医学影像学泌尿系统(英文)

1、DIAGNOSTIC IMAGING OF URINARY TRACT,Radiology = Anatomy + Pathology,影像诊断 = 定位诊断 + 定性诊断,Image,INTRODUCTION,Including both kidney, ureter, bladder and urethra. Lack of natural contrast. Need various kinds of contrast examination. Use of CT, USG,MRI.,METHODS OF EXAMINATION,Plain Film of the Abdomen (KUB),Including both sides of kidney, area of ureter and bladder. To show contour, size, shape of the above organs and psoas muscles margin. To demonstrate stone and calcification of urinary tract,KUB,In

2、travenous Urography (IVU),METHODS OF EXAMINATION,Preparation: 1. sensitivity test of iodine. 2.preparation of intestinal tract (fast 812h, catharsis) Contrast medium: 1.Urografin (泛影葡胺) 2. Iopamidol (碘必乐) 3. Iopromide (碘普罗胺),Technique: 1.intravenous instillation of contrast medium (100ml) should be over in 510minutes 2. films are taken at 3,5,10,15,25(KUB) minutes Display: 1.excretory function of kidney 2.morphology of urinary tract,Intravenous Urography (IVU),METHODS OF EXAMINATION,-C,+C,I.V.U.

3、,Retrograde Urography,METHODS OF EXAMINATION,To be used when IVU has been unsatisfactory or inconclusive. To show the morphology of urinary tract only.,Retrograde Urography,Renal Angiography,METHODS OF EXAMINATION,abdominal aortography. Selective renal arteriography.,Renal Angiography,Renal Angiography,插图,CT,METHODS OF EXAMINATION,Plain Scans,patient preparation : oral contrast medium administration or water for bowel and bladder filling 12%, 500ml of urografin for kidney CT 12%, 1000ml of urogr

4、afin for bladder CT the bladder must be fully distended Slice thickness and intervals: 510mm Scanning method: sequential CT scans Scanning ranges: upper pole of kidneyureterbladder,Plain Scans,CT,Contrast enhanced Scans,CT,METHODS OF EXAMINATION,Contrast medium: 60100ml, 1.52.5ml/s Intravascular administration: bolus injection Scanning: Sequential CT scans: start at 1520s after injection Delayed CT scans: can be performed at 510min. after injection to show filling the pelvis, ureter and bladder

5、with contrast medium,Contrast enhanced Scans,CT,MRI,Plain Scans: transverse T1WI (T1-Weighted imaging) + T2WI (T2-Weighted imaging) with SE (spin-echo sequences) coronal T1WI with SE Contrast enhanced scans: contrast medium: Gd-DTPA, 0.10.2mmol/kg scanning sequences: T1WI with SE MRU (MR urography): to demonstrate the obstruction of urinary tract,METHODS OF EXAMINATION,KUB,I.V.U.,R.U.,Angio,CT,US,NORMAL IMAGING OF URINARY TRACT,KUB & IVU,Kidney,1. position: T1112 to L12 2. size: 11135623cm (3612

6、cm),Contour: smooth Minor calyces: 1014 Major calyces: 24 Pelvis: trumpet , branch, ampulla,Pelvis,中间型 trumpet,分枝型 branch,壶腹型 ampulla,Ureter,NORMAL IMAGING OF URINARY TRACT,KUB & IVU,long: 2530cm width: 35mm physiological narrowings: pelvi-ureteral junction iliac vessels entry of bladder,15,Bladder,NORMAL IMAGING OF URINARY TRACT,KUB & IVU,shape: round or oval capacity: 200350ml,I.V.U.,CT,NORMAL IMAGING OF URINARY TRACT,Plain Scans,Kidney renal parenchyma: soft tissue density, 3050Hu pelvis: wat

7、er density, 1020Hu renal sinus: fat density, -60-100Hu Ureter soft tissue density Bladder water density when fully distended,Plain Scans,CT,Contrast Enhanced Scans,CT,NORMAL IMAGING OF URINARY TRACT,Kidney: 1after injection: cortical enhancement 2after injection: medullary enhancement 510after injection: parenchyma enhancement and filling the pelvis with contrast medium,Contrast enhanced Scans,CT,Contrast Enhanced Scans,CT,NORMAL IMAGING OF URINARY TRACT,Ureter and Bladder: bladder wall enhanced

8、 on early scans filling with the contrast medium on delayed scans,MRI,NORMAL IMAGING OF URINARY TRACT,Plain Scans,The signal intensity of renal cortex on T1WI is higher than that of renal medulla The signal intensity of renal cortex and medulla on T2WI are all higher The signal intensity of ureter and bladder are low on T1WI and higher on T2WI,c,MRI,NORMAL IMAGING OF URINARY TRACT,Contrast Enhanced Scans,Renal parenchyma and bladder wall show enhancement,CALCULUS OF URINARY TRACT,Radiopaque(calc

9、ium) in 90% of patient Radiolucent(urate) in 10% of patient,Renal Calculus,CALCULUS OF URINARY TRACT,round, horny, morula lie in the calyces or pelvis hydronephrosis CT: high density, 2001000Hu,男性，66岁，左侧腰部反复发作性隐痛,075970,女性，58岁，腰痛,Ureteral calculus,CALCULUS OF URINARY TRACT,grain of rice size, jujube core shaped long axis parallel to the ureter often stay in the sites of narrowness hydroureter or hydronephrosis above the stone CT: high density, 2001000Hu,Calculus of Urinary bladder,CALCULUS OF URINARY TRACT,round, oval, concentric circles shaped CT: high density MRI: low signal on T1WI and T2WI,Calculus of Urinary bladder,TUBERCULOSIS OF URINARY TRACT,Secondary infection Hematogenous dissemination,TUBERCULOSIS OF URINARY TRACT,Pathology,TB bacilli,renal cortex infection,medullary destruction,caseous necrosis,abscess (calcification),pelvicalyceal destruction,ureter and bladder TB,尿路结核,病理,TB 杆菌,

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