Faroes Lectures 2019

1. Renal and Lower Urinary Tract US
for Beginners
Seung Hyup KIM, M.D.
Professor Radiology and Urology
Seoul National University, Seoul, Korea
kimshrad@snu.ac.kr
www.k-radiology.com

2. Contents
 Basic principle
 Normal findings at grey-scale and Doppler
 Renal mass
 Hydronephrosis
 Ureter
 Urinary bladder

3. www.startradiology.com
Transducer position
Patient posture
Respiration
MAKE PATIENTS COMFORTABLE!!

4. Grey-scale US
 Gain
 Depth
 Focus
 TGC
Depth of field
Time gain compensation

5. Normal grey-scale US findings
Kidneys in neonate and young children
Higher cortical echo
Prominent medulla

6. Kidney<liver kidney=liver Kidney>liver
72% of patients with
kidney echo =liver echo
had normal renal function
Platt JF, AJR 1988;151:317
Lupus nephritis

7. CDUS/PDUS/SDUS
 CDUS/PDUS
 gain
 Spectral Doppler
 scale
 baseline
 PRF
 angle correction
 sweep speed

8. Spectral Doppler Sampling
Interlobar artery
Arcuate artery, interlobular artery

9. Resistive Index
 (S-D)/S
 usually < 0.65
 seldom exceeds 0.7
RI vs age, Terry JD, JUM, 1992;11:647-651

10. Doppler Equation
Δf = 2fv/c · cosθ
 To get better Doppler spectrum……
 use reasonably high frequency probe
 use reasonably low Doppler angle (30°~60°)

11. Renal mass: solid or cystic?

12. Indeterminate Renal Masses
 Mainly cystic
 Mixed cystic and solid
 Mainly solid
Increasing degree of
suspicion of malignancy

13.  Flow signals in solid-looking part
– flow (+): malignant>>
– flow (-): benign>>
Indeterminate Renal Masses
ccRCC

14. ccRCC
56/M

15. Prominent Column of Bertin
RCC

16. Junctional Parenchyma

17. Dromedary (splenic) Hump

18. Unusual Renal Sinus Echo

19. UCC
RCC
Pseudotumor

20. Hydronephrosis

21. Normal hilar vessels may mimic mild hydronephrosis
Pseudohydronephrosis

22. Parapelvic cysts

23. Parapelvic cysts

24. Ureter

25. Twinkling Artifact

26. AJR 2001;176:1441–1445
55% sensitivity for
detection of renal
calculi observed at CT
Radiology 2011;259:911-916

27. B

29. www.startradiology.com

30. Bladder US
 Easy and simple
 For the examiner
 Not for the patient
 Dynamic examination
 Bladder volume
 Residual urine
 Urine jet

31. Normal ureteral orifice areas may mimic small tumors

32. Blood clot may mimic lesions

33. Small TCC

35. Bladder stone: TAUS, TRUS

36. calcified TCC
Calcified tumor may mimic stone

37. Diverticulum
U
U
B
B

38. Ureterocele

39. kimshrad@snu.ac.kr
www.k-radiology.com
 US is very useful in evaluation
of whole urinary tract
 Doppler US is an integral part
of US examination
 You need to make patients comfortable
for a successful examination