Introduction to renal ct scan
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This is about Introduction To renal CT scan Protocol what are the indication and tailoring how to optimize the the right protocol for the patient according to the indication . Hopping you like it and helping you in daily practice . Dr Hisham AlKhatib Consultant Radiologist
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Introduction to renal ct scan
- 1. 9/10/1438 1 Introduction to Renal CT Scan Protocol Hisham AlKhatib, M.D. Consultant Radiologist Common Clinical Problems in the Kidney • suspected renal calculus • suspected renal infection • r/o renal mass • evaluate renal mass (cyst vs. tumor) • stage renal cancer • evaluate hematuria • trauma • ? renal artery stenosis • ? renal vein thrombosis
- 2. 9/10/1438 2 Patient preparation and technique Before study • Fasting 4 hours • Creatinine level • Pertinent history to decide the protocol needed • Protocol design
- 3. 9/10/1438 3 What are the risk factors for contrast induced acute renal failure? • preexisting renal failure • diabetes mellitus • dehydration • cardiovascular disease and diuretics • age over 75 years • multiple myeloma (in dehydrated person) • hypertension • uricosuria Scanning phases • precontrast phase • arterial • corticomedullary phase • nephrographic phase • excretory phase
- 4. 9/10/1438 4 Noncontrast scan • baseline density measurements for evaluating renal masses or renal cysts • urolithiasis, nephrolithiasis, renal calcifications • in patients unable to receive intravenous contrast (i.e., contrast allergy, poor renal function, etc.). Unenhanced CT of the Kidney • Optimal Phase For Detection of- - Calculus - Cyst versus mass (HDRC versus solid tumor) - High density renal cyst - Identify location of the kidneys to define coverage
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- 6. 9/10/1438 6 arterial phase • is a short phase that occurs about 15–25 seconds after the start of intravenous contrast medium injection and is marked by maximum opacification of the renal arteries. • The renal veins also usually opacify in the late arterial phase.
- 7. 9/10/1438 7 corticomedullary (angionephrographic) phase • The starts at about 30–40 seconds after the start of contrast medium injection. • There is intense enhancement of the renal cortex due to preferential arterial flow to the cortex and glomerular filtration of the contrast material, while the medulla remains relatively less enhanced. • This is also the best phase for maximum opacification of the renal veins.
- 8. 9/10/1438 8 nephrographic phase • begins at 80–120 seconds after the start of contrast medium injection. • Tubular filtration of contrast material produces homogeneous enhancement of the renal parenchyma. • the best phase for detection of subtle parenchymal lesions. Nephrographic Phase • (60-140 sec): • Optimal Phase For Detection of- - Renal lesion detection - Pyelonephritis - Tumor invasion (renal vein/IVC) - Characterize lesion density - Perfusion changes - Renal vein or IVC thrombus
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- 10. 9/10/1438 10 excretory or urographic phase • starts at 180 seconds (3 minutes) after the start of contrast medium injection. • Excretion of the contrast material allows opacification of the calyces, renal pelvises, and ureters, while the intensity of the nephrogram progressively declines. • routinely acquire excretory phase images at 4– 5 minutes to ensure opacification of the ureters.
- 11. 9/10/1438 11 Excretory (pyelogram)Phase • delayed scans ( 3-5 minutes) • Contrast in calyces ,pelvis and ureters • Excretory Phase Imaging is optimal for detecting; – pathology in the renal pelvis or collecting system – visualization of the renal parenchyma – pathology in the ureter CT Urography: Indications per Society of Uroradiology • - Painless gross and microscopic hematuria - Suspected transitional cell carcinoma - Follow up of transitional cell carcinoma - Recurrent UTI’s - Congenital anomalies - Renal trauma
- 12. 9/10/1438 12 Ct urogram Split Bolus Technique for CT Urography - Scan without contrast from top of kidneys thru the base of the bladder - Inject 50 ml of iodixanol at 3 cc/sec - Wait 5 minutes - Inject 80 ml of iodixanol at 3 cc/sec - Wait 100 seconds and then scan the patient from the top of the kidneys thru the pelvis (combined nephrographic and excretory phase)
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