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Imaging of Endocrine and
Genitourinary system
Radiology Department
Alexandria faculty of medicine
2019
Imaging of pituitary gland
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
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
Lateral Xray skull
1
2
3 4
5
6
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
1
2
3
4
5
6
1
2
3
4
5
6
1- pituitary gland
2- sphenoid sinus
3- optic chiasm
4- hypothalamus
5- pituitary stalk
6- clivus
NORMAL PITUITARY ADENOMA
1
2
3
4
5
6
1
2
3
4
5
6
Pituitary gland
Optic chiasm
Pituitary stalk
Carotid artery
Cavernous
sinus Sphenoid sinus
MRI pituitary
Imaging of thyroid gland
US thyroid
Imaging of pancreas
CT
MRI
Urinary system imaging
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
– 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.
KUB
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.
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.
CT urography
• 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))
• CT
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)
• 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.
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.
US kidney
The normal adult kidney is 9-12 cm in length.
• MRI
– T2WI: the kidney is of higher signal intensity
relative to liver and many other soft tissues
• T1WI:cortex is slightly higher in signal intensity than
the medulla which is iso-intense to the muscles
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.
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.
Urinary Bladder
• Generally should be distended on any imaging
technique
• US
• CT
– Normal bladder wall is uniform, thin and regular
with no diverticula or calcifications.
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.
Trans-abdominal US: No zonal anatomy clear
Trans-rectal US: better details &zonal anatomy if old
patient
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.
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.
• 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.
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
MRI
– T2WI:
convoluted
areas of high
signal
representing
seminal fluid
and low signal
walls
Testes
• US
The testicles are evaluated transversally and sagittally. Normal
testicles have an oval shape and are virtually homogeneous
MRI Testis
Imaging of female pelvis
Imaging Modalities
of Female genital system:
◦ US
◦ MRI
◦ Conventional: contrast study:
hystrosalpingography
◦ CT
Female Genital system
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
USHow should I prepare?
How does the procedure work?
How is the procedure performed?
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
Female Genital system
US (Transabdominal)
Female Genital system
US (Endovaginal)
Anatomy & Physiology
during menstruation
thin endometrial lining (1-4 mm) with a trace of fluid.
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.
secretory phase
thickened, echogenic endometrium due to edema ,it
measures up to 16 mm.(maximum thickness is at the mid
secretory phase
postmenopausal endometrium
Thin, homogeneous, and echogenic. Homogeneous,
measuring 5 mm or less with or without hormonal
replacement therapy
ovaries
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.
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.
Anatomy
Image from: www.uptodate.com
Female Genital system
US (Endovaginal)
Transverse US scan obtained in a 1-month-old girl shows
normal ovaries (arrows) with visible follicles. The ovarian
volume is 1 cm3.
the ovaries display hypo intense stroma with hyper
intense follicles on T2-weighted images
MRI
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.
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.
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.
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.
The third image
obtained to demonstrate and evaluate the fallopian
tubes.
The fourth image
should exhibit free intraperitoneal spillage of contrast
material.
Contraindications
Pregnancy
so patients with irregular cycles should do
pregnancy test before the procedure.
Active pelvic infection.
Female Genital system
MRI
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.
MRI sagittal female pelvis
MRI sagittal male pelvis
Imaging of breast
Imaging of breast
3. Fine needle
aspiration biopsy
2. Ultrasound
examination.
1. Mammographic
examination
Mammography
MLO view
• Mammogram position • Mammographic image
CC view
• Mammogram position
• Mammographic image
Mammography
Us normal breast
MRI breast
Exam orientation
• Two slides
• Imaging technique: ex : Xray ,CT,MRI
• Mention anatomical structure labeled in
radiological image
Imaging endocrine and gu    copy

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Imaging endocrine and gu copy

  • 1. Imaging of Endocrine and Genitourinary system Radiology Department Alexandria faculty of medicine 2019
  • 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
  • 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
  • 9. 1 2 3 4 5 6 1- pituitary gland 2- sphenoid sinus 3- optic chiasm 4- hypothalamus 5- pituitary stalk 6- clivus
  • 13. Pituitary gland Optic chiasm Pituitary stalk Carotid artery Cavernous sinus Sphenoid sinus
  • 16.
  • 19. CT
  • 20. MRI
  • 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.
  • 27.
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  • 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))
  • 35.
  • 36.
  • 38.
  • 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.
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  • 59.
  • 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.
  • 61.
  • 62. US kidney The normal adult kidney is 9-12 cm in length.
  • 63.
  • 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
  • 66.
  • 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.
  • 75.
  • 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
  • 81.
  • 82.
  • 85.
  • 86. Imaging Modalities of Female genital system: ◦ US ◦ MRI ◦ Conventional: contrast study: hystrosalpingography ◦ CT
  • 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)
  • 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
  • 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.
  • 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.
  • 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.
  • 115. MRI sagittal male pelvis
  • 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
  • 123. Exam orientation • Two slides • Imaging technique: ex : Xray ,CT,MRI • Mention anatomical structure labeled in radiological image

Editor's Notes

  1. Non-contrast, arterial, venous, nephrographic
  2. delayed
  3. Fat suppressed T1WI
  4. Excretory MRU