imaging the kidney and urinary tract

Question 1

what is the main indication for abdominal (KUB - kidney ureter bladder) radiograph (X-ray)?

Answer 1

urinary tract calculus (stone)

Question 2

what 4 things should you do when looking at an abdominal x-ray?

Answer 2

1. gas pattern — any dilated gas filled loops, any free gas
2. soft tissue outlines — any enlargement?
3. calcification — bones and other calcifications
4. any foreign objects — eg. surgical clips

Question 3

describe ultrasound

Answer 3

• involves imaging of the kidneys and the urinary bladder only
• the testes can also be imaged using US
• no radiation involved — only sound waves
• commonly used in paediatric radiology
• operator dependent
• can get contrast enhanced ultrasound — anything solid takes up ‘micro bubbles’

Question 4

describe fluoroscopy

Answer 4

• involves imaging of kidneys, ureters and bladder (KUB)
• used as part of a screening regime
• there is continual use of x-rays (radiation) to generate picture
• cystograms are used in paediatric radiology — a cystogram is an examination that takes pictures of the bladder and urethra — contrast material is introduced into your bladder through the catheter then x rays are taken
• can be used for urethrograms too
• intervention : nephrostomy and antegrade (normal path of urine flow) ureteric stent (=stent into kidney if it is blocked and into ureter)

radiation involved

Question 5

describe CT

Answer 5

• rotating x ray tube and detector
• IV contrast — renal function
• urianry tract calculi
• renal tumours
• urinary tract tumours
• cancer staging
• renal cyst characterisation

Question 6

describe MRI

Answer 6

• magnet and coils : radio waves and magnetic fields
• no radiation
• soft tissue
• IV contrast
• time
• diffusion weighted imaging — multi-para metric imaging for prostate cancer
• renal lesion characterisation
• renal and urinary tract tumours
• prostate cancer

Question 7

describe nuclear medicine

Answer 7

• radioactive tracer and gamma camera
• radiation
• assessment of function
• technetium-99m
• DMSA : dimercaptosuccinic acid
• MAG 3 : mercaptoacetyltriglycine

Question 8

what do these show

Answer 8

healthy kidney (left) and bladder (right). can see uterus behind bladder

Question 9

ultrasound

Answer 9

hydronephrosis of kidney

• renal pelvis in middle is dialted — blocked

Question 10

what can be assessed with ultrasound that is vital for transplant kidneys?

Answer 10

blood supply

Question 11

Answer 11

polycystic kidney disease (left)

angiomyolipoma in kidney (right ) - fatty mass

Question 12

what does a cystogram look like? when are they done?

Answer 12

• post pelvic surgery, trauma
• bladder filled with contrast - looking for all contrast to stay in bladder

Question 13

what is seen in a hydronephrotic kidney?

Answer 13

dilated pelvis

Question 14

what test would you do if got haematuria?

Answer 14

CT urogram