泌尿系统影像学 (英文)

1、DIAGNOSTIC IMAGING OF URINARY TRACT Radiology = Anatomy + Pathology影像诊断 = 定位诊断 + 定性诊断 ImageINTRODUCTION Including both kidney, ureter, bladder and urethra.Lack of natural contrast.Need various kinds of contrast examination.Use of CT, USG,MRI. METHODS OF EXAMINATION Plain Film of the Abdomen (KUB) In

2、cluding both sides of kidney, area of ureter and bladder.To show contour, size, shape of the above organs and psoas muscles margin.To demonstrate stone and calcification of urinary tract KUBIntravenous Urography (IVU) METHODS OF EXAMINATION Preparation: 1. sensitivity test of iodine. 2.preparation o

3、f intestinal tract (fast 812h, catharsis) Contrast medium:1.Urografin (泛影葡胺) 2. Iopamidol (碘必乐) 3. Iopromide (碘普罗胺)Technique: 1.intravenous instillation of contrast medium (100ml) should be over in 510minutes 2. films are taken at 3,5,10,15,25(KUB) minutesDisplay: 1.excretory function of kidney 2.mo

4、rphology of urinary tractIntravenous Urography (IVU) METHODS OF EXAMINATION -C+CI.V.U.Retrograde Urography METHODS OF EXAMINATION To be used when IVU has been unsatisfactory or inconclusive.To show the morphology of urinary tract only.Retrograde Urography Renal Angiography METHODS OF EXAMINATION abd

5、ominal aortography.Selective renal arteriography.Renal Angiography Renal Angiography 插图CT METHODS OF EXAMINATION Plain Scans patient preparation : oral contrast medium administration or water for bowel and bladder filling 12%, 500ml of urografin for kidney CT 12%, 1000ml of urografin for bladder CT

6、the bladder must be fully distendedSlice thickness and intervals: 510mmScanning method: sequential CT scansScanning ranges: upper pole of kidneyureterbladderPlain Scans CT Contrast enhanced Scans CT METHODS OF EXAMINATION Contrast medium: 60100ml, 1.52.5ml/sIntravascular administration: bolus inject

7、ion Scanning:Sequential CT scans: start at 1520s after injectionDelayed CT scans: can be performed at 510min. after injection to show filling the pelvis, ureter and bladder with contrast mediumContrast enhanced Scans CT MRI Plain Scans: transverse T1WI (T1-Weighted imaging) + T2WI (T2-Weighted imagi

8、ng) with SE (spin-echo sequences) coronal T1WI with SEContrast enhanced scans: contrast medium: Gd-DTPA, 0.10.2mmol/kg scanning sequences: T1WI with SEMRU (MR urography): to demonstrate the obstruction of urinary tractMETHODS OF EXAMINATION KUBI.V.U.R.U.AngioCTUSNORMAL IMAGING OF URINARY TRACT KUB &

9、 IVU Kidney 1. position: T1112 to L122. size: 11135623cm (3612cm) Contour: smooth Minor calyces: 1014Major calyces: 24Pelvis: trumpet , branch, ampulla Pelvis中间型 trumpet分枝型 branch壶腹型 ampullaUreter NORMAL IMAGING OF URINARY TRACT KUB & IVU long: 2530cmwidth: 35mmphysiological narrowings: pelvi-ureter

10、al junction iliac vessels entry of bladder 15Bladder NORMAL IMAGING OF URINARY TRACT KUB & IVU shape: round or ovalcapacity: 200350ml I.V.U.CT NORMAL IMAGING OF URINARY TRACT Plain Scans Kidney renal parenchyma: soft tissue density, 3050Hu pelvis: water density, 1020Hu renal sinus: fat density, -60-

11、100HuUretersoft tissue densityBladderwater density when fully distended Plain Scans CT Contrast Enhanced Scans CT NORMAL IMAGING OF URINARY TRACT Kidney: 1after injection: cortical enhancement 2after injection: medullary enhancement 510after injection: parenchyma enhancement and filling the pelvis w

12、ith contrast mediumContrast enhanced Scans CT Contrast Enhanced Scans CT NORMAL IMAGING OF URINARY TRACT Ureter and Bladder: bladder wall enhanced on early scans filling with the contrast medium on delayed scansMRI NORMAL IMAGING OF URINARY TRACT Plain Scans The signal intensity of renal cortex on T

13、1WI is higher than that of renal medullaThe signal intensity of renal cortex and medulla on T2WI are all higherThe signal intensity of ureter and bladder are low on T1WI and higher on T2WI cMRI NORMAL IMAGING OF URINARY TRACT Contrast Enhanced Scans Renal parenchyma and bladder wall show enhancement

14、 CALCULUS OF URINARY TRACT Radiopaque(calcium) in 90% of patientRadiolucent(urate) in 10% of patientRenal Calculus CALCULUS OF URINARY TRACT round, horny, morulalie in the calyces or pelvishydronephrosisCT: high density, 2001000Hu 男性，66岁，左侧腰部反复发作性隐痛075970女性，58岁，腰痛 Ureteral calculus CALCULUS OF URINA

15、RY TRACT grain of rice size, jujube core shapedlong axis parallel to the ureteroften stay in the sites of narrownesshydroureter or hydronephrosis above the stoneCT: high density, 2001000Hu Calculus of Urinary bladder CALCULUS OF URINARY TRACT round, oval, concentric circles shapedCT: high densityMRI

16、: low signal on T1WI and T2WI Calculus of Urinary bladder TUBERCULOSIS OF URINARY TRACT Secondary infectionHematogenous dissemination TUBERCULOSIS OF URINARY TRACT PathologyTB bacilli renal cortex infection medullary destruction caseous necrosis abscess (calcification) pelvicalyceal destruction uret

17、er and bladder TB 尿路结核病理TB 杆菌 皮质感染 髓质破坏 干酪坏死灶 脓肿 (钙化) 肾盂、肾盏破坏 输尿管、膀胱 TB TUBERCULOSISRenal Tuberculosis TUBERCULOSIS OF URINARY TRACT KUB: normal (early stage ) calcification Renal Tuberculosis TUBERCULOSIS OF URINARY TRACT IVU: calyceal destruction abscess and cavity formation pyonephrosis diffuse f

18、ibrotic contraction and calcification auto-resection of kidney TUBERCULOSIS OF URINARY TRACT Auto-resection of kidney Diffused calcification of caseous foci, or whole kidney + loss of renal function 男性 66岁，反复腰酸1年余，KUB+IVU 124777Renal Tuberculosis Auto-resection of kidney Plain CT scans: high density

19、 (calcification) low density areas (abscess or cavity) CT values: 2040Hu(abscess)Renal Tuberculosis TUBERCULOSIS OF URINARY TRACT Contrast-enhanced CT scans: low density areas without enhancement. contrast media is demonstrable within the abscess. pelvicalyceal enlargement Renal Tuberculosis TUBERCU

20、LOSIS OF URINARY TRACT MRI: low signal on T1WI high signal on T2WI Renal Tuberculosis TUBERCULOSIS OF URINARY TRACT TUBERCULOSIS OF URINARY TRACT Ureteral Tuberculosis KUB: calcification IVU: stricture shorten beadingTUBERCULOSIS OF URINARY BLADDER IVU: Small bladderContracted bladder TUMORS OF URIN

21、ARY TRACT Renal Carcinoma KUB: kidney enlarged, local protrusion calcification in 10% of patients IVU: renal contour: bulging calyces and pelvis: compressionnarrowingdissociation destructionRenal Carcinoma Plain CT scans: mass (2050Hu) calcification the tumor may be hypodense or isodense in comparis

22、on to the surrounding structures TUMORS OF URINARY TRACT Renal Carcinoma Contrast-enhanced CT scans: inhomogeneous enhancement peripheral enhancement non-enhanced necrotic areas in the tumor TUMORS OF URINARY TRACT Renal Carcinoma 244926男性，69岁，B超发现右肾占位 MRI:(1) Plain scans: inhomogeneous signals on T

23、1WI and T2WI(2) Contrast-enhanced scans: inhomogeneous enhancement TUMORS OF URINARY TRACT Renal Carcinoma Angioleimyolipoma Benign tumor of the kidney The tumor is histologically comprised of blood vessels, smooth muscle, and fat tissue.The proportions of the components in the tumor are variable KU

24、B and IVU Angioleimyolipoma kidney enlarged pelvicalyceal compression calcification in 20% of patients CT Angioleimyolipoma Fatty components of the tumor: much lower dentisy CT values:-40to-120Hu non-enhancementThe vascular and muscular structeres of the tumor: enhancementCalcification: high density

25、 女性 50岁，B超示右肾占位MRI Angioleimyolipoma Fatty components: high signal on T1WI and T2WI much lower signal on STIROther components: inhomogeneous signal on T1WI and T2WI Renal Pelvic Carcinoma Transitional cell carcinoma (8090%) KUB: normal IVU : filling defect within the pelvis CT: mass of renal sinus enhancement filling defect on delayed contrast CT imagingMRI: mass of renal sinus enhancement Renal Pelvic Carcinoma 126396女性 82岁，血尿1周余Carcinoma of the Urinary Bladder Papillary carcinoma of the epithelium of the urinary tractMass protruding on the bladder wall KUB: normal IVU: filling