CT urography provides a comprehensive noninvasive examination of the kidneys, ureters, and bladder. It allows identification of stones, masses, and other abnormalities. There are different techniques for CT urography, including single or split bolus with multiple phases and saline hydration. CT urography is indicated for patients over 40, those with a history of transitional cell carcinoma, positive urine cytology, or hematuria. It can detect various normal variants and abnormalities like cysts, infections, masses and urothelial neoplasms.

1. CT UROGRAPHY
FROM SEEING TO UNDERSTANDING
Dr. Hazem Abu Zeid Yousef
Lecturere of Radiodiagnosis
Faculty of Medicine
Assiut University

2. Although all imaging modalities play an
important role in imaging the urinary tract, CT
urography represents the most comprehensive
imaging examination of the urinary tract. It
provides a single noninvasive examination of the
kidneys, ureters, and bladder in one test. As a
result, CT urography is the current modality of
choice for evaluation of painless gross or
microscopic hematuria. CT urography allows for
identification of stones, renal parenchymal
masses, and urothelial abnormalities.

3. APPROACHES TO CTU
For a CT examination to allow for
comprehensive urinary tract imaging, it
must be able to adequately detect urinary
tract calculi, renal masses, and renal
collecting system, bladder, and ureteral
abnormalities.

4. TECHNIQUES OF CTU
• SINGLE BOLUS 3 OR 4 PHASES
TECHNIQUE
• SPLIT BOLUS TECHNIQUE
• SALINE HYDRATION
• IV DIURETICS.

5. INDICATIONS FOR MDCTU

6. Due to the radiation intensive nature of MDCTU,
some investigators have suggested that this study
be performed only on patients who are
preidentified by urologists as being at a high risk
for having urinary tract pathology, especially
transitional cell carcinoma. When these
restrictions are enforced, MDCTU is generally
performed on patients more than 40 years of age
and patients with at least one of the following: a
history of transitional cell carcinoma (and who are
therefore likely to have recurrences or
metachronous tumors), positive urine cytology,
previous equivocal imaging studies, and persistent
symptoms (e.g., ongoing hematuria).

7. In contrast, others suggest performing MDCTU as
a screening test on any patient who presents with
hematuria. According to these authors, MDCTU is
already in a position to replace EU completely.
Regardless of the differing recommendations as to
when MDCTU should be performed, all
investigators are extremely enthusiastic about its
potential. Even those advocating limited use have
stated that with a few additional radiation-
restricting modifications in CT hardware and
changes in CT technique, MDCTU is poised to
make EU obsolete in the very near future.

8. NORMAL ANATOMY

9. NORMAL ANATOMY
FRONTAL (ANTERIOR) VIEW OF VR IMAGES

10. MIP IMAGE (POSTERIOR VIEW) VR DOUBLE DENSITY IMAGE
(POSTERIOR VIEW)

11. NORMAL VARIANTS AND
CONGENITAL ANOMALIES

12. NORMAL PAPILLARY BLUSH

13. PROMINENT RENAL PAPILLA

14. COMPOUND CALYX

15. PTOTIC KIDNEY

16. ECTOPIC KIDNEY

17. VR IMAGE MIP IMAGE

18. HORSESHOE KIDNEY

19. DOUPLEX LEFT COLLECTING SYSTEM WITH
ECTOPIC UPPER MOIETY URETER

21. BENIGN TUBULAR ECTASIA

22. CROSSED FUSED ECTOPIA

23. UROLITHIASIS

24. CASE (1)
NON ENHANCED CT SHOWING
BILATERAL RENAL PELVIS
CALCULI WITH MARKED
PYELITIS.
ENHANCED CT SHOWING
GOOD ENHANCEMENT.

25. MIP; THE STONES ARE WELL-SEEN WITHIN THE
OPACIFIED RENAL PELVIS.

26. CASE (2)
THICK SLAP MIP
BILATERAL RENAL
AND UB STONES
CORONAL IMAGES
SHOWING MARKED
PYELITIS OF THE
LEFT KIDNEY

27. MIP; THE STONES ARE WELL-SEEN WITHIN THE
OPACIFIED RENAL PELVIS. MULTIPLE UB STONES.

28. CASE (3)
PRE AND POST CONTRAST SCANS.
MARKED STRANDING OF THE
PERINEPHRIC FAT ON THE RIGHT
SIDE.

29. SURFACE SHADED DISPLAY (SSD).
THE LUMEN AND THE STONES COULD NOT BER SEEN

30. CASE (4)
ACUTELY OBSTRUCTED
LEFT KIDNEY WITH
PERINEPHRIC COLLECTION
(FORNICEAL RUPTURE).

31. CURVED REFORMATS
SHOWING 3 LOWER
URETERIC STONES.

32. CASE (5)
CURVED REFORMAT
LOWER URETERIC STONE
CAUSING MILD HYDRONEPHROSIS
DOUBLE DENSITY VR IMAGE
THE STONE IS DEMONSTRATED
AGAINST THE UNDERLYINGBONE

33. CASE (6)
BILHARZIAL CALCIFICATION OF THE LEFT LOWER
URETER WITH LOWER URETERIC STONE.

34. CASE (9)
MEDULLARY NEPHROCALCINOSIS

36. RENAL INFECTIONS

37. CASE (1)
MULTIFOCAL NEPHRONIA

38. CASE (2)
OBSTRUCTED INFECTED KIDNEY
ENLARGED LEFT KIDNEY WITH MARKED STRANDING OF THE
PERINEPHRIC FAT AND OBSTRUCTING PELVIC CALCULUS

39. DOUBLE DENSITY VR IMAGE SHOWING
THE OBSTRUCTING CALCULUS

40. CASE (3)
RIGHT UPPER POLAR ABSCESS

41. CASE (3)
RIGHT UPPER POLAR ABSCESS

42. DELAYED FILLING OF THE ABSCESS

43. RENAL SOLs

44. CASE (1)
NON ENHANCED CT ENHANCED CT

45. DELAYED FILLING OF
CALYCEAL DIVERTICULUM

46. CASE (2)

47. SIMPLE (BOSNIAK TYPE I) RENAL CYST

48. CASE (3)

49. MULTILOCULAR PARAPELVIC CYST WITH
STRETCHING OF THE MAJOR CALYCES

50. CASE (4)

51. BOSNIOAK TYPE II CYST WITH THIN CALCIFIED
RIM AND INTRACYSTIC SEPTUM
(THANKS FOR THE SUBMILLEMETRIC SLICE THICKNESS)

52. CASE (5)

53. INITIALLY HYPERDENSE SIMPLE CYST (BOSNIAK TYPE II)

54. CASE (6)

55. BOSNIAK TYPE III CYST
THICK ENHANCING INCOMPLETE
SEPTUM AND IRREGULAR OUTLINES

56. CASE (7)

57. BOSNIAK TYPE IV CYST
THICK ENHANCING MURAL NODULE

58. CASE (8)

59. SOLID UPPER POLAR MASS
CLEARLY DEMONSTRATED
IN CORONAL IMAGES

60. CASE (9)

62. MALIGNANT LOWER POLAR LEFT RENAL MASS WITH
ENHANCING MALIGNANT THROMBUS WITHIN THE IVC
AND SECONDARY VARICOSITIES OF THE LEFT TESTICULAR VEIN.

63. CASE (10)
MALIGNAT SUPRARENAL MASS
WITH LIVER METASTASES

65. DISPLACED LEFT KIDNEY WITH
DOUPLEX RIGHT COLLECTING SYSTEM

66. INTRARENAL COLLECTING
SYSTEM

67. CASE (1)
PRE AND POST CONTRAST MIP IMAGES
TUBULAR DILATATION WITH TINY
CALCULI WITHIN THE DILATED TUBULES
(MEDULLARY SPONGE KIDNEY)

69. CASE (2)

70. ACUTE PAPILLARY NECROSIS
YOUNG FEMALE PATIENT WITH
PAINLESS HEMATUREA AND
HISTORY OF ANALGESIC ABUSE

71. CASE (3)

72. MALIGNANT UROTHELIAL NEOPLASM OF THE
UPPERE CALYX IN A MIDDLE AGED MALE WITH
PAINLESS HEMATUREA

73. CASE (4)

74. ANOTHER EXAMPLE OF MALIGNANT UROTHELIAL
NEOPLASM OF THE UPPERE CALYX

75. URETERS
AS A RULE;
MALIGNANT URETERIC NEOPLASMS CHARACTERISTICALLY
CAUSE DILATATION OF THE URETER BOTH PROXIMAL AND
DISTAL TO THE LESION.

76. CASE (1)

78. CASE (2)

80. CASE (3)

82. CASE (4)

84. CASE (5)

86. CASE (6)

87. FIBROVASCULAR POLYP OF THE URETER

88. URINARY BLADDER

89. CASE (1)

91. CASE (2)
EXTRAVESICAL PARARECTAL MASS

93. CASE (3)
URACHUS

94. RENAL ARTERY ASSESSMENT

96. THANK YOU