TYPES CAUSES VARIOUS PROTOCOLS IMAGING MODALITIES – XRAY IVU USG CT MRI ADVANTAGES & DISADVANTAGES INTERVENTIONS SUMMARY

1. By:
Dr.Karthik Adiraju

2.  TYPES
 CAUSES
 VARIOUS PROTOCOLS
 IMAGING MODALITIES – XRAY
IVU
USG
CT
MRI
 ADVANTAGES & DISADVANTAGES
 SUMMARY

3.  Haematuria : blood in the urine.
– Gross/macroscopic
– Microscopic -the urine is visually normal in color .
3 or greater RBCs / HPF on a properly collected urinary
specimen in the absence of an obvious benign cause.
Every red colour
urine– not
hematuria

5. Painful - stone,infection
Painless - malignancy
-Proteinuria
-Casts in urine

6. CAUSES :
 RENAL PARENCHYMA: –Glomerulus
–Interstitium
 URINARY TRACT : Renal pelvis
–Ureter
–Bladder
–Urethra
–Prostate

10.  HISTORY
 Sx – Cal/RCC/Bladder Ca/trauma/nephritis
 Lab – UA/PSA/Coagulation factors
 Imaging - ????

11. RISK FACTORS :
 AGE >50yRS
 Smoking
 Obesity
 Carcinogens : chemical & occupational exposure
 Chronic c/o cal/infection
 Congenital anomalies – horse shoe
 Pelvic irradiation

12.  Low risk category : Microscopic hematuria
Age < 50
(x)risk factors
 Medium risk category : Microhematuria with age >50
Macrohematuria with age <50
(+)risk factors
 High risk category : Macroscopic hematuria
Age >50
(+)risk factors

18.  Calculi detection.
 Large masses

19. Renal amyloidosis

20.  anatomical variants or
congenital anomalies.
 course of the ureters.
 detect and localise a
ureteric obstruction
 Cost effective

22. • Invasive procedure
• Contrast reactions.
• Small lesions may be
missed.
• Multiple films/Time.

23.  Easy accessbility.
 no radiation exposure .
 Better identification of
the lesion & vascularity.
 Internal architecture of
renal lesions can be
identified.(cyst vs
solid).

25. • Obesity
• Large abdominal mass
occupying whole
abdomen .
• Excessive bowel gas
makes accessibility
difficult .
• Poor sensitivity in
detecting lesions in
pelvicalyceal system
and ureters.
• Operator dependent.

26.  MDCT -thin section images ,higher spatial resolution
at a faster rate ,(3-D) reconstructions of images-display
any complex anatomy for surgical planning.
 The imaging protocol for CT should be tailored to
specific diagnostic goals.
 In haematuria , commonly used phases with single
bolus of contrast media are:
 (1) precontrast unenhanced phase,
 (2) nephrogenic phase and
 (3) excretory phase.

27. Unenhanced phase :
 Gold-standard investigation for renal calculi.
 Baseline attenuation value of mass for -enhancement
comparison.
 Low-dose protocol CT KUB used nowadays with
effective dose between 0.7 and 2.8 mSV

28. Nephrogenic phase :
 approximately 100 seconds after IV contrast
administration.
 characterises and detects renal masses most accurately
with the presence of enhancement.
 Enhancement (HU) <10 – non enhancing
10-20 - indeterminate
>20 - suspicious for malignancy

30.  Excretory phase :
 10–15 minutes after contrast injection.
 assess the urothelium by looking for any filling defects
or irregularities,hydronephrosis and periureteric/
perinephric stranding.

32.  Synchronous nephrographic & excretory phase of
images on single image acquisition.
 Limits radiation dose & provides information required
 TECHNIQUE :
- Unenhanced CT imaging
- 50% of the IV contrast is administered
- Wait for 8 min
- 50% of the IV contrast is administered
- Wait for 55-100 sec
- Image acquisition

33.  Second scan will contain both the nephrogenic phase
(from the second-dose contrast) and also excretory
phase (from the initial-dose contrast)
 High sensitivity,specificity and accuracy for detecting
upper tract tumor

34. Cortico medullary phase :
 always be obtained for renal vasculature .
 renal mass may represent an aneurysm or AVM or
fistula

36. DISADVANTGES :
 Pts with asymmetric excretion ; seen in unilateral
obstruction .
 High radiation dosage.

38.  Combination of heavily wtd static fluid T2 and
dynamic contrast-enhanced T1-weighted sequences
1. Static fluid T2-weighted –
 Non contrast images.
 useful in demonstrating the collecting system in an
obstructed kidney
2. Contrast-enhanced T1-weighted –
 Post contrast imaging : initial at 25-100 sec
 After 5- 10min for bladder lesions.

39. INDICATIONS
•Beneficial in pediatric or pregnant patients
• Conditions in which functional information is needed
eg,obstructive uropathy, renovascular disease,and renal
transplant dysfunction.
• To Avoid nephrotoxic iodinated contrast material

41. ADV
 No ionizing radiation
and no iodinated
contrast.
 Safe in paediatric, young
adults, pregnant
patients.
 Excellent in detection,
characterization and
staging of tumor .
 Detection of calculi and
air.
 Long image acquisition
time,susceptibility to
artefacts and relative
expense.
 Spatial resolution of
MRU is inferior to
MDCTU/IVU –subtle
abnormalities can be
missed.
DISADV

42. INTERVENTIONS :
1.Renal artery embolisation – Aneurysms/tumors
2.Percutaneous nephrostomy – cal/tumor/strc dila
3.Radiofreq ablation – thermal & cryo
Unfit fr surgery,poor renal func,multifocal RCC.

43. Hematuria Workup – Imaging :
 IVP
– Old “Gold Standard”
– Good visualization of collecting system & ureters
– May miss Renal & bladder lesions, dye Rxn
 „US
– Safer than IVP, good visualization of kidneys
– May miss small (<3 cm) lesions
 „CT
– Most sensitive and specific, new “Gold Standard”
– Expensive, dye Rxn
 MRU
- Pedistric,pregnant ladies.-
- Long scan time,expensive & artefacts.