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17 Cards in this Set
- Front
- Back
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Learning objectives
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Become familiar with different imaging techniques
Know what test to order for evaluation of hematuria Know what test to order for evaluation of renal insufficiency Know the best way to image urinary tract stones |
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Abdominal radiograph: what can you see, cons
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Shows most urinary tract stones
Bowel gas pattern Skeleton Very limited specificity & sensitivity Requires radiation Poor contrast Most of urinary tract invisible |
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When to order KUB
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Follow-up of radio-opaque stone
Evaluate position of stents, drains Evaluate bowel gas pattern |
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Intravenous urogram (IVU): procedure, what can you see
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Contrast media (iodinated benzene ring compounds) injected in any vein, followed by abdominal radiographs
Urine becomes opaque from the excreted contrast media Kidneys to bladder shown fairly well |
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Intravenous urogram: cons
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Requires radiation
Requires contrast media with risk of adverse reaction, nephrotoxicity Relatively slow Limited resolution compared to newer techniques (CT, US, MRI) Good but limited test Has been replaced by higher tech imaging studies |
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Indications for ordering an intravenous urogram
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Post-op evaluation (to see what’s connected where, & to look for leaks)
Gross anatomic assessment, e.g. number of ureters |
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Renal sonography (US): pros
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No toxicity
No radiation Readily available Real-time examination Good visualization of kidneys Great for differentiating solid vs. cystic masses Best test for acute renal insufficiency work-up |
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Renal sonography (US): cons
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Limited functional assessment
Ureters invisible Operator dependent Patient body habitus limitations Less accurate than CT for detection of masses, stones |
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Indications for renal US
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Evaluation for cause of renal insufficiency (best first imaging test)
Renal size Renal transplants: obstruction, blood flow Renal mass evaluation- - simple cyst, or not |
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Renal CT: pros
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Most accurate for renal masses
Most accurate for staging cancer Best test for stone diagnosis Entire abdomen visible Hematuria evaluation 3D reconstructions possible |
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Renal CT: cons
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Radiation: small potential risk of inducing cancer
Expense Contrast media sometimes needed |
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Renal CT: indications
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Suspected stone disease
Known or suspected renal mass -Diagnosis -Staging -Treatment Planning Blunt trauma Hematuria |
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Renal MRI: Pros and cons
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Similar strengths and indications as CT
More expensive Longer imaging time But…….. No nephrotoxic contrast needed No radiation |
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Renal MRI: Indications
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Problem solving issues
Renal tumor in patient who cannot get CT contrast media Imaging renal blood vessels & can’t get CT contrast media Urethra/periurethral region |
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Cystogram for bladder imaging: procedure and indications
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Catheterize bladder
Fill with contrast media Radiographs Suspected bladder trauma Suspected ureter reflux Post operative evaluation |
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Urethrogram: procedure and indications
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Inject contrast into urethra
Radiographs Urethral trauma Suspected stricture disease Post operative evaluation |
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Interventional uroradiology
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Percutaneous ablation of renal tumors
Image-guided abscess drainage Image-guided kidney drainage Image-guided biopsies |
