IMPORTANT

1. Imaging of the Renal
System
Dr. Reshaid Al Jurayyan
Department of Radiology

2. OUTLINE
•Introduction
•Imaging modalities
•Anatomy
•Case scenarios

3. Case (1)
• Young male patient presenting with left
flank pain and hematuria, no fever and
normal WBC count.

4. Case (2)
• Middle aged woman presenting with
flank pain, fever and high WBC.

5. Case (3)
• Elderly male patient with recurrent
urinary tract infections.

6. Case (4)
• Young female presenting with decreased
renal function (high urea and creatinine
level).

7. Case (5)
• Elderly male patient with painless
hematuria and weight loss.

8. Case (6)
• Young male patient involved in a motor
vehicle accident with sever blunt trauma
to the abdomen.

9. INTRODUCTION
•What is radiology?
It is a medical specialty that employs the
use of imaging to both diagnosing and
treating diseases within the human body.
•What is the renal system?
Kidneys, ureters, urinary bladder and
urethra.

10. What radiological modalities
can be used to image the renal
system ?

11. IMAGING MODALITIES
•Conventional radiography
•Intravenous urogram (IVU)
•US
•CT
•MRI
•Nuclear medicine

12. Terminology
•
X ray : Radio-opaque (white) vs radio-lucent (black)
•
US: Hyper-echoic (white) / hypo-echoic(black)
•
CT: Hyper-dense (white) / hypo-dense(black)
•
MRI: Hyper-signal (white) / hypo-signal
•
Nuclear med.: Highuptake(black) / lowuptake (white)

13. Conventional radiography
• First imaging
modality in most
cases.
• Cheap.
• Useful for radio-
opaque stones.
• Disadvantage :
radiation

14. Conventional radiography
Image features:
• Projectional image.
• Image contrast
determined by
tissue density.
• Good evaluation
radio-opaque
stones.

15. IVU
• Conventional x-ray
plus intravenous
contrast.
• Cheap.
• Recently replaced by
CT and MRI.
• Useful for radio-
opaque stones.
• Disadvantage :
impaired the kidney

16. IVU
Image features:
• Projectional image.
• Image contrast
determined by
tissue density and
IV contrast.
• Good evaluation of
collecting system
and radio-opaque
stones.

17. US
• Use high frequency
sound wave.
• No radiation
• Contrast between
tissue is
determined by
sound reflection.

18. US
Image features:
• Operator
dependant.
• Good resolution.
• Used for stone,
hydronephrosis,
focal lesion (ex.
masses).

19. CT
• Same basic
principle of
radiography.
• More precise.
• Costly.
• +/- IV contrast.
• Useful for trauma,
stone, tumor,
infection.
• Best in stones

20. CT
Image features:
• Cross sectional
images.
• Image contrast
determined by
tissue density +/-
contrast.
• Better evaluation of
soft tissue.

21. MRI
• Better evaluation of
soft tissue.
• Expensive.
• Useful for soft
tissue pathology:
tumor, infection.

22. MRI
Image features:
• Cross sectional
images.
• Image contrast
determine by tissue
properties.
• Excellent for soft
tissue evaluation.

23. Nuclear medicine
• Utilizes a gamma
camera and
radioactive isotopes.
• Good to assess
kidney function.
• Less expensive.

24. Nuclear medicine
Image features:
• Projectional image.
• Image contrast
by tissue uptake
and metabolism.

25. ANATOMY

32. •MRI IS NOT GOOD
IN STONES
•In MRI bones are
black

35. CASES

36. • What are the imaging modalities?
• What are the findings?
• Diagnosis?

37. Case (1)
• Young male patient presenting with left
flank pain and hematuria, no fever and
normal WBC count.
• Kidney stones with hydronephrosis.
• X-ray >> US >> CT

40. Case (2)
• Middle aged woman presenting with
flank pain, fever and high WBC.
• Inflammation (e.g. Pyelonephritis)
•US >> CT+contrast >> MRI

42. Case (3)
• Elderly male patient with recurrent
urinary tract infections.
• Bilateral hydronephrosis due to Prostate
enlargement.
• US

45. Case (4)
• Young female presenting with decreased
renal function (high urea and creatinine
level).
• Polycystic.
• US >> CT >> MRI
• Contrast is contraindicated

48. Case (5)
• Elderly male patient with painless
hematuria and weight loss.
• Tumor
• MRI (BEST) >> US >> CT+contrast

50. Case (6)
• Young male patient involved in a motor
vehicle accident with blunt trauma to the
abdomen.
• Truma
• CT (because it’s very fast)

52. Renal trauma grading

53. •
‫األسئلة‬ ‫عن‬ ‫الدكتور‬ ‫سألت‬
:
‫األسئلة‬ ‫تكون‬ ‫راح‬ ‫يقول‬
‫وبتكون‬ ‫بالنظري‬
‫جاه‬ ‫واحد‬ ‫مثال‬
‫حادث‬
‫أشعة‬ ‫افضل‬ ‫وش‬
‫هذا؟‬ ‫للشيء‬
‫األجهزة‬ ‫خاصية‬ ‫وكذلك‬
‫البريدي‬ ‫حمد‬

54. THANK YOU