urogenital radiology

Question 1

how to choose the proper method

Answer 1

• course diagnosis
• patient history and condition
• ALARA (policy that aims to maintain the level of exposure to radiation or other hazardous materials as far below regulatory limits as possible)
• accessibility
• cost/benefit

Question 2

contrast enhance genitourinary imaging

Answer 2

• CT, DSA:
• non ionic iodinated agents
• iso-osmolar
• renal elimination
• MRI:
• compounds with special magnetic features
• low complication risk
• > becomes high if: allergy, asthma bronchiale, cardiovascular disease, previous severe adverse effect, renal insufficiency, diabetes, dehydration, hemoglobinopathy, hyperproteinemia

Question 3

what to check before an examination with iodinated contrast material

Answer 3

• history of patient
• hydration
• metformint type antidiabetics
• creatinine level < 130 mmol/L
• GFR > 60 ml/min
• hyperthyreosis

Question 4

congenital anomalies of the renal parenchyma

Answer 4

• unilateral agenesis
• supernumentary kidney
• horseshoe kidney
• ectopic kidney
• crossed renal ectopy
• renal cysts: polycystic kidney, multicystic kidney
• medullary sponge kidney

Question 5

congenital anomalies of pelvi-calyeal system

Answer 5

• calyceal diverticulum
• calyx cyst
• congenital hydronephrosis
• pyelon + ureter duplication
• bifid ureter
• megaureter
• ectopic ureter aperture
• ureterocele
• urinary bladder diverticulum

Question 6

renal tumors: benign

Answer 6

• adenoma
• oncocytoma
• angiomyolipoma
• mesenchymal tumors
• multicystic nephroma

Question 7

angiomyolipoma: MRI

Answer 7

• T1: hyperintense

- T2: isointense to prerenal fatty tissue

Question 8

renal tumors: malignant

Answer 8

• hypernephroma
• Wilm’s tumor
• lymphoma
• leukemia
• metastasis

Question 9

conventional radiography in dagnosis of RCC

Answer 9

• intraveous urography
• sensitivity 67%
• non-specific sign of expansile renal mass
• margins compression
• lack of contrast material filling
• displaced calyces

Question 10

the role of US in diagnosis of RCC

Answer 10

• B-mode
• Doppler mode
• sensitivity: 79%
• hypo-, iso-, hyper- echoic solid tumor
• central necrosis
• hypervascularisation
• high sensitivity in cases of renal vessel infiltration

Question 11

MDCT in RCC

Answer 11

• gold standard!
• in unenhanced images, the density is almost the same as the surrounding parenchyma (30-50 HU)
• in arterial phase -> transient hyper-dense blush
• in parenchymal phase -> hypo-dense lesion

Question 12

Bosniak classification for cysts

Answer 12

I. simple cyst
II. needs follow up
III. malignant in 50%
IV. malignant in 100%

Question 13

nephrolithiasis/urolithiasis - which modality to use?

Answer 13

low dose CT (best diagnostic method)

Question 14

chronic prostatitis in US

Answer 14

hypo-echogenicity in the peripheral zone.
small hyper-echoic foci with acoustic shadowing.
coarse intraprostatic calcification.

Question 15

diagnostic methods in malignant prostate tumors

Answer 15

• transrectal US

- MRI

Question 16

MRI of prostate cancer (T1 Vs T2)

Answer 16

• multiplanar, T2: assess localisation, size, local invasion.
• T1: assess pelvic bone, lymph node metastases, post-biopsy bleeding

Question 17

MR-spectroscopy in prostate cancer

Answer 17

changes in metabolite concentrations in prostate cancer, as compared to the normal parenchyma:

• choline is increased (incr. cell proliferation, incr. cell density)
• citrate is decreased (cancer cells oxidise citrate, because of high energy demand).

Question 18

testis sonography

Answer 18

• high frequency probes (7.5-10 MHz)
• bilateral comparison
• technical parameters set to normal side
• longitudinal section
• transverse sections only for localising the pathology

Question 19

normal sonogram of testis

Answer 19

• wide variation is size
• most confident parameter in adults in maximal thickness on longitudinal sections (>20 mm).
• head and tail of epididymis -> echogenic structures below the testis
• normal body of epididymis, efferent ductuli, ductus deferens: not discernible.

Question 20

testicular tumors

Answer 20

• most frequent malignant tumors in males 25-34 y.o.
• 1-2% of all malignant tumors
• risk factors: family history, Caucasians, cryptorchidism
• types: Germ cell tumors, Seminoma, non-seminomas (embryonal cell tumor, teratomas, choriocarcinoma, yolk-sac tumor), stromal tumors (Leydig & Sertoli cell tumors), metastasis, lymphoma, leukemia

Question 21

seminomas

Answer 21

• most common in 30-40 y.o.
• hyper-echoic, homogenous
• metastasis (lung) present in 25% at time of diagnosis
• AFP is normal
• BHCG is increased
• sensitive to radio-, chemo- therapy
• 10-year survival rate: 75-85%

Question 22

non-seminomas

Answer 22

• US: mixed echogenicity, due to bleeding, fibrosis, calcification

a) embryonal cell cancer:
- < 2 y.o. or 20-30 y.o.
- very aggressive, early visceral metastasis
b) teratoma:
- benign in boys
- can transform to malignant in adulthood
c) choriocarcinoma:
- 20-30 y.o.
- early metastasis to lung

Question 23

choriocarcinoma

lymphoma / leukemia

Answer 23

• 7% of all testicular tumors
• > 5 y.o.
• bilateral in 40%
• hypo-echoic areas -> diffuse or local in the lesion
• the entire testis may be involved in leukemia

Question 24

tumors of female pelvis

& which imaging modalities to use

Answer 24

• benign tumors
• endometrial cc
• cervical cc
• ovarian cc
• use: US, MRI, CT

Question 25

urinary bladder cancer: MRI

Answer 25

Endorectal & surface coils allow good assessment of the bladder wall (including the base and neck), the prostate and seminal vesicles.
The bladder wall and the lesion can be well differentiated both in T1 and T2 weighted images.

Question 26

virtual cytoscopy: when to use

Answer 26

In post-operative conditions and injuries.

The goal is to accurately describe the complications.