1. Imaging of the Renal System Dr. Reshaid AlJurayyan Department of Radiology

2. OUTLINE Introduction Imaging modalities Anatomy Cases

3. INTRODUCTION What is radiology? It is a medical specialty that employs the use of imaging to both diagnose and treat disease within the human body. What is the renal system? Kidneys, ureters, urinary bladder and urethra.

4. IMAGING MODALITIES Conventional radiography Intravenous urogram (IVU) US CT MRI Nuclear medicine

5. Conventional radiography First imaging modality. Cheap. Useful for radio- opaque stones.

6. Conventional radiography Image features: Projectional image. Image contrast determined by tissue density. Good evaluation radio-opaque stones.

7. IVU Conventional x-ray plus intravenous contrast. Cheap. Recently replaced by CT and MRI. Useful for radio- opaque stones.

8. IVU Image features: Projectional image. Image contrast determined by tissue density and IV contrast. Good evaluation of collecting system and radio-opaque stones.

9. US Use high frequency sound wave. Contrast between tissue is determined by sound reflection.

10. US Image features: Operator dependant. Projectional image. Good resolution. Used for stone, hydronephrosis, focal lesion.

11. CT Same basic principle of radiography. More precise. Costly. +/- contrast. Useful for trauma, stone, tumor, infection.

12. CT Image features: Cross sectional images. Image contrast determined by tissue density +/- contrast. Better evaluation of soft tissue.

13. MRI Better evaluation of soft tissue. Expensive. Useful for soft tissue pathology: tumor, infection.

14. MRI Image features: Cross sectional images. Image contrast determine by tissue properties. Excellent for soft tissue evaluation.

15. Nuclear medicine Utilizes a gamma camera and radioactive isotopes. Functional test. Less expensive. Useful for: obstruction and split function.

16. Nuclear medicine Image features: Projectional image. Image contrast by tissue uptake and metabolism.

17. ANATOMY

26. CASES

27. What are the imaging modalities? What are the findings? Diagnosis?

28. Case (1) Young male patient presenting with left flank pain and hematuria, no fever and normal WBC count.

31. Case (2) Middle aged woman presenting with flank pain, fever and high WBC.

33. Case (3) Elderly male patient with recurrent urinary tract infections.

36. Case (4) Young female presenting with decreased renal function (high urea and creatinine level).

39. Case (5) Elderly male patient with painless hematuria and weight loss.

41. Case (6) Young male patient involved in a motor vehicle accident with blunt trauma to the abdomen.

43. Renal trauma grading

44. THANK YOU