This document provides an overview of various imaging modalities and techniques used to image the endocrine and genitourinary systems. It describes the normal anatomy, imaging indications, and key findings for structures like the pituitary gland, thyroid gland, pancreas, kidneys, adrenal glands, prostate, ovaries and female pelvis. Specific modalities covered include MRI, CT, ultrasound, mammography, intravenous urography, cystourethrography and hysterosalpingography. Example images are provided to illustrate normal anatomy on different exams.

1. Imaging of Endocrine and
Genitourinary system
Radiology Department
Alexandria faculty of medicine
2019

2. Imaging of pituitary gland

3. NORMAL PITUITARY GLAND
 The gland is composed of
two parts:
Anterior lobe (adeno
hypophysis)
Posterior lobe (neuro
hypophysis)
 Normal size:
Weight: 0.5g
Height: 4-16 mm

4. INDICATIONS FOR IMAGING THE
PITUITARY GLAND
Hormonal dysfunction
 Cushing syndrome
 Growth abnormalities e.g. Growth hormone
deficiency, acromegaly
Visual abnormalities
Headache
Best imaging tool: MRI pitutray

5. Lateral Xray skull

6. 1
2
3 4
5
6

7. 1
2
3 4
5
6
1-Optic sulcus
2- Anterior clinoid process
3-Floor of sella turcia
(Pituitary fossa)
4- Posterior clinoid process
5- Dorsum sella
6- Sphenoid sinus

8. 1
2
3
4
5
6

9. 1
2
3
4
5
6
1- pituitary gland
2- sphenoid sinus
3- optic chiasm
4- hypothalamus
5- pituitary stalk
6- clivus

10. NORMAL PITUITARY ADENOMA

11. 1
2
3
4
5
6

12. 1
2
3
4
5
6

13. Pituitary gland
Optic chiasm
Pituitary stalk
Carotid artery
Cavernous
sinus Sphenoid sinus

14. MRI pituitary

15. Imaging of thyroid gland

17. US thyroid

18. Imaging of pancreas

19. CT

20. MRI

21. Urinary system imaging

22. Urinary tract
• Plain X-ray
– INDICATIONS:
• 1- Suspected renal calculi.
• 2- Demonstrate calcifications in urinary tract.
• 3- Preliminary before IVU.
– VIEWS:
• 1-Anteroposterior (KUB)
• 2-Lateral view
• 3-Anteroposterior view standing for ptosed kidney

23. – RADIOGRAPHIC ANATOMY:
• Kidneys:
– Soft tissue shadow of kidneys is outlined by the surrounding perirenal fat
especially the lower halves.
– Right renal soft tissue shadow extends from 12th rib to L3.
– Left renal soft tissue shadow extends from 11th rib to L3.
• Urinary bladder:
– Casts a water density soft tissue shadow in pelvic cavity.

24. KUB

25. Intravenous urogram (IVU)
• Delineation of the urinary tract through
injection of contrast medium intravenously.
• INDICATION:
1- Hematuria.
2- Renal colic.
3- Recurrent urinary tract infection.
4- Suspected urinary tract pathology.
• CONTRAINDICATIONS:
Contrast allergy, raised serum creatinine, pregnancy,
hepatorenal syndrome and thyrotoxicosis.

26. Sufficient excretion of contrast: Density of contrast  density of bone.
It should be preceded by a plain film (KUB)
Values of plain film:
a- Detect radiopaque stones or calcifications.
b- Check patient preparation.
c-To check exposure factors.

33. CT urography

34. • Indications:
– Hematuria
– Upper urinary tract tumors (detection, staging
&post-treatment follow-up)
– Urinary bladder tumors (detection of synchronous
tumors, staging nodal and distant metastasis
&post-treatment follow-up))

37. • CT

39. Voiding cystourethrogram
• It is a fluoroscopic study of the lower urinary
tract in which contrast is introduced into the
bladder via a catheter.
• The purpose of the examination is to assess
the bladder, urethra, postoperative anatomy
and micturition in order to determine the
presence or absence of bladder and urethral
abnormalities, including vesicoureteric reflux
(VUR)

40. • It is more commonly performed in the pediatric
population than adults
• The bladder is filled with contrast medium under
aseptic precautions
• The following projections should be acquired:
– AP with full bladder for demonstration of the
presence or absence of VUR.
– both obliques to demonstrate bilateral vesicoureteric
junctions.
– post void film to check for a ureterocoele.

60. Ascending urethrogram
• Retrograde filling of the contrast agent into the urethra
• INDICATIONS:
1- Stricture and rupture of the urethra following trauma
when retrograde filling is essential.
2- When investigating prostatic abnormalities.
3- Indeterminate genital anatomy.
4- Prior to catheterization following major pelvic trauma to
assess for any urethral damage
• CONTRAINDICATIONS:
1- Care should be exercised with patients who may be
sensitive to iodine contrast agents.
2- Acute urethritis & balanitis.

62. US kidney
The normal adult kidney is 9-12 cm in length.

64. • MRI
– T2WI: the kidney is of higher signal intensity
relative to liver and many other soft tissues

65. • T1WI:cortex is slightly higher in signal intensity than
the medulla which is iso-intense to the muscles

67. Suprarenal gland
• CT:
– The normal adrenals
have soft tissue
densities similar to that
of the liver,
– The limbs should have
uniform thickness that
should not exceed the
thickness of the
diaphragmatic crus, any
area thicker than 10
mm is probably
abnormal.

68. MRI
• On T1WI and T2WI without fat suppression, the adrenal
glands have homogeneous, hypointense in contrast to
surrounding fat, and are isointense or hypointense relative
to liver.

69. Urinary Bladder
• Generally should be distended on any imaging
technique
• US

70. • CT
– Normal bladder wall is uniform, thin and regular
with no diverticula or calcifications.

71. Prostate
• US
– Normal prostatic echo-pattern:
• Normal prostate sonogram often contain isoechoic
structures most characteristically in the peripheral,
transition, and central zones
• Smooth muscles produce hypoechoic appearance,
although an enlarged transition zone is also able to
produce such echogenicity.
• Hyperechoic structures are characteristic of fat,
corpora amylacea, or calculi.

72. Trans-abdominal US: No zonal anatomy clear

73. Trans-rectal US: better details &zonal anatomy if old
patient

74. An axial transrectal ultrasound view of the normal
prostate gland. Note the homogeneous hyperechoic
appearance of the peripheral zone. The arrow points to
the urethra.

76. CT
• Prostate appears in cross-section as a rounded
isodense structure just below and inseparable from
the urinary bladder.
• Few small calcifications can be seen.

77. • MRI
– On T2-weighted images, the normal peripheral
zone demonstrates a high signal intensity.
– The peripheral zone is surrounded by a thin rim of
low signal intensity, which represents the
anatomic or true capsule.

78. Seminal vesicles
CT
The paired seminal vesicles are perched posterolateral and
superior to the prostate gland typical "bow-tie" appearance
•
The paired seminal vesicles are perched
posterolateral and superior to the prostate
gland

79. MRI
– T2WI:
convoluted
areas of high
signal
representing
seminal fluid
and low signal
walls

80. Testes
• US
The testicles are evaluated transversally and sagittally. Normal
testicles have an oval shape and are virtually homogeneous

83. MRI Testis

84. Imaging of female pelvis

86. Imaging Modalities
of Female genital system:
◦ US
◦ MRI
◦ Conventional: contrast study:
hystrosalpingography
◦ CT

87. Female Genital system

88. US
 high-frequency sound
waves to produce pictures
of the inside of the body
 No ionizing radiation
 real-time - structure and
movement (Doppler)
 Non-invasive

89. USHow should I prepare?
How does the procedure work?
How is the procedure performed?

90. Anatomy & Physiology
• Single pear shaped muscular organ
• Consists of:
 Cervix
 Body
 Fundus
 Connected to two fallopian tubes
• Dynamic organ under the influence of sex
hormone

91. Female Genital system
US (Transabdominal)

92. Female Genital system
US (Endovaginal)

93. Anatomy & Physiology

94. during menstruation
thin endometrial lining (1-4 mm) with a trace of fluid.

95. proliferative phase
the endometrium with a multilayered appearance ,an
echogenic basal layer and hypoechoic inner functional layer,
separated by a thin echogenic median layer arising from the
central interface .it measures up to 11 mm.

96. secretory phase
thickened, echogenic endometrium due to edema ,it
measures up to 16 mm.(maximum thickness is at the mid
secretory phase

97. postmenopausal endometrium
Thin, homogeneous, and echogenic. Homogeneous,
measuring 5 mm or less with or without hormonal
replacement therapy

98. ovaries

99. Position
It is located close to the lateral pelvic sidewall in a
shallow peritoneal depression called the ovarian fossa
The fossa is bounded posteriorly by the ureter and superiorly
by the external iliac vein.

100. Anatomy & Physiology of ovaries
• The ovaries are a pair of female reproductive
organs.
• They are located in the pelvis, one on each
side of the uterus.
• The ovaries are connected to each other by
the Fallopian tubes.

101. Anatomy
Image from: www.uptodate.com

102. Female Genital system
US (Endovaginal)

103. Transverse US scan obtained in a 1-month-old girl shows
normal ovaries (arrows) with visible follicles. The ovarian
volume is 1 cm3.

104. the ovaries display hypo intense stroma with hyper
intense follicles on T2-weighted images
MRI

105. Hystrosalpingography
Technique
 scheduled during days 7–12 of
the menstrual cycle.
 Scout radiograph
 iodinated contrast agent is
injected(about 10 ml)
 Then we obtain four spot
radiographs.

106. HSG
Technique:
The examination should be scheduled during
days 7–12 of the menstrual cycle.
scout radiograph is obtained.
Speculum is used to expose the cervix.
Traction of the cervix by volsellum.
 iodinated contrast agent is injected (about 10 ml)
women are advised to take a non steroidal anti-
inflammatory drug 1 hour prior to the procedure.
Then we obtain four spot radiographs.

107. The first image
obtained during early filling of the uterus and is used to
evaluate for any filling defect or contour abnormality.
Small filling defects are best seen at this stage.

108. The second image
obtained with the uterus fully distended. The shape of the
uterus is best evaluated at this stage, although small filling
defects may be obscured when the uterus is well opacified.

109. The third image
obtained to demonstrate and evaluate the fallopian
tubes.

110. The fourth image
should exhibit free intraperitoneal spillage of contrast
material.

111. Contraindications
Pregnancy
so patients with irregular cycles should do
pregnancy test before the procedure.
Active pelvic infection.

112. Female Genital system
MRI

113. MRI
On T2-weighted images The endometrium has high signal intensity. The
junctional zone, which corresponds to the innermost myometrium,appears
as a band of low signal intensity. The peripheral myometrium has
intermediate signal intensity that is higher than that of the striated muscle.

114. MRI sagittal female pelvis

115. MRI sagittal male pelvis

116. Imaging of breast

117. Imaging of breast
3. Fine needle
aspiration biopsy
2. Ultrasound
examination.
1. Mammographic
examination

118. Mammography
MLO view
• Mammogram position • Mammographic image

119. CC view
• Mammogram position
• Mammographic image

120. Mammography

121. Us normal breast

122. MRI breast

123. Exam orientation
• Two slides
• Imaging technique: ex : Xray ,CT,MRI
• Mention anatomical structure labeled in
radiological image