1. DIAGNOSTIC IMAGING OF URINARY TRACT
Radiology Department of Ruijin Medical College
Affiliated to Shanghai Jiaotong University Medical School

2. 骨关节系统影像学
瑞金临床医学院
医学影像学教研室

3. INTRODUCTION Including both kidney, ureter, bladder and urethra.
Lack of natural contrast.
Need various kinds of contrast examination.
Use of CT, USG,MRI.

4. METHODS OF EXAMINATION
Plain Film of the Abdomen (KUB)
Including 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

5. KUB

6. METHODS OF EXAMINATION
Intravenous Urography (IVU)
Preparation: 1. sensitivity test of iodine.
2.preparation of intestinal tract
(fast 8~12h, catharsis)
Contrast medium: 1.Urografin (泛影葡胺)
2. Iopamidol (碘必乐)
3. Iopromide (碘普罗胺)

7. METHODS OF EXAMINATION
Intravenous Urography (IVU)
Technique: 1.intravenous instillation of contrast medium
(100ml) should be over in 5~10minutes
2. films are taken at 3,5,10,15,25(KUB) minutes
Display: excretory function of kidney
2.morphology of urinary tract

8. -C +C
I.V.U.

11. I.V.U.

12. METHODS OF EXAMINATION
Retrograde Urography
To be used when IVU has been unsatisfactory or inconclusive.
To show the morphology of urinary tract only.

13. Retrograde Urography

14. METHODS OF EXAMINATION
Renal Angiography
abdominal aortography.
Selective renal arteriography.

15. Renal Angiography

16. Renal Angiography

19. METHODS OF EXAMINATIONCT
Plain Scans
patient preparation :
⑴ oral contrast mediun administration for bowel and bladder filling
⑵ 1~2%, 500ml of urografin for kidney CT
⑶ 1~2%, 1000ml of urografin for bladder CT
⑷ the bladder must be fully distended
Slice thickness and intervals: 5~10mm
Scanning method: sequential CT scans
Scanning ranges: upper pole of kidney→ureter→bladder

21. CT
Plain Scans

22. METHODS OF EXAMINATIONCT
Contrast enhanced Scans
Contrast medium: 60~100ml, 1.5~2.5ml/s
Intravascular administration: bolus injection
Scanning:
⑴Sequential CT scans: start at 15~20s after injection
⑵Delayed CT scans: can be performed at 5~10min. after injection to show filling the pelvis, ureter and bladder with contrast medium

23. CT
Contrast enhanced Scans

24. METHODS OF EXAMINATION
MRI
Plain Scans:
⑴ transverse T1WI (T1-Weighted imaging) + T2WI
(T2-Weighted imaging) with SE (spin-echo sequences)
⑵ coronal T1WI with SE
Contrast enhanced scans:
⑴ contrast medium: Gd-DTPA, 0.1~0.2mmol/kg
⑵ scanning sequences: T1WI with SE
MRU (MR urography):
to demonstrate the obstruction of urinary tract

26. KUB
I.V.U.
R.U. US
Angio CT

27. NORMAL IMAGING OF URINARY TRACT
KUB & IVU
Kidney
1. position: T11~12 to L1~2
2. size: 11~13×5~6×2~3cm (3×6×12cm)
Contour: smooth
Minor calyces: 10~14
Major calyces: 2~4
Pelvis: trumpet , branch, ampulla

32. NORMAL IMAGING OF URINARY TRACT
KUB & IVU
Ureter
long: 25~30cm
width: 3~5mm
physiological narrowings:
⑴ pelvi-ureteral junction
⑵ iliac vessels
⑶ entry of bladder

33. NORMAL IMAGING OF URINARY TRACT
KUB & IVU
Bladder
shape: round or oval
capacity: 200~350ml

38. I.V.U.

39. NORMAL IMAGING OF URINARY TRACT
Plain Scans
Kidney
⑴ renal parenchyma: soft tissue density, 30~50Hu
⑵ pelvis: water density, 10~20Hu
⑶ renal sinus: fat density, -60~-100Hu
Ureter
soft tissue density
Bladder
water density when fully distended

41. NORMAL IMAGING OF URINARY TRACT
Contrast Enhanced Scans
Kidney:
⑴ 1′after injection: cortical enhancement
⑵ 2′after injection: medullary enhancement
⑶ 5~10′after injection: parenchyma enhancement and filling the pelvis with contrast medium

43. NORMAL IMAGING OF URINARY TRACT
Contrast Enhanced Scans
Ureter and Bladder:
⑴ bladder wall enhanced on early scans
⑵ filling with the contrast medium on delayed scans

46. NORMAL IMAGING OF URINARY TRACT
MRI
Plain Scans
The signal intensity of renal cortex on T1WI is higher than that of renal medulla
The signal intensity of renal cortex and medulla on T2WI are all higher
The signal intensity of ureter and bladder are low on T1WIand higher on T2WI

49. NORMAL IMAGING OF URINARY TRACT
MRI
Contrast Enhanced Scans
Renal parenchyma and bladder wall show enhancement

50. CALCULUS OF URINARY TRACT
Radiopaque(calcium) in 90% of patient
Radiolucent(urate) in 10% of patient

52. CALCULUS OF URINARY TRACT
Renal Calculus
round, horny, morula
lie in the calyces or pelvis
hydronephrosis
CT: high density, 200~1000Hu

57. CALCULUS OF URINARY TRACT
Ureteral calculus
grain of rice size, jujube core shaped
long axis parallel to the ureter
often stay in the sites of narrowness
hydroureter or hydronephrosis above the stone
CT: high density, 200~1000Hu

59. Ureteral calculus

61. CALCULUS OF URINARY TRACT
Calculus of Urinary bladder
round, oval, laminited, concentric circles shaped
CT: high density
MRI: low signal on T1WI and T2WI

62. Calculus of Urinary bladder

64. TUBERCULOSIS OF URINARY TRACT
Secondary infection
Hematogenous dissemination

65. TUBERCULOSIS OF URINARY TRACT
Pathology
TB bacilli
renal cortex infection
medullary destruction
caseous necrosis
abscess (calcification)
pelvicalyceal destruction
ureter and bladder TB

67. TUBERCULOSIS

68. TUBERCULOSIS OF URINARY TRACT
Auto-resection of kidney
Diffused calcification of caseous foci,
or whole kidney + loss of renal function

69. Auto-resection of kidney

70. TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
KUB:
⑴ normal (early stage )
⑵ calcification

71. TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
IVU:
⑴ calyceal destruction
⑵ abscess and cavity formation
⑶ pyonephrosis
⑷ diffuse fibrotic contraction and calcification
⑸ auto-resection of kidney

74. Renal Tuberculosis

77. TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
Plain CT scans:
⑴ high density (calcification)
⑵ low density areas (abscess or cavity)
⑶ CT values: 20~40Hu(abscess)

79. TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
Contrast-enhanced CT scans:
⑴ low density areas without enhancement.
⑵ contrast media is demonstrable within the abscess.
⑶ pelvicalyceal enlargement

81. TUBERCULOSIS OF URINARY TRACT
Renal Tuberculosis
MRI:
⑴ low signal on T1WI
⑵ high signal on T2WI

82. TUBERCULOSIS OF URINARY TRACT
Ureteral Tuberculosis
KUB:
calcification
IVU:
⑴ stricture
⑵ shorten
⑶ beading

84. TUBERCULOSIS OF URINARY BLADDER
IVU:
Small bladder
Contracted bladder

85. TUMORS OF URINARY TRACT
Renal Carcinoma
KUB:
⑴ kidney enlarged, local protrusion
⑵ calcification in 10% of patients
IVU:
⑴ renal contour: bulging
⑵ calyces and pelvis:
compression
narrowing
dissociation
destruction

88. Renal Carcinoma

89. TUMORS OF URINARY TRACT
Renal Carcinoma
Plain CT scans:
⑴ mass (20~50Hu)
⑵ calcification
⑶ the tumor may be hypodense or isodense in comparison to the surrounding structures

90. TUMORS OF URINARY TRACT
Renal Carcinoma
Contrast-enhanced CT scans:
⑴ inhomogeneous enhancement
⑵ peripheral enhancement
⑶ non-enhanced necrotic areas in the tumor

92. Renal Carcinoma

94. TUMORS OF URINARY TRACT
Renal Carcinoma
MRI:
(1) Plain scans: inhomogeneous signals on T1WI and T2WI
(2) Contrast-enhanced scans: inhomogeneous enhancement

96. Angioleimyolipoma Benign tumor of the kidney
The tumor is histologically comprised of blood vessels, smooth muscle, and fat tissue.
The proprtions of the conponents in the tumor are variable

97. Angioleimyolipoma KUB and IVU kidney enlarged
pelvicalyceal compression
calcification in 20% of patients

98. Angioleimyolipoma CT Fatty components of the tumor:
⑴ much lower dentisy
⑵ CT values:-40to-120Hu
⑶ non-enhancement
The vascular and muscular structeres of the tumor:
enhancement
Calcification: high density

101. Angioleimyolipoma MRI Fatty components: ⑴ high signal on T1WI and T2WI
⑵ much lower signal on STIR
Other components:
inhomogeneous signal on T1WI and T2WI

103. Renal Pelvic Carcinoma
Transitional cell carcinoma (80~90%)
KUB: normal
IVU : filling defect within the pelvis
CT: ⑴ mass of renal sinus
⑵ enhancement
⑶ filling defect on delayed contrast CT imaging
MRI: ⑴ mass of renal sinus

105. Renal Pelvic Carcinoma

110. Carcinoma of the Urinary Bladder
Papillary carcinoma of the epithelium of the urinary tract
Mass protruding on the bladder wall
KUB: normal
IVU: filling defect within the bladder
CT and MRI:
⑴ mass in the bladder
⑵ enhancement
⑶ invasion of surrounding structures
⑷ demonstrate metastatic lymph nodes

112. Carcinoma of the Urinary Bladder

118. RENAL CYST Simple Renal cyst Single or multiple
KUB: normal or bulging contour
IVU: pelvicalyceal compression

119. RENAL CYST Simple Renal cyst CT:
⑴ round ⑵ clear margin ⑶ homogeneous low density ⑷ CT values: 6~18Hu ⑹ nonenhancement
MRI: ⑴ low signal on T1WI
⑵ high signal on T2WI
⑶ nonenhancement

121. Simple Renal cyst

122. Polycystic Renal Disease in Adults
Genetic disease
Accompanied with polycystic hepatic disease in 30~60% of patients
KUB: enlargment of both kidney
IVU: pelvicalyceal compression, shift, dissociation-- “spider feet”
CT and MRI:
⑴ multiple cysts in various sizes
⑵ nonenhancement

126. RENAL AND URETERAL DYSPLASIA
Double pelvis and ureter
Solitary kidey
Horse-shoe kidney
Ectopic kidney

130. Thank you