown here?

A

CT
right sided renal stone

25
Q

what is shown here?

A

CT showing renal tumour with IVC thrombus

26
Q

what is shown here?

A

CT
Bladder tumour

27
Q

what is shown here?

A

CTU
left ureteric tumour

28
Q

what are the advantages of MR?

A

Multiplanar imaging

Excellent contrast resolution

Imaging of urothelium without contrast injection (MRU)

29
Q

what are the disadvantages of MR?

A

Poor spatial resolution

Poor detection of calcification and stones

Cost

Contraindications: pace maker, claustrophobia,etc

Contrast reaction and other side effects

30
Q

what is shown here?

A

Angiomyolipoma Right kidney
MR

31
Q

what is shown here?

A

Tumour right kidney
MR

32
Q

what is shown here?

A

MRU
Duplex collecting system

33
Q

What is shown here?

A

MRU
Horseshoe kidney

34
Q

What is shown here?

A

MRU
transitional cell tumour

35
Q

What is shown here?

A

Bilateral renal tumours and cysts

36
Q

Isotope scan - what are each of the following used for:

DMSA

MAG3

Bone scan

A

DMSA - To look for renal scarring

MAG3 - Assess renal function and drainage

Bone scan - Metastatic disease e.g. prostate cancer

37
Q

is a PET-CT useful?

A

Limited use in staging of urological malignancies due to high uptake in urine and variable uptake by tumours

May be useful for extra-urological metastatic disease if other imaging modalities are equivocal or in poor surgical candidates

38
Q

case 1:

45 year old man with right sided renal colic

No hematuria

No other medical problems of note

What does US show?

What other imaging test that you would like to request?

What is your plan of management?

A

What does US show?

  • Hydoronephrosis
  • Ureter not dilated. .?PUJ obstruction

What other imaging test(s) that you would like to request?

  • CT: Assess anatomy and cause of obstruction: eg stone, tumour
  • MAG3: Assess function
  • Or MR

What is your plan of management?

  • Confirm diagnosis of PUJ
  • Exclude an aberrant renal artery
  • Treatment - Interventional radiology, Surgery
39
Q

What is shown here?

A

CT angiography
crossing accessory renal artery

40
Q

Case 2:

65 year old male with medically resistant hypertension and suspected renal artery stenosis. eGFR 55 ml/min

What is the initial test that you would like to request?

How would you plan further management?

A

What is the initial test that you would like to request?

  • MRA
  • CTA
  • Historically US and Renal isotope

How would you plan further management?

  • Conventional angiography
  • Dilation and stent
41
Q

What is the best imaging modality to diagnose renal tract stones?

a) Plain films
b) US
c) CT
d) MR
e) Pyelography

A

C

42
Q

What imaging modality of choice in staging of renal tumours

a) US
b) CT
c) MR
d) PET-CT

A

B

43
Q

What is the least helpful imaging modality in assessment of patient with suspected renal artery stenosis

a) CTA
b) MRA
c) US
d) Conventional angiography

A

C

year 2 renal (26 decks)

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