IMAGING OF URORADIOLOGY

PRESENTED BY
DR. NAHAR-E-ZANNAT
M.B.B.S, M.C.P.S
ASSISTANT PROFESSOR (RADIOLOGY AND
IMAGING)
 IMAGING MODALITIES
• PLAIN X-RAY KUB
• USG
• CT SCAN
• IVU
• RGU
• MCU
• CT UROGRAM
PLAIN X-RAY KUB
• Calcium oxalate 80%
• Calcium phosphate 5–10%
• Uric acid 5–10%
• Struvite 10–15%
• Cystine 1–2%
• Xanthine Extremely rare
PLAIN X-RAY KUB
 Axial CT scan of abdomen without
contrast, showing a 3-mm stone (marked
by an arrow) in the left proximal ureter
• Composition
• Kidney stone type Population Circumstances Color Sensitivity Details Calcium oxalate
80% when urine is acidic (decreased pH) [55] Black/dark brown Radio-opaque Some of the
oxalate in urine is produced by the body. Calcium and oxalate in the diet play a part but
are not the only factors that affect the formation of calcium oxalate stones. Dietary
oxalate is found in many vegetables, fruits, and nuts. Calcium from bone may also play a
role in kidney stone formation. Calcium phosphate 5–10% when urine is alkaline (high
pH) Dirty white Radio-opaque Tends to grow in alkaline urine especially when proteus
bacteria are present. Uric acid 5–10% when urine is persistently acidic Yellow/reddish
brown Radiolucent Diets rich in animal proteins and purines: substances found naturally
in all food but especially in organ meats, fish, and shellfish. Struvite 10–15% infections
in the kidney Dirty white Radio-opaque Prevention of struvite stones depends on
staying infection-free. Diet has not been shown to affect struvite stone formation.
Cystine 1–2%[56] rare genetic disorder Pink/yellow Radio-opaque Cystine, an amino acid
(one of the building blocks of protein), leaks through the kidneys and into the urine to
form crystals. Xanthine[57] Extremely rare Brick red Radiolucent
• There are four main types of kidney stones.
• Calcium stones
• Most kidney stones are made of calcium compounds,
especially calcium oxalate. Calcium phosphate and
other minerals also may be present. Conditions that
cause high calcium levels in the body, such as
hyperparathyroidism, increase the risk of calcium
stones. High levels of oxalate also increase the risk for
calcium stones.
• Certain medicines may prevent calcium stones.
• Uric acid stones
• Some kidney stones are made of uric acid, a waste
product normally passed out of the body in the urine.
You are more likely to have uric acid stones if you have:
• Low urine output.
• A diet high in animal protein, such as red meat.
• An increase in how much alcohol you drink.
• Gout.
• Inflammatory bowel disease.
• Struvite stones
• Some kidney stones are struvite stones. They can also be
called infection stones if they occur with kidney or
urinary tract infections (UTIs). These types of kidney stones
sometimes are also called staghorn calculi if they grow large
enough.
• Struvite stones can be serious, because they are often large
stones and may occur with an infection. Medical treatment,
including antibiotics and removal of the stone, is usually
needed for struvite stones. Women are affected more than
men because of their higher risk of urinary tract infections.
• Cystine stones
• Less common are kidney stones made of a chemical
called cystine. Cystine stones are more likely to
occur in people whose families have a condition that
results in too much cystine in the urine (cystinuria).
• Cystine stones may be prevented or dissolved with
medicine. But this may be difficult and not very
effective. If a stone causes blockage in the urinary
tract or is too large, then it will need to be removed
 IVU
• An intravenous pyelogram (IVP), also called an
intravenous urogram (IVU), is a radiological
procedure used to visualize abnormalities of
the urinary system, including the kidneys,
ureters, and bladder.
IVU
• . An injection of X-ray contrast medium is given to a
patient via a needle or cannula into the vein, typically in
the antecubital fossa of arm. The contrast is excreted or
removed from the bloodstream via the kidneys, and the
contrast media becomes visible on X-rays almost
immediately after injection. X-rays are taken at specific
time intervals to capture the contrast as it travels
through the different parts of the urinary system. This
gives a comprehensive view of the patient's anatomy and
some information on the functioning of the renal system.
• Normal appearances
• Immediately after the contrast is administered, it appears on an
X-ray as a 'renal blush'. This is the contrast being filtered through
the cortex. At an interval of 3 minutes, the renal blush is still
evident (to a lesser extent) but the calyces and renal pelvis are
now visible. At 9 to 13 minutes the contrast begins to empty into
the ureters and travel to the bladder which has now begun to
fill. To visualize the bladder correctly, a post micturition X-ray is
taken, so that the bulk of the contrast (which can mask a
pathology) is emptied.
• An IVP can be performed in either emergency or routine
circumstances.
• Routine IVP
• This procedure is most common for patients who have
unexplained microscopic or macroscopic hematuria. It is used to
ascertain the presence of a tumour or similar anatomy-altering
disorders. The sequence of images is roughly as follows:
• plain or Control KUB image;
• immediate X-ray of just the renal area;
• 5 minute X-ray of just the renal area.
• 15 minute X-ray of just the renal area.
• At this point, compression may or may not be applied (this is
contraindicated in cases of obstruction).
• In pyelography, compression involves pressing on the lower
abdominal area, which results in distension of the upper
urinary tract.[2]
• If compression is applied: a 10 minutes post-injection X-ray
of the renal area is taken, followed by a KUB on release of
the compression.
• If compression is not given: a standard KUB is taken to
show the ureters emptying. This may sometimes be done
with the patient lying in a prone position.
• A post-micturition X-ray is taken afterwards. This is usually
a coned bladder view.
• Image assessment
• The kidneys are assessed and compared for:
• Regular appearance, smooth outlines, size, position,
equal filtration and flow.
• The ureters are assessed and compared for:
• Size, a smooth regular and symmetrical appearance. A
'standing column' is suggestive of a partial obstruction.
• The bladder is assessed for:
• Regular smooth appearance and complete voiding.
• IVP is commonly done to identify diseases of
the urinary tract, such as kidney stones ,
tumors, or infection. It is also used to look for
problems with the structure of the urinary
tract that were present from birth
(congenital).
• An intravenous pyelogram (IVP) is done to:
• Look for problems with the structure of the urinary
tract.
• Find the cause of blood in the urine.
• Find the cause of ongoing back or flank pain.
• Locate and measure a tumor of the urinary tract.
• Locate and measure a kidney stone.
• Find the cause of recurring urinary tract infections.
• Look for damage to the urinary tract after an injury.
• Diagnoses
• Chronic pyelonephritis
• Kidney stones
• Renal cell carcinoma (RCC)
• Transitional cell carcinoma (TCC)
• Polycystic kidneys
• Anatomical variations, i.e. horseshoe kidney or a duplex
collecting system
• Obstruction (commonly at the pelvic-ureteric junction or PUJ
and the vesicoureteric junction or VUJ) This is very useful.
• How To Prepare
• Before having an intravenous pyelogram (IVP), tell your doctor if:
• You are or might be pregnant.
• You are breastfeeding. The contrast material used in this test can
get into your breast milk. Do not breastfeed your baby for 2 days
after this test. During this time, you can give your baby breast
milk you stored before the test, or formula. Discard the breast
milk you pump for 2 days after the test.
• You have an intrauterine device (IUD) in place.
• You are allergic to the iodine dye used as the contrast material for
X-ray
• tests or to anything else that contains iodine.
• You have ever had a serious allergic reaction (anaphylaxis), such
as after being stung by a bee or from eating shellfish.
• Within the past 4 days, you have had an X-ray test using barium
contrast material (such as a barium enema).
• You have had kidney problems in the past or have diabetes,
especially if you take metformin (Glucophage) to control your
diabetes. The contrast material used during an IVP can cause
kidney damage in people who have poor kidney function. If you
have had kidney problems in the past, blood tests (creatinine,
blood urea nitrogen) may be done before the test to make sure
that your kidneys are working properly.
• You may need to stop eating and drinking for 8 to 12 hours before the
IVP. You also may need to take a laxative the evening before the test
(and possibly have an enema the morning of the test) to make sure
that your bowels are empty.
• This test is often done in children to see if they may have an abnormal
backflow of urine (vesicoureteral reflux).
Prepare your child for exams and tests that are needed. Explain them
in a simple way. Use positive words as much as possible. Doing so will
help your child understand what to expect and can help reduce fears.
• Talk to your doctor about any concerns you have regarding the need
for the test, its risks, how it will be done, or what the results will
mean. To help you understand the importance of this test, fill out the
medical test information form(What is a PDF document?).
• You will need to remove any jewelry that might interfere with the
X-ray picture. You will need to take off all or most of your clothes,
and you will be given a cloth or paper covering to use during the
test. You will be asked to urinate just before the test begins.
• During the test
• You will lie on your back on an X-ray table. An X-ray picture of your
belly will be taken and reviewed by the radiologist before the next
part of the test begins.
• The injection site on your arm will be cleaned and the contrast
material will be injected into a vein on the inside of your elbow.
The dye travels through the bloodstream, is filtered out by the
kidneys, and passes into the urine
• The urine then flows into the tubes (ureters)
that lead to the bladder.
• X-ray pictures are taken several minutes apart
as the dye goes through the urinary tract. Each
picture is developed right away. Sometimes
more pictures are taken based on earlier ones.
You may be asked to turn from side to side or
to hold several different positions so the
radiologist can take a complete series of X-rays.
• During IVP, a compression device may wrapped around your
belly to keep the dye in the kidneys. The most common
compression device is a wide belt containing two inflated
balloons that push in on either side of your belly to block the
passage of dye through the ureters. If you have recently had
abdominal surgery or have an abdominal disorder, the band
will not be used.
• A special type of X-ray technique called fluoroscopy may also
be used during IVP. During fluoroscopy, a continuous X-ray
beam is used to display a moving image on a video monitor.
• IVP usually takes about an hour.
• After the test is over, you will need to drink
plenty of liquids to help flush the contrast
material out of your body.
 RISK OF IVU
• radiation,
• allergic reaction
• People with certain conditions (such as
diabetes, multiple myeloma,
chronic kidney disease, sickle cell disease, or
pheochromocytoma) have increased chances
of having sudden kidney failure from IVP