RADIOLOGY OF THE RADIOLOGY OF THE RENAL SYSTEMRENAL SYSTEM

DR. Reshaid AljurayyanDR. Reshaid Aljurayyan

DEPARTMENT OF RADIOLOGYDEPARTMENT OF RADIOLOGY

OutlineOutline::

► IntroductionIntroduction► Imaging modalities used to study the Imaging modalities used to study the

renal systemrenal system►Anatomy and normal appearance of Anatomy and normal appearance of

the renal systemthe renal system►Common pathological casesCommon pathological cases

IntroductionIntroduction

►What is the radiology?What is the radiology?

Radiology is a medical specialty that Radiology is a medical specialty that employs the use of imaging to both employs the use of imaging to both diagnose and treat disease visualized diagnose and treat disease visualized within the human body. within the human body.

►What is the renal system?What is the renal system?

OutlineOutline::

► Introduction.Introduction.► Imaging modalities used to study the Imaging modalities used to study the

renal system.renal system.►Anatomy and normal appearance of Anatomy and normal appearance of

the renal system.the renal system.►Common pathological cases.Common pathological cases.

What are the radiological What are the radiological modalities that can be used modalities that can be used

to image the renal systemto image the renal system? ?

Imaging modalitiesImaging modalities::

►Conventional X-RayConventional X-Ray► IVU (intra-venous urogram) / IVU (intra-venous urogram) / X-Ray + X-Ray +

Contrast Contrast

►USUS►CTCT►MRIMRI►Nuclear medicineNuclear medicine

Imaging modalitiesImaging modalities::

Conventional Radiography Conventional Radiography (X-ray)(X-ray)

►+ve:+ve: Cheap & widely availableCheap & widely available Often used as first choiceOften used as first choice

►-ve:-ve: RadiationRadiation Limited anatomyLimited anatomy

►Used for:Used for: Evaluate abdomen painEvaluate abdomen pain Some time good for Some time good for

diagnosing kidney stonesdiagnosing kidney stones

► Radio lucent Radio lucent black (air) black (air)► Radio opaque Radio opaque white white

(bone/stone)(bone/stone)

Radiograph (X-ray)Radiograph (X-ray)

Where are the kidneys??

Radiograph (X-ray)Radiograph (X-ray)

Where are the kidneys??

IVUIVU

► Same as X ray but Same as X ray but with IV contrastwith IV contrast

IVUIVU►+ve:+ve:

Cheap & availableCheap & available

►-ve:-ve: RadiationRadiation Needs IV contrast (?Needs IV contrast (?

reaction)reaction) Old (replaced by CT & Old (replaced by CT &

MRI)MRI)

► Used for:Used for: To diagnose kidney stonesTo diagnose kidney stones To diagnose hydronephrosis To diagnose hydronephrosis

USUS

► Ultrasound.Ultrasound.► Use high frequency Use high frequency

sound wave.sound wave.► Contrast between Contrast between

tissue is determined tissue is determined by sound reflection.by sound reflection.

USUS►+ ve:+ ve:

AvailableAvailable No radiationNo radiation Good anatomyGood anatomy

►- ve:- ve: Operator dependent Operator dependent

► Used for:Used for: Good for kidney stonesGood for kidney stones Excellent for Excellent for

hydronephrosishydronephrosis Excellent for focal lesion Excellent for focal lesion

e.g. cysts, masses e.g. cysts, masses

► Hyper-echoic Hyper-echoic white white► Hypo-echoic Hypo-echoic grey grey► An-echoicAn-echoic black black

(fluid)(fluid)

CTCT::►+ ve:+ ve:

Relatively available (more then Relatively available (more then MRI)MRI)

Very good anatomyVery good anatomy

►- ve:- ve: Radiation Radiation Some times need IV contrast (? Some times need IV contrast (?

reactionreaction))

► Used for:Used for: Excellent for kidney stones (the Excellent for kidney stones (the

best)best) Excellent for hydronephrosis & Excellent for hydronephrosis &

massesmasses Excellent for kidney traumaExcellent for kidney trauma

► Hyper-denseHyper-dense white white (stone/bone)(stone/bone)

► Hypo-dense grey to Hypo-dense grey to black (fat/fluid)black (fat/fluid)

CTCT

MRIMRI►+ ve:+ ve:

Excellent anatomy detailsExcellent anatomy details No radiation No radiation

►- ve:- ve: ExpensiveExpensive Long scanning time (30 to 60 Long scanning time (30 to 60

min)min) Not used to diagnosed kidney Not used to diagnosed kidney

stonestone

► Used for:Used for: Excellent for masses Excellent for masses Good for hydronephrosis Good for hydronephrosis

► Hyper-intense (white)Hyper-intense (white)► Hypo-intense (grey to Hypo-intense (grey to

black)black)

MRIMRI

MRIMRI

Nuclear medicineNuclear medicine

►+ ve:+ ve: Excellent to assess Excellent to assess

functionfunction

►- ve:- ve: RadiationRadiation Poor anatomy detailsPoor anatomy details

► Used for:Used for: Evaluated functionEvaluated function Evaluated obstructionEvaluated obstruction

Nuclear medicineNuclear medicine

► Image features:Image features:► Projectional image.Projectional image.► Image contrast by Image contrast by

tissue uptake and tissue uptake and metabolism.metabolism.

NMNM

ObjectivesObjectives::

► Introduction.Introduction.► Imaging modalities used to study the Imaging modalities used to study the

back.back.►Anatomy and normal appearance of Anatomy and normal appearance of

the back.the back.►Common pathological cases.Common pathological cases.

Case oneCase one::

►Young male patient presented with left Young male patient presented with left flank pain and hematuria no fever and flank pain and hematuria no fever and normal WBC count.normal WBC count.

Renal stonesRenal stones

Renal stonesRenal stones

Case twoCase two::

►Middle age women complaining of Middle age women complaining of flank pain , fever and high WBC.flank pain , fever and high WBC.

Inflammatory/ infectiousInflammatory/ infectious

Case threeCase three::

►Old male patient complaining of Old male patient complaining of recurrent renal infection. recurrent renal infection.

HydronephrosisHydronephrosis::

HydronephrosisHydronephrosis::

Case fourCase four::

►Young female presented with decrease Young female presented with decrease renal function (high urea and renal function (high urea and creatinine level). creatinine level).

CongenitalCongenital::

Case sixCase six::

► old male patient presented with pain old male patient presented with pain less hematura and weight loss.less hematura and weight loss.

TumorTumor::

Case sevenCase seven::

Young male patient involved in road Young male patient involved in road traffic accident with blunt trauma to traffic accident with blunt trauma to the abdomen.the abdomen.

TraumaTrauma::