RADIOLOGY OF THE
UROGENITAL SYSTEM
Dr Richard Bullock
Consultant Radiologist
UHWI
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Imaging Evaluation Of Urinary
Tract
Structural Assessment
Renal parenchyma
Collecting System-pelvicalyceal
system,ureter and bladder
Functional Assessment
Renal perfusion
Renal excretion
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Urinary Tract Modalities
Plain Radiographs- KUB
Ultrasound
Computed Tomography(CT)
Magnetic Resonance Imaging(MRI)
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Urinary Tract Modalities
Contrast studies-
Intravenous Pyelogram(IVP)
Retrograde pyelogram
Micturating Cystourethrogram(MCUG)
Nuclear Scintigraphy
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KUB
Readily available
Affordable($1000-1500)
X-radiation
Limited soft tissue detail
Useful findings-
Calcification-calculi,nephrocalcinosis
Air- renal infections,trauma
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KUB
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KUB
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Ultrasound
Based on sound waves, no ionizing
radiation is used
No adverse effects recorded
Equipment widely available
Most procedures average $3000- $4000
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Ultrasound
Sound is generated through a transducer
applied to the skin.
Gel applied to the skin allows good contact and
movement across the skin
Dynamic real time images acquired. Still images
or a video can be recorded from the
equipment.
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Ultrasound
The images are represented as a gray scale
image.
This is generated from the echoes returned
from the tissues.
The pattern of gray dots is called the
echopattern and each organ has a distinctive
echopattern
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Ultrasound
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Ultrasound
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Ultrasound
Good anatomic detail
Renal cortex-outline,thickness,echogenicity
Renal medulla- collecting system
Bladder-volume, wall thickness
Ureter-not seen unless dilated
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Ultrasound Normal Kidney
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Ultrasound Normal Bladder
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ULTRASOUND
Renal size-large/small
Renal cortical loss eg scars
Hydronephrosis/obstruction
Renal masses-
Cysts,masses,calculi
Bladder
Masses,calculi
Trabeculation,diverticula
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Ultrasound Of Renal Calculus
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IVP
Contrast examination of kidney,ureter
and bladder
NPO morning of exam
Consent for IV injection of iodinated
contrast
Renal uptake and excretion
Plain radiographs taken at intervals
during uptake and excretion
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IVP
Contrast mediated anaphylaxis
Contrast induced nephrotoxicity eg
diabetics, sickler
Uses restricted due to above risks
Primarily used to assess causes of
obstruction
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IVP
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IVP
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IVP
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Retrograde Pyelogram
Ureteric catheter placed via cystoscope
Contrast injected via catheter
Used to delineate lower limit of
obstructive lesion, or where poor renal
function makes IVP unacceptable
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MCUG
Used to evaluate
urethral obstruction-strictures, posterior
urethral valves
Vesicoureteric reflux
Structural abnormalities of the bladder
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MCUG
Urethral catheter placed in bladder
Bladder filled with contrast
Catheter withdrawn
Films taken during voiding
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MCUG
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Posterior Urethral Valve
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Vesicoureteric Reflux(VUR)
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Computed Tomography
Special application of xrays involving a
rotating xray tube
Patient lies on a moving table that carries
them through the rotating beam
Rotating beam housed in gantry
Generates cross sectional images at different
levels eg through kidneys,ureter,bladder
The levels are selected by the operator
Gives good anatomic depiction of structures
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Computed Tomography
Cost - $20,000
Depicts difference in density of the tissues
Normal pattern of tissue density for each
organ.
In order of density from the lowest to the
highest are air, fat, fluid, soft tissue, bone,
contrast and metal
Abnormal tissues are referred to as hyper or
hypodense relative to the normal tissues
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Computed Tomography
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Computed Tomography
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CT
Calculi detected without contrast
Further evaluation of urinary tract
masses
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CT of Calculi
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MRI
Expensive
Limited role
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Renal Scintigraphy
Best method for assessing renal
function
Renal perfusion/excretion+diuretic
Split function
Detects scarring,obstruction,poor
function
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Female Genital Tract
Uterus
Ovaries
Fallopian tubes
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Pelvic Ultrasound
Transabdominal- full bladder used as a
window to view uterus and ovaries
Transvaginal-
excellent detail of uterus and ovaries
Does not require bladder distension
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Pelvic Ultrasound
Uterus
Gravid vs non gravid
Position-ante or retroverted
Myometrium-fibroid
Endometrium- thickening
Ovaries
Volume
Follicular size/distibution
Cysts/solid masses
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Normal Pelvic Ultrasound
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Pelvic Ultrasound-Fibroid
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Pelvic Ultrasound-Ovarian Cyst
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Hysterosalpingography(HSG)
Contrast study of uterine cavity and
Fallopian tubes
Speculum examination of cervix
Cervix cannulated with small Foley
catheter
Contrast injected
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HSG
Primarily done to assess causes of
infertility
Done 10 days from beginning of LMP
Pregnancy test -ve
Patient may experience pain or bleeding
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Normal HSG
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HSG-TUBAL OBSTRUCTION
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HSG -Fibroid
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Male Genital System
Scrotal evaluation
Ultrasound
MRI
Prostatic evaluation
US
CT/MRI
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Scrotal Ultrasound
Testicular size- masses
Testicular position-cryptorchidism
Testicular blood flow-orchitis; torsion
Epididymal size-epididymitis
Pampiniform plexus- varicocele
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Prostatic Ultrasound
Transabdominal-
Volume- BPH,prostatic carcinoma,
Nodularity
2°effects- bladder
obstruction,hydronephrosis
Transrectal
Guide biopsy of enlarged/nodular gland
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Further prostatic evaluation
For local staging of prostatic carcinoma
Computed tomography
Magnetic resonance imaging
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