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1、IMAGING OF URINARY TRACT,Learning Points,The methodology for imaging the urinary tract The normal appearances and the spectrum of abnormal imaging findings on various imaging modalities The imaging diagnosis of some common diseases,Imaging Methodology,Plain film (KUB, Kidney-Ureter-Bladder) Excretor
2、y Urography or Intravenous Pyelograhy (IVP), Retrograde Urography Renal Arteriography CT, CT Urography (CTU) MR, MR Urography (MRU),KUB,IVP,Retrograde Urography,Renal Arteriography,CT,Plain CT Contrast-enhanced CT Corticomedullary Phase （2570 s） Nephrographic Phase （80180 s） Excretory Phase （180 s）
3、CT angiography CTU 810 min, or even more,CTA,CTU,MRI,T1WI and T2WI: Identify cortex from medullary DWI Contrast-enhanced MRI: DCE-MRI MRA MRU,MRA,Transplanted kidney,MRA,MRU,Choice of methology,Kidney and bladder: CT is the first choice. If there is dysfunction of the kidney, MRI would be the better
4、 choice Ureter and urethra: IVP or retrograde urography is the first choice. CTU would show details. MRU is recommended for the dysfunctional,Normal Imaging Appearance,Kidney,location: L2 Size: length: 12-13Cm, width: 5-6Cm,KUB,IVP,CT,MRI,MRI,Ureter,Length: 25-30cm diameter: 3-7mm Three physiologica
5、l narrows,Three strictures of the ureter,Bladder,Abnormal Imaging Appearances,Abnomal of location: Genetic acquired Abnomal of size: unilateral, bilateral Enlargement, shrinkage Abnomal of shape: Lesion inside kidney Lesion outside kidney,nephroptosis,Ectopic right kidney,Aplasia of the left kidney,
6、Atrophy of bilateral kidneys,Hypertrophy of the transplanted kidney,Irregular contour of kidneys,Abnomal of the pelvis and calyx Compression or deformity Lesion inside kidney Lesion outside kidney Destruction Of the pelvis Of the calyx,Compression or deformity of the pelvis and calyx,Filling defect
7、of the urinary tract Pelvis: tumor, calculus, bubble Ureter: calculus, bubble, tumor, Bladder: tumor, calculus, blood clot, polypus, enlarged prostate gland,Filling defect of the urinary tract,CTU-Filling defect of the right upper calyx,Diverticulum,Dilatation of the urinary tract： obstructive： Pelv
8、is and calyx：tumor, calculus, blood clot, blood vessel compression Lesion inside kidney: acute tubular necrosis, tumor Ureter: various and complex Bladder: primary obstruction of the neck of the bladder Urethra: various Non-obstructive： giant pelvis and/or ureter, regurgitation from the bladder to t
9、he ureter, neurogenic bladder,Ureteropelvic Junction Obstruction (UPJO) of the right kidney,Bilateral giant ureter,Bilateral giant ureter,Hydronephrosis of the left kidney with bleeding,Imaging Appearances of Common Diseases,Congenital malformation Inflammation Calculus Tumors Cyst,Congenital malfor
10、mation,Abnormal in number: Single Kidney Renal fusion anomalies： Horseshoe kidney is the most comment type 90% Horseshoe kidney fusion in the lower polar of the kidney, with the shape of “v” Malrotation of the kidney Ectopic kidney,Single kidney with hydronephrosis,Single kidney with hydronephrosis,
11、Horseshoe kidney,Malrotation of the right kidney,Ectopic right kidney,Ectopic right kidney,Duplex kidney：with upper and lower portions with separate pylorus, ureter and vessels Complete Incomplete: Weigert-meyer rule,Congenital malformation,Incomplete duplex,Incomplete duplex,Incomplete duplex,Weige
12、rt-meyer rule,complete duplex,Inflammations,Tuberculosis Early stage: Necrosis of the renal papilla Advanced stage: cavity, invasion into the pararenal space, calyx, pelvis, ureter and bladder involved sequentially Final stage：renal abscess, autonephrectomy Ureter: ulceration, granuloma, thickened w
13、all, stenosis, occlusion Bladder: edema, ulceration, granulation tissue, contracture,TB of kidney and ureter,TB of the right kidney,TB of the right ureter and bladder,autonephrectomy,calculus,Calculus in the left UPJ with hydro-nephrosis,Staghorn calculus,Multiple stones with hydronephrosis,Calculus
14、 in the left ureter,Calculus in the left ureter,Caculus in the bladder,Tumors,Renal cell carcinoma Pathology: 8090% of neoplasm of kidney 70% are clear cell renal cell carcinoma The intracytoplasmic glycogen and lipids get dissolved during histologic processing, rendering the cells “clear” With netw
15、ork of small, thin-walled sinusoid-like blood vessels, hypervascular Male: female2:1,CT manifestation Plain scan: Heterogeneous, due to hemorrhage, necrosis, cyst change (15%), or calcification (1015%) Contrast-enhanced scan: Heterogeneous enhanced, hypervascular Corticomedullary phase: density high
16、er than the cortex Nephrographic phase: relatively lower in density Cystic change: 40% multilocular,with cancer thrombus in the left renal vein,Clear cell carcinoma,Staging of RCC,renal pelvic carcinoma About 10% neoplasm of kidney Most are urothelial Male: female3:1 Hematuria is most common symptom multicentric nature,renal pelvic carcinoma,renal pelvic carcinoma,Angiomyolipoma( MEA) most common benign neoplasm of the kidney Sporadically (50%
