Uroradiology What do we depict: * uropoetic system and surrounding structures, some parts of genital systém (those with close relation with uropoetic syst.) * morfology and partially function Basic pathological changes * CONGENITAL ANOMALIES * ECTOPIAS * VASCULAR DISEASES * INFLAMMATORY DISEASES * NEFROCALCINOSIS * UROLITHIASIS * OBSTRUCTIVE UROPATHY * EXPANSIVE PROCESSES * PROSTATE DISEASES (HYPERPLASIA, TUMORS, INFLAMMATIONS) * TRAUMA * TESTICULAR, EPIDIDYMAL , URETHRAL DISEASES, ABNORMALITIES OF PENIS VESSELS * ADRENAL GLAND DISEASES * RETROPERITONEAL TUMORS Imaging methods * plain film (KUB X-ray) * US * IVU * CUG, MCUG * CT * Angiography (DSA) * Direct pyelography * MR * HSG Plain film (KUB) * X-ray (similar absorption coefficient of soft tissue structures, different: calcifications, gas) * soft technique * Th11- symphysis pubis ­ positional changes, size, shape of kidneys ­ psoas muscles ­ stones, calcifications ­ bone structures ­ first step of each contrast examination (to compare precontrast and post-contrast scans) calycolithiasis cystolithiasis bladder ectasia US * ultrasound energy produces a cyclic mechanical pressure wave through soft tissue * + no known harmful effects associated with the medical use of sonography - widespread clinical use * + cheap, easily avalilable, quite high efficacy * - depends on experience of examinator and the quality of US machine * different types of probes (including endocavitary) * morphology of kidneys, bladder, surrounding structures, perfusion (aa. renales) * prostate gland (abdominal, transrectal US), scrotum, penile arteries... * interventions m.m. prostate AortaVCI vertebra testis epididymis prostate (transrect.) testicular seminoma varicocoele Intravenous urography * kidneys, ureters, bladder * + whole urotract, collecting system, calcifications, obstruction, low price * - depends on renal function, parenchymal lesions non-distinguishable, surrounding structures (in AP direction) * some indications, more preferred CT * congenital anomalies, altered drainage, calcifications, calculi, mucous abnormalities (papiloCa) Pelvis duplex, ureter fissus a duplex horseshoe kidney congenital dystopia cyst juxtavesical ureterolithiasis ureterocoele bladder prolaps ureterolithiasis- distal prostate hyperplasia, bladder diverticula, ureteritis cystica Hydronefrosis, megaureter JJ stent CUG,MCUG * A) examination of urethra and bladder (morfology, pathologic conditions ­ diverticles, leak, expansions, VUR...( US , cystoskopy) * B) Men ­ retrograde and miction CUG ­ morfology and patologies of urethra (strictures , diverticula, TU, trauma) Women ­ chain CUG (specif. anatom. configuration - stress. inkontinence) normal VUR diverticula BPH Carcinoma traumatic rupture miction phase CUG Diverticulum of uretrae Stenosis chain CUG . stress type of incintinence CT * we can see whole urotract, also surrounding structures, suprarenal glands * Nativ + postcontrast (coritcomedullary, parenchymatous, excretory phase) * kidneys, adrenal glands, ureters, bladder, prostate, seminal vesicles, surrounding structures, trauma Img_0023.jpg Img_0017.jpg Polycystosa ranal carcinoma of left kidney polycystic kidneys ­ medullary type Dist. ureterolithiasis Trauma traumatic bladder rupture Angiography * Seldinger method (abdominlal, slective) * not for diagnose ( US, CT , MR angio) ­ for some special therapy * Interventions (angioplasty, embolisations) * before surgery (anomalies, resections) cyst malignant tumor Aneurysma a.ren. Direct pyelography * directly into urotract ­ invasive method * retrograde filling - asc. (via urethra) or antegrade (via nephrostomic catether) * similar image to IVU, but non-dependent on renal function * risk of parenchymal or vascular reflux! nephrolithiasis in PUJ CM in nephrostomic drain MR * CM possible, but not needed * pelvis, bladder, prostate, uterus * MR angio * availability is worse Hysterosalpingography * uterus, tuba uterina * anatomy, penetrance of CM through tubae * CM into cervix ­ peritoneal cavity * main indication: infertility * aseptic cautions