URINARY TRACT

IMAGING
Dr. Putu Utami Dewi SpRad
• Imaging Role
• Imaging Modalities :
• Indication & contraindication
• Exam procedure & preparation
• Advantage & disadvantage
 IMAGING ROLE

Urinary tract problem

❑Diagnostic such as :
❑Treatment planning • Stones
• Congenital anomaly
❑Follow up
• Infection
• Trauma
• Tumor
 Abdominal
Xray

Renal Contrast
Scintigraphy Study

Urinary Tract
Imaging
Modality

MR
Ultrasound
urography

CT
urography
KUB / BNO (ABDOMINAL XRAY)
• KUB=KIDNEY-URETER-BLADDER
• BNO=BUICH-NEER-OVERSICH
• It use a small dose of ionizing radiation to produce
abdominal cavity pictures
• Indication:
• Radioopaque calculi
• Calcifications
• Gas pattern
• Organomegaly
• Bony abnormalities
• Radioopaque foreign bodies
• Post procedural evaluation of radiopaque tube & line
• Contraindication : pregnancy
• Preparation : BNO need bowel
preparation
• Emergency case → without
preparation (BOF)
• Advantage : widely available, low
cost
• Disadvantage : xray exposure, lower
sensitivity & specificity, poorly
differentiation soft tissue
BLADDER STONE KIDNEY STONE
LEFT URETER
STONE
 CONTRAST STUDY

• Intravenous Pyelography/ Intravenous Urography

• Uretrography Retrograde
• VCUG
INTRA VENOUS PYELOGRAPHY
• Is an Xray examination that uses an intravenous contrast
material to evaluate kidney, ureter and bladder
• Indication :
• Evaluate qualitative kidney function
• Evaluate anatomical variants or congenital anomalies (e.g. horse-
shoe kidney)
• detect and localize a ureteric obstruction
• assess for synchronous upper tract disease in those with bladder
transitional cell carcinoma (TCC)
• Evaluate abnormality of ureter and bladder

• Contraindication: pregnancy, Iodine contrast allergy,

decreased renal function (eGFR< 15)
- PREPARATION : Advantage : evaluate
- Serum Creatinin & eGFR : high function and anatomy of
risk Contrast induced kidney
nefropathy if GFR < 15 → Disadvantage : invasive,
suggest another modality
- History of allergy & informed radiation (+)
consent
- Bowel preparation :
- Laxative at night and
morning before
examination
- Overnight FASTING
before examination
Renal
calyces

ureter

Urinary
bladder
DOUBLE COLLECTING SYSTEM
BLADDER RENAL AND BLADDER
MASS
STONE
URETROGRAPHY RETROGRADE

• A diagnostic procedure performed to diagnose

male urethral pathology by retrograde injection of
radiopaque contrast into the urethra
• Indication :
• urethral stricture
• Urethral trauma
Advantage : Disadvantage :
- Visualization of - Not widely available,
urethral anatomy - Radiation (+)
- Invasive procedure
NORMAL URETROGRAPHY
URETRAL RUPTURE URETRAL STRICTURE
 VCUG

• A diagnostic procedure performed to diagnose

vesicoureter pathology by filling radiopaque
contrast into the bladder
• Indication :
• Vesicoureter reflux evaluation
• Predisposing factor evaluation for repeated UTI
• Urethral evaluation during micturiting

• Contraindication : acute urinary tract infection

Advantage :
Disadvantage :
- Visualization of
- Not widely available,
bladder,ureter and
- Radiation (+)
urethra anatomy
- Invasive procedure
 UROLOGY ULTRASOUND
• Non invasive imaging technique by using sound wave to evaluate
urinary organ
• Indication :
• Evaluate renal parenchyma, Congenital renal anomaly
• stone
• Hidronephrosis evaluation
• Infection
• Renal and bladder mass; other focal lesion e.g cyst
• Renal trauma
• Doppler ultrasound to evaluate vascularization
• Urinary Bladder wall
• Prostate/uterus
Advantage :
- Widely available, Disadvantage :
- no radiation - Operator dependent
- non invasive - can’t evaluate ureter
- Affordable thoroughly
- It can differentiate - Difficult to evaluate
cystic vs solid lesion obese px
KIDNEY STONE
HYDRONEPHROSIS
CYSTITIS PYONEFROSIS
RENAL MASS RENAL CYST
SUBCAPSULAR HEMATOME
 CT SCAN UROGRAFI
• Without contrast → CT stonografi/ CT stone searching
• With intravenous contrast material → evaluate anatomical &
functional of the kidney, ureter and bladder
• Indication :
• hematuria
• urothelial mass
• obstructive uropathy
• hydronephrosis
• hydroureter
• urothelial cancer surveillance
• stricture
• congenital collecting system abnormality
• Renal arterial vessel evaluation (Renal CT angiography)

• Contraindication : pregnancy, iodine contrast allergy, decreased

renal function (EGFR <15)
- PREPARATION :
- Serum Creatinin & eGFR (CT
uro with contrast) : high risk
Contrast induced nefropathy if
GFR < 15 → suggest another
modality
- History of allergy & informed
consent
- Bowel preparation :
- Laxative at night and
morning before
examination
- Overnight FASTING
before examination
Advantage :
- Higher specificity &
sensitivity than BNO Disadvantage :
IVP - Not widely available
- It can evaluate - Higher radiaton dose
intraabdominal organ - Relative expensive
better than IVP
URETER STONE SUBCAPSULAR HEMATOME
RENAL CT ANGIOGRAPHY
 MR UROGRAPHY
• Alternative modality for people who allergic to iodine contrast
• With intravenous gadolinium contrast material → evaluate
anatomical & functional of the kidney, ureter and bladder
• Indication :
• hematuria
• urothelial mass
• obstructive uropathy
• hydronephrosis
• hydroureter
• urothelial cancer surveillance
• stricture
• congenital collecting system abnormality

• Contraindication : pace maker, claustrophobia, gadolinium

contrast alergy
Advantage :
- Higher specificity & • Disadvantage :
sensitivity than CT
- Not widely available
scan
- Without radiation - More expensive
 RENAL SCINTIGRAPHY
• a method to assess the kidneys and collecting
systems via radioactive tracers.
• Indication :
• evaluation of mechanical renal tract obstruction
(including pelviureteric and vesicoureteric junction
obstruction)
• Evaluation of vesicoureter reflux
• Renal scarring
• perfusional abnormalities
• investigation of quantitative renal function (percentage
function on each kidney)
• Follow up renal transplants complication

• Contraindication : pregnancy
 Disadvantage :
Advantage :
- Not widely available,
- It can evaluate each
- Radiation to other
kidney’s function
people around the
percentage
patient
- expensive
THANK YOU