1. Dr/ ABD ALLAH NAZEER. MD.
Imaging of the Upper
urinary tract (part 1).

2. Imaging of the Urinary system.
Plain kidney, ureters and bladder (KUB) testing
Intravenous urogram
Ultrasonography
Nuclear medicine - including
mercaptoacetyltriglycine (MAG3) and
dimercaptosuccinic acid (DMSA) scans
Cystography
Computed tomography (CT) scan
Magnetic resonance imaging (MRI) scan
More invasive tests.

17. Stones.

20. Bladder mass.
Bladder diverticulum.

22. Ultrasonography
Generally ultrasonography is an
excellent imaging modality as it is
noninvasive, reliable and affordable.
It can be used to investigate the kidney,
bladder, and prostate gland. It can also
be combined with voiding, providing an
indication of the residual volume. This
gives an indirect measure of bladder
function.

25. Computed tomography scanning of the urinary tract.
CT Advantage.
Detection of radio-opaque and radio-lucent calculi.
Diagnosis of urinary obstruction and its level.
Congenital anomalies.
Detection and staging of urinary system neoplasm.
Differentiation between cystic and solid urinary
neoplasm.
CT Urography.
CT Angiography in renal stenosis and vascular
anomalies.

33. Radioisotope renography is a form of kidney imaging involving radioisotopes
The two most common radiolabelled pharmaceutical agents used are Tc99m-
MAG3 (Mercaptoacetyltriglycine) and Tc99m-DTPA (Diethylene Triamine
Pentacaetic Acid). Some other radiolabelled pharmaceuticals are EC (Ethyl
Cysteine) and 131-Iodine labelled OIH (Ortho Iodo Hippurate). MAG3 is by
far a better diagnostic agent than Tc-99m-DTPA, particularly in neonates,
patients with impaired function, and patients with suspected obstruction.
The MAG3 clearance is highly correlated with the effective renal plasma flow
(ERPF), and the MAG3 clearance can be used as an independent measure of
renal function. After intravenous administration, about 40-50% of the MAG3
in the blood is extracted by the proximal tubules with each pass through the
kidneys; the proximal tubules then secrete the MAG3 into the tubular
lumen. DTPA is the second most commonly used renal radiopharmaceutical
in the United States, primarily because it is the least expensive. Tc-99m-DTPA
is filtered by the glomerulus and may be used to measure the glomerular
filtration rate (GFR). The extraction fraction of DTPA is approximately 20%,
less than half that of MAG3. However, EC is preferred when the serum
Creatinine is high.

34. Items should be assessed.
Congenital anomalies.
Urinary stones.
Inflammatory disease.
Renal neoplasm(cystic and solid
masses).
Renal trauma.
Urinary tract pathology.

35. I-Congenital anomalies:
1.Renal agenesis. Absence of the kidney usually
the left one
2.Renal hypoplasia.
3.Horse shoe kidney. Fused kidneys at their
poles.
4.Ectopic Kidney.
5.Aberrant renal artery.
6-Persisteuce of fetal lobulation.
7-Congenital polycystic kidney.
8-Congenital solitary cyst.
9-Double ureters and pelvis.
10-Megaureter. Due to absence of ganglion cells
11-Congenital stricture of the ureter.

36. Renal agenesis refers to a congenital absence of one or both
kidneys. If bilateral (traditionally known as the classic Potter
syndrome) the condition is fatal, whereas if unilateral, patients
can have a normal life expectancy.
Radiographic features
Antenatal ultrasound.
Absent kidney
absent ipsilateral renal artery
compensatory hypertrophy of the
contralateral (opposite) kidney
Postnatal ultrasound, CT and MRI.
All imaging modalities will demonstrate the absence of a
kidney, with associated hypertrophy of the single kidney.
Again, care must be taken not to misinterpret cross-fused
renal ectopia for renal agenesis.

37. CT Scan of right renal agenesis.

38. Right renal hypoplasia.

39. Horse shoe kidneys.

40. Horse shoe kidneys.

41. Ectopic thoracic Kidney and contra-lateral ureteral duplication.

42. Ectopic pelvic kidney.

44. Congenital mega ureter.

45. Pathogenesis: failure of fusion between secretory and
excretory parts of the nephrons. due defective
PKD 1 or PKD 2 genes
Complications:
Secondary hypertension
Chronic renal failure
Hematuria

46. Congenital polycystic kidney disease.

47. Congenital polycystic kidney disease.

48. Persistent fetal lobulation is a normal variant seen occasionally
in adult kidneys. It occurs when there is incomplete fusion of the
developing renal lobules. Embryologically, the kidneys originate
as distinct lobules that fuse as they develop and grow.

49. Congenital Double left ureter and pelvis.

50. Left megaureter

51. Renal and ureteric stones.

52. Stag-horn renal stones. Left renal stone.

53. IVP with ureteric stones.

56. right renal stone.Left renal stone.

57. Left renal stag-horn stone.Bilateral staghorn stones.

60. Ureteric stricture.
MRU images.

61. Bilateral obstructed megaureter.

62. Bilateral PUJ obstruction.

63. ureteric stone with hydronephrosis.

85. Thank You.