Uroradiology

Question 1

common uroradiology exams

Answer 1

*abdomen radiographs (aka KUB)
*fluoroscopic cystogram (images of bladder)
*fluoroscopic urethrogram (images of urethra)
*CT
*sonography
*MRI
*interventional

Question 2

abdominal radiographs (KUB) - overview

Answer 2

*basic abdominal film
*shows urinary tract stones + other calcifications
*evaluate bowel gas pattern
*upright views can assess for free intraperitoneal air
*evaluate osseous structures

Question 3

indications for KUB

Answer 3

*follow up of radio-opaque stone
*evaluate position of stents, drains
*evaluate bowel gas pattern

Question 4

KUB - limitations

Answer 4

*very limited specificity and sensitivity
*requires radiation
*poor contrast
*most of urinary tract invisible

Question 5

renal sonography - limitations

Answer 5

*limited functional assessment
*ureters invisible (unless dilated)
*OPERATOR DEPENDENT
*patient body habitus limitations
*less accurate than CT for detection of masses, stones

Question 6

indications for renal ultrasound

Answer 6

*evaluation for cause of renal insufficiency
*renal size
*renal transplants: obstruction, blood flow, fluid collections
*renal mass evaluation: CYST OR SOLID mass

Question 7

renal CT - overview

Answer 7

*most accurate for renal masses
*most accurate for STAGING CANCER
*best test for stone diagnosis
*hematuria evaluation
*entire abdomen visible
*3D reconstructions possible

Question 8

indications for renal CT

Answer 8

*suspected stone disease
*known or suspected renal mass: diagnosis, STAGING, treatment planning
*blunt trauma
*HEMATURIA EVALUATION

Question 9

renal CT - limitations

Answer 9

*radiation
*relatively expensive
*contrast media often needed

Question 10

best uroradiology imaging for STAGING OF CANCER

Answer 10

renal CT

Question 11

important limitation of renal sonography

Answer 11

operator dependent

Question 12

CT urography - pros and cons

Answer 12

*pros: able to visualize the kidneys, bladder, ureters; great screening exam for hematuria
*cons: radiation exposure (essentially 3 CT scans in one study), contrast use

*3 scans: noncontrast, nephrographic phase, urographic phase

Question 13

indications for cystogram

Answer 13

*suspected bladder trauma
*suspected vesicoureteral reflux
*post-op evaluation (evaluate for leak after prostatectomy)

Question 14

indications for urtherogram

Answer 14

*urethral trauma
*suspected stricture disease
*post-op evaluation

Question 15

interventional uroradiology

Answer 15

*percutaneous ablation of renal tumors
*image-guided abscess drainage
*image-guided kidney drainage
*image-guided biopsies

Question 16

best test for hydronephrosis

Answer 16

*renal ultrasound

Question 17

best test for acute flank pain + hematuria

Answer 17

*renal CT

Question 18

best test for determining cysts vs. tumors

Answer 18

*ultrasound
*anechoic = simple cyst
*hyperechoic + blood flow is likely a tumor

Question 19

renal sonography - overview

Answer 19

*no toxicity or radiation
*readily available
*real-time examination
*good visualization of kidneys (mostly)
*great for differentiation solid vs. cystic masses
*best test for acute renal insufficiency work-up