Radiological diagnostics of Urinary System

1. Radiological semioticsRadiological semiotics
of diseases of urinaryof diseases of urinary
and genital system.and genital system.

2. X-ray semiotics of urogenital system
and mammary gland pathology
Main syndrome at natural contrasting - opacity
(intensive opacity).
Morphological substratum (MSub)
of the intensive opacity in
the projection of pelvis, calices, ureter
or urinary bladder -
X-ray positive (opaque) concretion
(stone).
Plain radiogram

3. Plain radiogram. The opacity has a shape
the same as intrarenal collecting system
shape - coral-shaped stone.
MSub of intensive opacity in the projection of kidney
parenchyma - calcification of parenchyma, calcification of
tumour or calcified echinococcus cyst.

4. MSub of intensive opacity in
breast parenchyma -
calcification of malignant tumour.
MSub of round opacity in
breast parenchyma -
cyst, tumour (benign, malignant).
MSub of irregular-shaped opacity in
breast parenchyma -
malignant tumour (cancer),
excrescence of connective tissue
(fibrous mastopathy),
inflammatory infiltration.
Mammograms

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6. Main syndromes at artificial contrasting:Main syndromes at artificial contrasting:
1.1. Absence of kidney andAbsence of kidney and collecting systemcollecting system shadowshadow onon
one sideone side -- absent kidneyabsent kidney ((aplasia, nephrectomyaplasia, nephrectomy),), non-non-
functioning kidneyfunctioning kidney..
2. Dislocation of kidney and2. Dislocation of kidney and collecting systemcollecting system shadowshadow --
congenitalcongenital dislocationdislocation ((lumbar orlumbar or
pelvis distopia); nephroptosispelvis distopia); nephroptosis..
AtAt distopia ureter is shot.distopia ureter is shot.
AtAt nephroptosis ureter has normalnephroptosis ureter has normal
length but abnormal shape (it’s winding).length but abnormal shape (it’s winding).
Intravenous urogram.
Lumbar distopia of
right kidney

7. 3. Double shadow of collecting system - complete or
incomplete - kidney anomalies.
Retrograde urogram.
There are too intrarenal collecting
systems and too ureters in
both of sides -
double-sided complete
collecting system duplication
Intravenous urogram.
There are too collecting systems
in the left kidney but too ureters are joined -
incomplete collecting system duplication

8. 44.1..1. MSubMSub ofof inside round filling defectinside round filling defect::
-- tumourtumour in collecting system,in collecting system, mammarymammary
ductduct, uterus cavity;, uterus cavity;
-- X-ray negative (nonopaque)X-ray negative (nonopaque)
stonestone in collecting systemin collecting system..
4.2.4.2. MSubMSub ofof round filling defect alonground filling defect along
the outlinethe outline –– tumourtumour oror cystcyst in surroundingin surrounding
tissues that presses cavity –tissues that presses cavity –
compressioncompression from outsidefrom outside..
Ductogram
4. Decreasing shadow (filling defect) of collecting
system, mammary duct, uterus and uterine tube cavities.

9. 4.3.4.3. MSubMSub ofof linear fillinglinear filling
defect indefect in upper part of ureterupper part of ureter --
additional vesseladditional vessel that pressesthat presses
ureter.ureter.
4.4.4.4. MSubMSub ofof circulating filling defect incirculating filling defect in ureter,ureter,
mammary ductmammary duct -- tumourtumour withwith infiltrative growth.infiltrative growth.
4.5. MSub of decreasing or absent shadow
of uterine tube - obstruction of the tube by
adhesions (scars) at chronic inflammation.
Hysterosalpingogram

10. 5. Increasing shadow of collecting system or uterine tube.
5.1. Increasing uterine tube shadow -
inflammatory fluid, pus, blood
in tube - hydrosalpinx - often is
combined with obstruction of tube
(contrast medium does not go out
the tube).
5.2. Increasing quantity of calyces -
polycalycosis. There are a lot of cavities
connected with collecting
system (additional calyces) - spongy kidney
(result of dysplasia).

11. 5.3.5.3. Increasing shadow of one calyx (Increasing shadow of one calyx (hydro-hydro-
calycosis)calycosis) oror calices and pelvis (calices and pelvis (hydro-hydro-
pyelocalycosis)pyelocalycosis) oror calices, pelvis and uretercalices, pelvis and ureter
((hydroureterpyelocalycosis)hydroureterpyelocalycosis) -- dilatation -dilatation -
result ofresult of obstructionobstruction byby stone, tumour,stone, tumour,
additional vesseladditional vessel oror stricture of ureterstricture of ureter..
The syndrome “increasing shadow” often is revealed in
combination with syndrome “filling defect”.
The dilatation also may be conditioned
by hypotonia of collecting system at
chronic pyelonephritis and by megaureter
(congenital dilation).

12. 6. Increasing shadow of kidney.
Enlargement of one kidney - tumour or cyst.
Angiogram.
Left kidney is enlarged.
Its vessels are shifted by cyst

13. Enlargement of both of kidneys - polycystosis.
The syndrome increasing shadow
of kidney often is revealed at the
same time with syndrome round
filling defect along the outline of
intrarenal collecting system.
Intravenous urogram.
Polycystosis

14. 7. Decreasing shadow of kidney – hypoplasia or sclerosis
of parenchyma (contracted kidney).
Angiogram.
Hypoplasia of left kidney

15. 8. Deformation and displacement of uterus - anomalies,
pressing from outside, shifting by fibrous adhesions at
chronic inflammation (often - in combination with
obstruction of tubes).
Bicornate uterus Saddle-shaped uterus
Uterus anomalies

16. CT- andCT- and MRI-MRI-semiotics of urogenital systemsemiotics of urogenital system
and mammary gland pathologyand mammary gland pathology
1. Changes of shape, sizes, quantity, location of kidney.1. Changes of shape, sizes, quantity, location of kidney.
CT-gram. Hypoplasia of right
kidney due to hypoplasia of
right renal artery
MR-tomogram. Enlargement
and deformation of right
kidney due to tumor

17. 2.2. AtypicalAtypical (heterodense(heterodense oror heterointense)heterointense) focus in kidney,focus in kidney,
breast, prostate gland, ovary parenchyma -breast, prostate gland, ovary parenchyma - massmass oror cavity;cavity; inin
wall or cavity of uterus -wall or cavity of uterus - massmass..
TumourTumour -- homogeneoushomogeneous ((hypo-hypo- oror hyperdensehyperdense on CT-grams,on CT-grams,
hypo-hypo- oror hyperintensehyperintense on MR-images);on MR-images);
-- inhomogeneousinhomogeneous,, with regular or irregular contourswith regular or irregular contours..
Metastases may be found in kidney, as a rule - homogeneous
with irregular contours.
Metastases unlike tumour do not enlarge kidney!

18. Cyst always is seen as hypodense on CT-grams, hypointense
on T1-weighted and hyperintense on T2-weighted MR-
images, with regular contours.
On MRI cyst often has hypo- or hyperintense outline (wall).
Abscess as a rule is seen similar to cyst but with irregular
contours.
Echinococcus (hydatid) cysts very rarely are found in
kidneys (unlike liver), may be inhomogeneous with
hyperdense (on CT), hypointense (on MRI) outline
conditioned by calcified wall.

19. 3.3. HyperdenseHyperdense (on CT)(on CT),, hypointensehypointense
(on MRI)(on MRI) focus in calyx, pelvis,focus in calyx, pelvis,
ureter, urinary bladderureter, urinary bladder -- stonestone..
CT-gram. Stone in the pelvisCT-gram. Stone in the pelvis
of right kidneyof right kidney
44.. Changing collecting systemChanging collecting system cancan
be visualized with MR-urographybe visualized with MR-urography
(like(like X-ray urography but withoutX-ray urography but without
using contrast medium)using contrast medium) oror
withwith CT.CT.

20. Ultrasound semiotics of urogenital systemUltrasound semiotics of urogenital system
and mammary gland pathologyand mammary gland pathology
1. Hypo- or hyperechoic focus in parenchyma of kidney,1. Hypo- or hyperechoic focus in parenchyma of kidney,
prostate gland, ovary, breast; in wall or cavity of uterus –prostate gland, ovary, breast; in wall or cavity of uterus –
tumour.tumour. MalignantMalignant tumor often istumor often is inhomogeneousinhomogeneous due todue to
areas of necrosis or calcification.areas of necrosis or calcification. Metastasis (homogeneous),Metastasis (homogeneous),
eechinococcus cystchinococcus cyst ((inhomogeneous)inhomogeneous) may be found in kidneymay be found in kidney..
Echogram of prostate.
Heteroechoic focus - tumor
Echogram of uterus.
Inhomogeneous focus in cavity
that grows from wall - tumor

21. 2. Hypoechoic focus in parenchyma of kidney, prostate,
ovary, breast - abscess.
3. Anechoic focus (foci) with dorsal enhancement in
parenchyma of kidney, prostate, ovary, breast – cyst (cysts).
After cavity wall dorsal acoustic shadow often is
visualized.
Abscess has more irregular contours, thicker wall than cyst.
Echograms of mammary glands: 1 - fluid in cavity, 2 - dorsal
enhancement after fluid, 3 - dorsal acoustic shadow after wall of cavity
1
CystAbscess
2
3

22. 4. Hyperechoic focus in calyx, pelvis, urinary bladder -
stone, tumor.
After stone dorsal acoustic shadow always is seen.
Echograms of urinary bladder
Tumour Stones Echogram of kidney.
Stone in collecting
system
1
1 - dorsal acoustic shadow after stone,
2 - kidney collecting system, 3 - kidney parenchyma
3
2

23. 4. Increasing anechoic zone of kidney collecting system -
hydropyelocalycosis or pyelocalycoectasia - dilation:
-result of obstruction by stone, tumour, additional vessel
or stricture of ureter;
- hypotonia of collecting sys-
tem at chronic pyelonephritis;
- megaureter .
The syndrome increasing
anechoic zone often is found
in combination with syndrome
hyperechoic focus
in collecting system.
1
2
3
1 - increasing calyces, 2 - stone
in pelvis, 3 - kidney parenchyma

24. 5. Increasing quantity of calyces -
polycalycosis - spongy kidney.
7. Decreasing kidney - hypoplasia,
sclerosis of parenchyma.
6. Increasing kidney - tumour, cyst
(cysts) - in combination with
heteroechoic zone in parenchima.
Contracted right kidney.
It is smaller and more echoic
than left kidney

25. Radionuclide semiotics of kidney pathology
1.Absence of RPH accumulation
in kidney - absent or non-functioning
kidney.
2. Diffuse decreased accumulation of RPH in kidney -
total decreasing kidney function.
At chronic glomerulonephritis,
bilateral chronic pyelolonephritis,
nephropathy both of kidneys are
changed. At chronic one-sided
pyelonephritis one kidney is changed.

26. 3. Changing shape, sizes of kidney.
Right kidney is decreased and deformed,
accumulation of RPH in it is decreased -
contracted kidney
Nephroscintigrams in posterior projection
Kidneys are linked at one end by a band of
tissue - horse-shoe kidney (anomaly).
RPH accumulation in left kidney is decreased.

27. 4. Changing location of kidney -
dystopia, nephroptosis.
5. Local decreased accumulation
of RPH - “cold” area - mass, cavity.
Nephroscintigrams in posterior projection

28. Segments (phases) of renograms:
1st
- a sharp quick rise during 30 s
after RPH injection (it represents
function of kidney vessels) –
vascular phase.
2nd
- a slower rise in the next 3-5 min
(it represents nephron accumulation
of RPH) - secretion phase.
3d
- a slow fall during the next 20
min (it represents excretion of RPH) -
excretion phase.
Renogram
Dynamic scintigram
1
2
3
1
2
3

29. Types of pathological traces:
1 - obstructive - obstruction of urinary tract (3d
phase is
horizontal or rising).
2 - hypofunctional - minor or moderate decreasing of
kidney function (2nd
and 3d
phases are changed).
3 - parenchymal - renal failure (2nd
phase is absent and 3d
phase is changed).
4 - anfunctional - considerable renal failure - contracted
kidney (all of 3 phases are absent).
1 2
3
4