1. Imaging of the Renal System Dr. Reshaid Al Jurayyan Department of Radiology

2. OUTLINE Introduction Imaging modalities Anatomy Case scenarios

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

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

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

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

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

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

9. INTRODUCTION What is radiology? It is a medical specialty that employs the use of imaging to both diagnosing and treating diseases within the human body. What is the renal system? Kidneys, ureters, urinary bladder and urethra.

10. What radiological modalities can be used to image the renal system ?

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

12. Terminology X ray : Radio-opaque (white) vs radio-lucent (black) US: Hyper-echoic (white) / hypo-echoic (black) CT: Hyper-dense (white) / hypo-dense (black) MRI: Hyper-signal (white) / hypo-signal Nuclear med.: Highuptake (black) / lowuptake (white)

13. Conventional radiography First imaging modality in most cases. Cheap. Useful for radio- opaque stones. Disadvantage : radiation

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

15. IVU Conventional x-ray plus intravenous contrast. Cheap. Recently replaced by CT and MRI. Useful for radio- opaque stones. Disadvantage : impaired the kidney

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

17. US Use high frequency sound wave. No radiation Contrast between tissue is determined by sound reflection.

18. US Image features: Operator dependant. Good resolution. Used for stone, hydronephrosis, focal lesion (ex. masses).

19. CT Same basic principle of radiography. More precise. Costly. +/- IV contrast. Useful for trauma, stone, tumor, infection. Best in stones

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

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

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

23. Nuclear medicine Utilizes a gamma camera and radioactive isotopes. Good to assess kidney function. Less expensive.

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

25. ANATOMY

32. MRI IS NOT GOOD IN STONES In MRI bones are black

35. CASES

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

37. Case (1) Young male patient presenting with left flank pain and hematuria, no fever and normal WBC count. Kidney stones with hydronephrosis. X-ray >> US >> CT

40. Case (2) Middle aged woman presenting with flank pain, fever and high WBC. Inflammation (e.g. Pyelonephritis) US >> CT+contrast >> MRI

42. Case (3) Elderly male patient with recurrent urinary tract infections. Bilateral hydronephrosis due to Prostate enlargement. US

45. Case (4) Young female presenting with decreased renal function (high urea and creatinine level). Polycystic. US >> CT >> MRI Contrast is contraindicated

48. Case (5) Elderly male patient with painless hematuria and weight loss. Tumor MRI (BEST) >> US >> CT+contrast

50. Case (6) Young male patient involved in a motor vehicle accident with blunt trauma to the abdomen. Truma CT (because it’s very fast)

52. Renal trauma grading

53. سألت الدكتور عن الأسئلة : يقول راح تكون الأسئلة بالنظري وبتكون مثلا واحد جاه حادث وش افضل أشعة للشيء هذا؟ وكذلك خاصية الأجهزة حمد البريدي

54. THANK YOU