urogenital radiology Flashcards
how to choose the proper method
- 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
contrast enhance genitourinary imaging
- 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
what to check before an examination with iodinated contrast material
- history of patient
- hydration
- metformint type antidiabetics
- creatinine level < 130 mmol/L
- GFR > 60 ml/min
- hyperthyreosis
congenital anomalies of the renal parenchyma
- unilateral agenesis
- supernumentary kidney
- horseshoe kidney
- ectopic kidney
- crossed renal ectopy
- renal cysts: polycystic kidney, multicystic kidney
- medullary sponge kidney
congenital anomalies of pelvi-calyeal system
- calyceal diverticulum
- calyx cyst
- congenital hydronephrosis
- pyelon + ureter duplication
- bifid ureter
- megaureter
- ectopic ureter aperture
- ureterocele
- urinary bladder diverticulum
renal tumors: benign
- adenoma
- oncocytoma
- angiomyolipoma
- mesenchymal tumors
- multicystic nephroma
angiomyolipoma: MRI
- T1: hyperintense
- T2: isointense to prerenal fatty tissue
renal tumors: malignant
- hypernephroma
- Wilm’s tumor
- lymphoma
- leukemia
- metastasis
conventional radiography in dagnosis of RCC
- intraveous urography
- sensitivity 67%
- non-specific sign of expansile renal mass
- margins compression
- lack of contrast material filling
- displaced calyces
the role of US in diagnosis of RCC
- B-mode
- Doppler mode
- sensitivity: 79%
- hypo-, iso-, hyper- echoic solid tumor
- central necrosis
- hypervascularisation
- high sensitivity in cases of renal vessel infiltration
MDCT in RCC
- 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
Bosniak classification for cysts
I. simple cyst
II. needs follow up
III. malignant in 50%
IV. malignant in 100%
nephrolithiasis/urolithiasis - which modality to use?
low dose CT (best diagnostic method)
chronic prostatitis in US
hypo-echogenicity in the peripheral zone.
small hyper-echoic foci with acoustic shadowing.
coarse intraprostatic calcification.
diagnostic methods in malignant prostate tumors
- transrectal US
- MRI
MRI of prostate cancer (T1 Vs T2)
- multiplanar, T2: assess localisation, size, local invasion.
- T1: assess pelvic bone, lymph node metastases, post-biopsy bleeding
MR-spectroscopy in prostate cancer
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).
testis sonography
- high frequency probes (7.5-10 MHz)
- bilateral comparison
- technical parameters set to normal side
- longitudinal section
- transverse sections only for localising the pathology
normal sonogram of testis
- 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.
testicular tumors
- 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
seminomas
- 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%
non-seminomas
- 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
choriocarcinoma
lymphoma / leukemia
- 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
tumors of female pelvis
& which imaging modalities to use
- benign tumors
- endometrial cc
- cervical cc
- ovarian cc
- use: US, MRI, CT
