泌尿系统影像学课件

骨關節系統影像學

INTRODUCTIONIncludingbothkidney,ureter,bladderandurethra.Lackofnaturalcontrast.Needvariouskindsofcontrastexamination.UseofCT,USG,MRI.METHODSOFEXAMINATIONPlainFilmoftheAbdomen(KUB)Includingbothsidesofkidney,areaofureterandbladder.Toshowcontour,size,shapeoftheaboveorgansandpsoasmusclesmargin.TodemonstratestoneandcalcificationofurinarytractKUBIntravenousUrography(IVU)METHODSOFEXAMINATIONPreparation: 1.sensitivitytestofiodine. 2.preparationofintestinaltract (fast8~12h,catharsis)Contrastmedium: 1.Urografin(泛影葡胺) 2.Iopamidol(碘必樂) 3.Iopromide(碘普羅胺)Technique:1.intravenousinstillationofcontrastmedium (100ml)shouldbeoverin5~10minutes 2.filmsaretakenat3,5,10,15,25(KUB) minutesDisplay:1.excretoryfunctionofkidney 2.morphologyofurinarytractIntravenousUrography(IVU)METHODSOFEXAMINATION-C+CI.V.U.I.V.U.RetrogradeUrographyMETHODSOFEXAMINATIONTobeusedwhenIVUhasbeenunsatisfactoryorinconclusive.Toshowthemorphologyofurinarytractonly.RetrogradeUrographyRenalAngiographyMETHODSOFEXAMINATIONabdominalaortography.Selectiverenalarteriography.RenalAngiographyRenalAngiographyCT

METHODSOFEXAMINATIONPlainScanspatientpreparation: ⑴oralcontrastmediunadministrationforbowelandbladderfilling ⑵1~2%,500mlofurografinforkidneyCT ⑶1~2%,1000mlofurografinforbladderCT ⑷thebladdermustbefullydistendedSlicethicknessandintervals:5~10mmScanningmethod:sequentialCTscansScanningranges:upperpoleofkidney→ureter→bladderCT

PlainScansContrastenhancedScansCTMETHODSOFEXAMINATIONContrastmedium:60~100ml,1.5~2.5ml/sIntravascularadministration:bolusinjectionScanning:

⑴SequentialCTscans:startat15~20safterinjection ⑵DelayedCTscans:canbeperformedat5~10min.afterinjectiontoshowfillingthepelvis,ureterandbladderwithcontrastmediumContrastenhancedScansCTMRIPlainScans: ⑴transverseT1WI(T1-Weightedimaging)+T2WI (T2-Weightedimaging)withSE(spin-echosequences) ⑵coronalT1WIwithSEContrastenhancedscans: ⑴contrastmedium:Gd-DTPA,0.1~0.2mmol/kg ⑵scanningsequences:T1WIwithSEMRU(MRurography):

todemonstratetheobstructionofurinarytractMETHODSOFEXAMINATIONKUBI.V.U.R.U.AngioCTUSNORMALIMAGINGOFURINARYTRACTKUB&IVUKidney

1.position:T11~12toL1~22.size:11~13×5~6×2~3cm(3×6×12cm)

Contour: smoothMinorcalyces: 10~14Majorcalyces: 2~4Pelvis: trumpet,branch,ampullaUreterNORMALIMAGINGOFURINARYTRACTKUB&IVUlong: 25~30cmwidth: 3~5mmphysiologicalnarrowings: ⑴pelvi-ureteraljunction ⑵iliacvessels ⑶entryofbladderBladderNORMALIMAGINGOFURINARYTRACTKUB&IVUshape:roundorovalcapacity:200~350ml

I.V.U.CTNORMALIMAGINGOFURINARYTRACTPlainScansKidney⑴renalparenchyma:softtissuedensity,30~50Hu⑵pelvis:waterdensity,10~20Hu⑶renalsinus:fatdensity,-60~-100HuUretersofttissuedensityBladderwaterdensitywhenfullydistendedContrastEnhancedScans

CTNORMALIMAGINGOFURINARYTRACTKidney:⑴1′afterinjection:corticalenhancement⑵2′afterinjection:medullaryenhancement⑶5~10′afterinjection:parenchymaenhancement andfillingthepelviswithcontrastmediumContrastEnhancedScans

CTNORMALIMAGINGOFURINARYTRACTUreterandBladder:⑴bladderwallenhancedonearlyscans⑵fillingwiththecontrastmediumondelayedscansMRINORMALIMAGINGOFURINARYTRACTPlainScansThesignalintensityofrenalcortexonT1WIishigherthanthatofrenalmedullaThesignalintensityofrenalcortexandmedullaonT2WIareallhigherThesignalintensityofureterandbladderarelowonT1WIandhigheronT2WI

MRINORMALIMAGINGOFURINARYTRACTContrastEnhancedScans

Renalparenchymaandbladderwallshowenhancement

CALCULUSOFURINARYTRACTRadiopaque(calcium)in90%ofpatientRadiolucent(urate)in10%ofpatientRenalCalculusCALCULUSOFURINARYTRACTround,horny,morulalieinthecalycesorpelvishydronephrosisCT:highdensity,200~1000HuUreteralcalculusCALCULUSOFURINARYTRACTgrainofricesize,jujubecoreshapedlongaxisparalleltotheureteroftenstayinthesitesofnarrownesshydroureterorhydronephrosisabovethestoneCT:highdensity,200~1000HuUreteralcalculusCalculusofUrinarybladderCALCULUSOFURINARYTRACTround,oval,laminited,concentriccirclesshapedCT:highdensityMRI:lowsignalonT1WIandT2WICalculusofUrinarybladderTUBERCULOSISOFURINARYTRACTSecondaryinfectionHematogenousdisseminationTUBERCULOSISOFURINARYTRACTPathologyTBbacilli

renalcortexinfectionmedullarydestructioncaseousnecrosisabscess(calcification)pelvicalycealdestructionureterandbladderTBTUBERCULOSISTUBERCULOSISOFURINARYTRACTAuto-resectionofkidneyDiffusedcalcificationofcaseousfoci,orwholekidney+lossofrenalfunctionAuto-resectionofkidneyRenalTuberculosisTUBERCULOSISOFURINARYTRACTKUB:⑴normal(earlystage)⑵calcification

RenalTuberculosisTUBERCULOSISOFURINARYTRACTIVU:

⑴calycealdestruction⑵abscessandcavityformation⑶pyonephrosis⑷diffusefibroticcontractionandcalcification⑸auto-resectionofkidneyRenalTuberculosisPlainCTscans:⑴highdensity(calcification)⑵lowdensityareas(abscessorcavity)⑶CTvalues:20~40Hu(abscess)RenalTuberculosisTUBERCULOSISOFURINARYTRACTContrast-enhancedCTscans:⑴lowdensityareaswithoutenhancement.⑵contrastmediaisdemonstrablewithintheabscess.⑶pelvicalycealenlargementRenalTuberculosisTUBERCULOSISOFURINARYTRACTMRI:

⑴lowsignalonT1WI⑵highsignalonT2WIRenalTuberculosisTUBERCULOSISOFURINARYTRACTTUBERCULOSISOFURINARYTRACTUreteralTuberculosisKUB:

calcificationIVU:⑴stricture⑵shorten⑶beadingTUBERCULOSISOFURINARYBLADDERIVU:SmallbladderContractedbladderTUMORSOFURINARYTRACTRenalCarcinomaKUB:

⑴kidneyenlarged,localprotrusion⑵calcificationin10%ofpatients

IVU:

⑴renalcontour:bulging⑵calycesandpelvis: compression narrowing dissociation destructionRenalCarcinomaPlainCTscans:⑴mass(20~50Hu)⑵calcification⑶thetumormaybehypodenseorisodenseincomparisontothesurroundingstructuresTUMORSOFURINARYTRACTRenalCarcinomaContrast-enhancedCTscans:⑴inhomogeneousenhancement⑵peripheralenhancement⑶non-enhancednecroticareasinthetumorTUMORSOFURINARYTRACTRenalCarcinomaRenalCarcinomaMRI:(1)Plainscans:inhomogeneoussignalsonT1WIandT2WI(2)Contrast-enhancedscans:inhomogeneousenhancementTUMORSOFURINARYTRACTRenalCarcinomaAngioleimyolipomaBenigntumorofthekidneyThetumorishistologicallycomprisedofbloodvessels,smoothmuscle,andfattissue.TheproprtionsoftheconponentsinthetumorarevariableKUBandIVUAngioleimyolipomakidneyenlargedpelvicalycealcompressioncalcificationin20%ofpatientsCTAngioleimyolipomaFattycomponentsofthetumor: ⑴muchlowerdentisy ⑵CTvalues:-40to-120Hu ⑶non-enhancementThevascularandmuscularstructeresofthetumor: enhancementCalcification:highdensityMRIAngioleimyolipomaFattycomponents: ⑴highsignalonT1WIandT2WI ⑵muchlowersignalonSTIROthercomponents: inhomogeneoussignalonT1WIandT2WIRenalPelvicCarcinomaTransitionalcellcarcinoma(80~90%)KUB: normalIVU: fillingdefectwithinthepelvisCT: ⑴massofrenalsinus ⑵enhancement ⑶fillingdefectondelayedcontrastCTimagingMRI: ⑴massofrenalsinus ⑵enhancementRenalPelvicCarcinomaCarcinomaoftheUrinaryBladderPapillarycarcinomaoftheepitheliumoftheurinarytractMassprotrudingonthebladderwallKUB: normalIVU: fill