Christine Sababan-Sagpao,

Radio 250

Introduction to Radiology

Genitourinary Tract Imaging

Outline: A. Retroperitoneum, Adrenals, Kidneys, Ureters, and Urinary Bladder B. Uterus, Ovaries, and Adne ae C. !estis, "pididymis, and #rostate

O$%ectives
1. Review anatomy of the genitourinary organs 2. Evaluate the radiologic studies used in imaging the genitourinary tract (GUT) 3. how the normal images of each organ using availa!le modality ". how some a!normal imaging findings in each organ using availa!le modality

Figures 1 and 2: 'ormal adrenal 0lands in C! scan

A. R"!RO#"R&!O'"U(, A)R"'A*+, K&)'"Y+, UR"!"R+, and UR&'ARY B*A))"R

A. Retroperitoneal Space

C. Kidneys Bean2s/aped or0ans (ost 7idneys /ave $et:een ;<2;3 minor calyces Renal pelvis: may $e completely :it/in t/e renal sinus or partially = e trarenal=

Orientation and size: #erirenal space ,#R+Anterior pararenal space ,A#+#osterior pararenal space ,##+Retromesenteric anterior inter.ascial space ,R(+Retrorenal posterior inter.ascial space ,RR+ > to 3 lum$ar verte$ral $odies in len0t/? ;@2;3 cm lon0 *e.t and ri0/t 7idney si9e s/ould not vary more t/an ; cm Ri0/t 7idney is ;2@ cm lo:er t/an le.t 7idney and sli0/tly more lateral Renal a is parallels a is o. psoas muscles

Imaging Methods &ntravenous pyelo0rap/y ,&1#-, /as $een t/e traditional met/od o. ima0in0 t/e 7idneys U+, C!, and (R all provide $etter ima0es o. t/e renal parenc/yma (ultidetector C! ,()C!- :it/ &1 contrast is currently t/e $est ima0in0 study to detect and evaluate suspected renal tumors #recontrast scans are o$tained to detect urinary stones and calci.ications Arterial2p/ase scans t/rou0/ t/e 7idneys s/o: early en/ancement o. renal tumors At appro imately @ minutes t/e renal parenc/yma is normally uni.ormly en/anced ,nep/ro0ram p/aseAt > to 4 minutes ,pyelo0ram p/ase-, contrast .ills t/e collectin0 system and ureters

B. Adrenals Composed o. t/e corte and medulla Appear trian0ular, linear, or inverted 12 or Y2s/aped *im$s: 324 cm in len0t/ 5 426 mm t/ic7 Ri0/t adrenal lies t/rou0/out its e tent ad%acent to &1C

*e.t adrenal lies ad%acent to splenic vessels at its cep/alad mar0in C! is t/e ima0in0 modality o. c/oice (R& provides /i0/ 8uality ima0es o. adrenal lesions and c/emical s/i.t c/aracteri9es $eni0n adrenal adenoma Ultrasound is e cellent .or screenin0 adrenal 0lands in in.ants and c/ildren especially to detect /emorr/a0e

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August 23, 2011 TUESDAY

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Christine Sababan-Sagpao,

Radio 250

Introduction to Radiology

Genitourinary Tract Imaging

Figure ". U!Z o. normal 7idney, corte medulla delineated. Figure #. Coronal (R& o. normal 7idneys

and

Figures ' and (. Corses/oe 7idney in (R& and &1# respectively.

Figure $. Renal mass in ()C! # A parenc/yma ,dense, posterior-B ! A tumor ,anterior and middle-B ' A necrosis ,lucent, anterolateral-

Figure ). C/ronic Renal )isease in U!Z. &t is small and /ypoec/oic indicatin0 parenc/ymal loss.

!. *reters Classi%ication o% Renal asses: ; cm in diameter 5 @4 cm lon0 Course t/rou0/ t/e posterior a$dominal :all > normal narro:in0s: ;. @. >. At t/e pelvo2ureteric %unction As t/e ureter crosses t/e pelvic $rim At t/e vesico2ureteric %unction

Figure 1+. #elvo2ureteral stone in C! scan.

Figure &. )uplication anomaly. Upper moiety inserts a$normally to tri0one and is prone to o$structionB lo:er moiety is normal $ut prone to re.lu .

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August 23, 2011 TUESDAY

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Christine Sababan-Sagpao,

Radio 250

Introduction to Radiology

Genitourinary Tract Imaging

Figure 11. +ta0/orn calculus on plain ADR2KUB.

,. Bladder !/e $ladder is a #"*1&C or0an :/en empty :/ile it can rise up to t/e level o. t/e um$ilicus :/en .illed U!Z: $ladder /as a posterior acoustic en/ancement Figure 1&. Bladder mass A small polypoid. (ay $e a tumor or $lood clot, $ut not a stone since it is not radioopa8ue. 'ote t/e .illin0 de.ect caused $y t/e mass. !/e most common mali0nancy in t/e $ladder is transitional cell CA.

Figure 12. Cystitis on U!Z. 'ote irre0ular $orders.

Figure 1'. Bladder )iverticulum. #ost2void ima0in0 is important to see i. t/ere is retention. &. openin0 o. diverticulum is small, stasis and conse8uent in.ection is more li7ely to occur.

B. U!"RU+, O1AR&"+, and A)'"DA"

Figure 1". 'ote t/ic7ened $ladder :alls. !/is commonly occurs in pelvic irradiation. A. *terus prepu$ertal in.antile uterus is ci0ar2s/aped postpu$ertal uterus is pear2s/aped ma imum normal uterine dimensions: E F 3 cm ,* G A# normal position ,H<I-: anteversion and ante.le ion ,in relation to urinary $ladder Jor transa$dominal U!Z, $ladder s/ould $e .illed so t/at uterus can $e visuali9ed

Figure 1(. U!Z o. endometrium. *e.t: endometrium at normal proli.erative p/ase, :/ic/ /as a tri2laminar stripe. Ri0/t: endometrium at secretory p/ase, :/ic/ is /omo0enously t/ic7ened :it/out stripin0. B. -.aries and Adne/ae Adne a includes ovaries, .allopian tu$es, $road li0ament, and ovarian and uterine vessels Ovaries avera0e 3 > @ cm in si9e (a imum ovarian volume K @@ m*

Figures 1# and 1$. Urolit/iasis

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August 23, 2011 TUESDAY

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Christine Sababan-Sagpao,

Radio 250

Introduction to Radiology

Genitourinary Tract Imaging

Figure 2". !/e le.t testis is /ypoec/oic, :/ic/ may si0ni.y or/icits. 'ote t/e presence o. a /ydrocoele ,mar7ed LCM- on t/e medial aspect o. t/e le.t testis.

Figure1). Comparison o. pre2menopausal ,le.tand post2menopausal ,ri0/t- ovary. !/e .ollicles can $e appreciated in t/e premenopausal ovary. !/e post2menopausal ovary is atrop/ied and /as no .ollicles.

Figure 2#. !/e le.t picture is t/e color .lo: duple o. a normal testis. !/e ri0/t picture s/o:s a testis :it/out spectral .lo: as represented on t/e 0rap/ on t/e lo:er part. !/is may $e indicative o. testicular torsion. Figures 2+. "ndometrial cyst. 'ote t/in :alls and /omo0enous anec/oic density. Figure 21. Cemorr/a0e or endometrioma. As a0ainst Ji0ure @<, t/is is /ypoec/o0enic and /etero0enous. B. #rostate Composed o. t/e perip/eral 9one and an inner 0land composed o. t/e central and transitional 9ones

C. !"+!&+, "#&)&)Y(&+, and #RO+!A!"

A. !estis and "pididymis Bot/ testes must $e vie:ed to0et/er to compare. +li0/t asymmetry is normal.

Figure 2$. 'ormal prostate U!Z. !/e ima0e is usually inverted.

Figure 22. 'ormal testes. Bot/ are uni.ormly /omo0enous.

Figure 2&. Beni0n #rostatic Cypertrop/y ,B#C- on U!Z. !/e centromedial 9one is enlar0ed. !/e prostate is impin0in0 t/e $ladder nec7. Appendi/ 1. Radio0rap/ic Gor72Up .or Genitourinary Conditions

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August 23, 2011 TUESDAY

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Christine Sababan-Sagpao,

Radio 250

Introduction to Radiology

Genitourinary Tract Imaging

Zie | Grace | Yen | Cons

August 23, 2011 TUESDAY

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