basic Genitourinaria Imaging in basic .ppt

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1. BASIC
DIAGNOSTIC
GENITOURINARY
IMAGING
RIMA ZAKIYAH

2. ANATOMY
Genitourinary System
Urinary System
Kidney
Ureter
Bladder
Urethra

5. ANATOMY

6. ANATOMY
Male Reproductive System

7. Modalities Available in
Radiology
Plain Film / X-Ray (BNO-BOF)
BNO-IVU/IVP
Fluoroscopy
Retrograde uretrography/cystography/urethrocystography
Bipolar Urethrocystography
Voiding Cystourethrography
Ultrasound- Doppler US
CT
MRI
Nuclear Medicine/Molecular Imaging
Angiography (Interventional Radiology)

8. Relative Cost of Imaging
Studies

9. Relative Availability of
Diagnostic Imaging
Teaching
Hospital
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Urban
Hospital
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Suburban
Commun
-ity Hosp
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Rural
Hospital
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Plain
Film
Fluoro
U/SCTNMMRI
Angio-
interven-
tional

10. Most Useful Applications
for Plain X-Rays
Chest
Musculoskeletal
Abdomen: limited usefulness
GU
GI

11. Plain X-Rays
+ -
Widely available
Inexpensive
Doesn’t require
advanced technologist
knowledge
Can be performed
quickly
Portable
Ionizing Radiation
Relatively insensitive
Requires patient
cooperation

13. BNO-IVP
Use contrast media intravenously
Anatomic function:
Depict the minor calyx,
major calyx,
renal pelvis,
ureter,
urinary bladder.
Physiologic function:
Assess the kidney function in contrast media
filtration and excretion.

15. BNO-IVP
Procedure
1-3minute : Nephrogram phase
 Ureteral compression
 5 minute : Excretory function
 15 minute : Pelviocalyceal system
Compression can be released if the pelviocalyceal system has
been seen adequately
30 minute : After the compression was released to
see the urinary tract from the kidney
to the bladder
45-60 minute : fullbladder
 Post voiding : passage of contrast agent, retention

20. Fluoroscopy
Utilizes X-Rays
Real-time imaging
Utilizes image intensifier
Involves use of contrast agents

21. Main Uses of Fluoroscopy
Genitourinary Imaging
Gastrointestinal Imaging
Angiography
Other
Intraoperative
Foreign body removal
Musculoskeletal

22. Fluoroscopy
+ -
Widely Available
Inexpensive
Functional and Anatomic
No sedation required
Requires ingestion/injection
of contrast
Patient cooperation
Time consuming

23. Genitourinary Fluoroscopy
Cystogram
Voiding cystourethrogram
Retrograde urethrogram

24. Cystogram
Usually in adult patients
Looking for tear or intraluminal mass
Catheter placed and bladder filled with contrast
to capacity: usually 300-500 ml.
Spot films obtained when full
Post void film: usually overhead

26. Cystogram

27. Voiding Cystourethrogram
VCUG
Usually in children with history of UTI
Searching for vesicoureteral reflux
In males, evaluate for urethral abnormalities:
posterior urethral valves
Same as cystogram except when full patient
voids under fluoro with spot films

29. Retrograde Urethrogram
RUG
Male patients
Pelvic Trauma
Post-infectious: STD- looking for stricture
Different techniques
Meatus occluded and contrast injected into
urethra under fluoroscopy

30. Retrograde Urethrogram
RUG

31. ULTRASOUND OF KIDNEYS



NORMAL STUDY
DILATED RENAL
PELVIS

32. Ultrasound of Right Kidney
USG

33. Ultrasound of Right Kidney

35. Ultrasound is the best method
to measure the size of the
Kidney

38. Computed Tomography (CT)
•Cross Sectional imaging modality
•Mobile X-ray tube that rotates around a pt
•Slices of X-ray transmission data reconstructed to
generate image
•Data displayed in multiple window settings (lungs
parenchyma, bone, etc.)
•Density measurements/Hounsfield Units analyze
chemical component of tissue
•HU: -150-0 = fat, 0 = water, 0-20 = serous fluid,
45-75 = blood,
100-1000 =bone/calcium

39. CT Contrast Agents
•Intravenous contrast---iodinated
Differentiate blood vessels vs. vascular internal organs
•Enteric contrast---barium
Differentiate bowel vs. intra-abdominal fluid/masses
•Rectal contrast
•Retrograde urinary bladder contrast

42. CT Applications
•Body Imaging
Renal Calculi (without contrast) CT Stonography
•Specialized protocols:
Renal masses, adrenal masses

43. CT Applications
•Acute Abdomen
- Renal-ureteral colic
•Vascular Imaging
-CT angiography--- i.e. coronary arteries,
renal arteries (for transplantation etc.)

44. CTA
(CT Renal Angiography)
The Power of CT

46. CT
Axial, with oral contrast in stomach, no IV contrast

47. Inferior
Vena
Cava

48. Left Renal Vein Passes Anterior to
the Abdominal Aorta

50. RENAL ANGIOGRAPHY

NORMAL SUPPLY
OF BOTH
KIDNEYS BY
SINGLE RENAL
ARTERY
LEFT KIDNEY
SUPPLIED BY
TWO RENAL
ARTERIES

51. CT PET PET/CT

53. Magnetic Resonance Imaging (MRI)
•Multi-planar scanning
•Without ionizing radiation
•Images generated using powerful magnets and
pulsed radio waves passing through the body
•Data from Pt’s body used to generate image
•Field strength of magnets 0.3-3.0 Tesla

54. MRI showing Left Kidney is
higher than Right Kidney
MRI

55. Long axis of the kidneys is directed downward and outward, Long axis of the kidneys is directed downward and outward,
parallel to the lateral border of the psoas musclesparallel to the lateral border of the psoas muscles

58. MRI of Kidneys

59. MR Contrast Agents
•Intravenous contrast---Gadolinium chelate-based
contrast agents
•Gadolinium is a paramagnetic lanthanide that is
toxic as a free metal
•Contrast to evaluate BBB, intracranial edema and
hemorrhage
•Novel agents being developed as tagged
Monoclonal antibodies for Molecular Imaging

60. MR Applications
Abdominal imaging
-Excellent tool due to high soft tissue contrast
resolution
-Multi-planar capability allows for monitoring
extent of disease
-Differentiating subtle soft tissue boundaries of
abdominal mass, ex: Renal cell ca

61. Innovative Modalities
•Constantly evolving face of radiology
•New contrast agents for CT and MR
•Molecular Imaging
- Imaging molecular events---enzymatic
activity, receptor binding, cellular events
•Interventional Radiology and Interventional
Neuroradiology

62. Ultrasound of Prostate
Gland

64. CT SCAN

67. URINARY TRACT ABNORMALITIES

68. TERIMA KASIH
SELAMAT BELAJAR
SEMOGA SUKSES