Conventional imaging of ut by dr.abd alla shady md

1. By
Abdalla Abdelhamid Shady, MD
Radiology Department
Urology and Nephrology Center
Mansoura University

2.  Radiography: is an imaging technique using X-rays to view the
internal form of an object.
 It is relatively inexpensive to produce, can be obtained almost
anywhere by using portable or mobile machines, and are still the
most widely obtained imaging studies.
 They require a source to produce the x-rays (the “x-ray machine”),
a method to record the image.

3. Anatomy

4. Conventional imaging of the urinary tract
 UTP ( KUB).
 Intravenous Urography (IVU).
 VCUG.
 Retrograde urethrography.
Others; Antegrade pyelography ,Retrograde pyelography,
loopography.

5. Five main basic densities:

6. 5-Metal
1- Air
2- Fat
4-Bone
3-Soft tissue and fluids
4
2
15
3
BASIC
DENSITIES
3

7. PLAIN RADIOGRAPHY(UTP / KUB)
- from the suprarenal
region to a level below
the symphysis pubis.
Proper scout

8. Proper scout

9. Additional views:
- Oblique conventional
radiographs.

10. Additional
views:
Open bladder film.

11. Conventional
Tomograms
Conventional tomograms (also known as plain film
tomograms) are radiographs, which are used to evaluate
a specific plane within the body by blurring out tissues
above and below the plane of interest.
The x-ray source and detector are moved about a focal
plane centered in the body. The tissues above and below
the plane of interest are blurred, and the focal plane
remains sharp.

14. KUB Analysis
• Calcifications
• Abnormal soft tissue
• Air within urinary tract
• Bony abnormalities

16. Causes of
Medullary
Nephrocalcinosis
* Hyperparathyroidism
* Renal tubular acidosis
* Medullary sponge kidney
* Renal papillary necrosis (especially
analgesic nephropathy)
* Bone metastases
* Hyperthyroidism
* Hypothyroidism
* Idiopathic hypercalcemia
• Malignancy
• Nephrotoxic drugs (amphotericin
* Renal tuberculosis
* Sarcoidosis
* Sickle cell diseas
* Vitamin D excess

19. • Renal outlines
• Spleen
• Liver
• Loss of psoas margin may indicate retroperitoneal
pathology
Abnormal Soft Tissue

22. Air within urinary tract
• Fistula
• Gas forming infections
• Bladder substitutes ; V-U reflux

24.  Metastases
 Spine abnormalities
BONY ABNORMALITIES

28. Intravenous urography

29. IVU:
Indications
Superseded
 Renovascular hypertension
 Prostate enlargement.
 UTI.
 Pelvi-abdominal mass.

30. Reduced
 Renal colic.
 Renal trauma.
 Hematuria.
 Obstructive uropathy.
IVU:
Indications

31. Indicated
 Prior to endourological procedures.
 State of papillae and minor calyces.
 Complex congenital anomalies.
 Possible fistulas.
IVU: Indications

32. IVU: Procedures

33. The preliminary kidney, ureter, bladder (KUB)
radiograph is an indispensable part of the sequence.

34. Interpretation of
IVU
 Evaluation of the kidney (size, position,
parenchyma and contour)
 Evaluation of the PCS.
 Evaluation of the ureter.
 Evaluation of the urinary bladder.

35. Renal size

36. IVU
 Kidney position.
 Longitudinal axis.

38. position of the kidney.

39. position of the kidney.

40. Renal parenchyma:
-Beak sign.
-Double contour sign

41. Nephrogram

42. Types of
nephrogram
 Faint persistent nephrogram: hypotension,
impaired function ( High dose urography).
 Increasing dense nephrogram: distal
obstruction, RAS, Renal vein thrombosis.
 Immediate dense: ATN, APN.
 Striated nephrogram: APN, ARPKD, Medullary
sponge kidney.

43. IVU
 Evaluation of the PCS.

46. Grading of hydronephrosis

47. -Evaluation of the renal papillae
-Obstruction (round forniceal margin).
-CM inside the papillae.
-Parenchymal cavities filled with CM.
-Filling defect.

51.  Medial deviation of the ureter should be
considered when the ureter overlies the ipsilateral
lumbar pedicle.
 lateral deviation should be considered when the
ureter lies more than 1.5 cm beyond the tip of the
transverse process.

53. Bladder
- Bladder contour.
- Wall thickness and irregularities.
- Extrinsic compression.
- Filling defect.

54. Post-voiding films
To determine residual urine in bladder especially in older
male patients.
.

55. To look for bladder neoplasms

56. Contraindications
 High serum creatinine.
 Pregnancy.
 Allergic condition.
 Hepatorenal syndrome.
 Multiple myeloma.
 Thyrotoxicosis

58. Cystography
Describes visualization of the bladder
Urethrography
Visualization of urethra
Cystourethrography
Combined study to visualize bladder and urethra

59.  VCUG is commonly performed in children with
prenatally diagnosed hydronephrosis, urinary
tract infections, and voiding abnormalities.
 The procedure should include:
- Assessment of the spine and pelvis.
- Bladder capacity, contour.
- VUR.
- Vesical masses .
- Vesical stones.
- Urethral appearance.

62. Bladder capacity=(Age(ys)+2)x30.
A smaller than expected voiding volume may also indicate a neurologic
abnormality (spastic bladder) or active bladder infection.

63. Bladder capacity=(Age(ys)+2}x30.
A smaller than expected voiding volume may also indicate a neurologic
abnormality (spastic bladder) or active bladder infection.

67. Urethrograph
y

70. Retrograde Urethrography Voiding Urethrography

72. Antegrade pyelography

73. Retrograde
Pyelography

74. Loopogram

75. Thank You