radiological invest.of renal system

Radiological investigation of renal system

By
Dr . Mohammed bader
FIBMS, DMRD,MBChB
1.plain film (KUB ) and tomography
2.excreation urography
3 micturating cystourethrography
4 retrograde pelography
5.percutaneous renal puncture ( antegrade urography )
6.ascending urethrography
7arteriography
8.venography
9.US
10 CTscan
11 MRI
12 radionuclied imaging
static, dynamicand ,radionuclied cystography direct and indirect
IVU (excretion urography )
indication (suspected urinary tract pathology)
contraindicated
1.if the contrast media contraindication or high risk , like allergy to contrast media , sickle cell anemia
2.pregnancy
technique
the contrast media used is LOCM, the dose for adult is 50 ml
Pediatric dose is 1ml /kg
patient preparation
no food for5 h,
bowel preparation
films preliminary film ( KUB )
inspiration , the lower border of the film is at the level of symphesis pubis
other preliminary films (supine AP ,posterior oblique , and tomography if there is opacities over the renal area
post injection of contrast films
1.immediatfilm AP of the renal area it is exposed after (10-15 s ) after injection (arm to kid time ) it is aim is to show nephrogram (renal paranchyma opaciefied by renal tubuls )
2. 5 min film AP of the renal area the film is taken top determine the excretion ,
compression band is then applied around the PT its aim is to produce better PCS distension
contraindicated 1.evidence of obstruction
on the 5-minute image, 2.abdominal aortic
aneurysm 3.abdominal mass, 4.recent
abdominal surgery 5. severe abdominal pain,
6.suspected urinary tract trauma,7.renal transplant
3.15min AP of the renal area for adequate evaluation of PCS
compression band is then applied around the PT its aim is to produce better PCS distension contraindicated 1.evidence of obstruction on the 5-minute image, 2.abdominal aortic aneurysm 3.abdominal mass, 4.recent abdominal surgery 5. severe abdominal pain,6.suspected urinary tract trauma,7.renal transplant
release film
supine AP film to show the whole UT if it is satisfactory ask the patient to empty the bladder
or do cystogram which is a film centered on the UB
5. after micturation film for assessing bladder emptying
If there is an obstructive uropathy there will be delay of excretion it is better to do 30 min film , if no excretion seen then role of 8 is used i.e 4 h later another film is taken .
retrograde pyelouretrography
indication
demonstration of the site , length , lower limit and nature of obstruction
demonstrate PCS after unsatisfactory EX urography (seldom used with modern imaging methods )
contraindication (acute UTI)
contrast media LOCM , not too dense (10 ml )


complication
contrast advers reaction
chemical pyelitis
extravasation of contrast
infection
mucosal damage
perforation of the ureter

TACHNIQUE

the surgeon catheterized the ureter via cystoscopy

the patient transferd to the X ray department

urine is inspirited
then contrast media is injected in the PCS and taken a film , then withdraw 10 cm another contrast media is injected and film is taken , then it withdrawn to the level just above the orifice of ureter and repeat the injection of contrast and film taken
2ml of contrast is injected for each level
films ( Ap and both posterior oblique is taken )
Antegrade peylography
Procedure in which the contrast medium is introduced by percutaneous needle puncture into the renal pelvis.
Indication
1. when other less invasive technique fail to delineate cause or level of obstruction
2.when retrograde pyelography is fail to delinate obstruction
3.to facilitate renal pressure
4.prior to or as apart of percutanoes nephrostomy


contraindication 1. if contrast media is contraindicated
2.bleeding diathesis
3. hydatid cyst
4.pregnancy
Procedure
under the US guide or florscopy a 22 -G needle is passed directly under local anesthesia while the patient is prone position and suspending inspiration
the needle passed directly through renal paranchyma into minor calyx , then contrast media is introduce until the level of obstruction is outlined
films ( Ap and both 35degree post. oblique views )
then contrast media is removed to reduce chemical peylitis
micturation cystourethrography
VUR
study the urtheral lesion during mict
bladder abnormalities
stress incontinence
Complication
(adverse reaction to contrast
or contrast induce cystitis
UTI
cath truma
cathe of vagina
retention of folys cathe
Procedure
contra indicated
1. (UTI )
2.pregnancy
3.Allergy to contrast preliminary film (cone view to the bladder ) to see any preliminary lesion or calcification

technique
Under aseptic technique folly's catheter is introduced , then injection of LOCM ,slowly and filing is observed under floroscopic technique
any reflux is recorded


ask the patient to urinate and spot films are taken to demonstrate reflux , lateral spot films are needed to determine vesico vaginal fistula

renal angiography

indications
renal art stenosis
2.renal tumour
3 donor kid
4. haematuria unknown cause
US of UT

1.renal mass
2.suspected renal paranch diseas
3. obstructive uropathy
4.haematuria
5.renal cyst
6.renal size measurement
interventional procedure
prostates
bladder volumes
bladder tumour or calculie
Advantages and disadvantages
Advantages of renal ultrasound:
Painless and non-invasive.
Does not involve exposure to radiation.
Requires little preparation.
No contrast needed
Cheap ,avilable , real time
Disadvantages of renal ultrasound:
The nature of ultrasound images means the renal tract urothelium detail is limited.
The image quality may be reduced by obesity, overlying bowel gas or inability of the patient to co-operate with positional and breath holding instructions.
Operator dependant
CT urography
Standard CT urography consists of unenhanced, nephrographic, and pyelographic phases.
CT urography is an excellent technique for the evaluation of urinary tract calculi and renal masses, having high sensitivity and specificity for both conditions because it facilitates multiplanar imaging of the urinary system.
Advantages (multiplanar , tumor extension and staging ,native CT have very high sensitivty for small stone
Disadvantages : high dose of radiation
MR urography
MR urography (MRU) can be performed without contrast administration with static-fluid T2-weighted sequences and after IV contrast administration with excretory T1-weighted sequences (excretory MRU).
No radiation , contrast not always used
Less spatial resolution than CT urography ,not sensitive for calcification .

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