IMAGING MODALITIES OF THE KIDNEY - u-szeged.hu€¦ · • Kidney failure: parenchyma destruction,...

IMAGING MODALITIES OF THE KIDNEYIMAGING MODALITIES OF THE KIDNEY

Dr. Nagy EndreDr. Nagy Endre

Anatomical reviewAnatomical review

Anatomical reviewAnatomical review

PyelonPyelon

Examination modalities:Examination modalities:

• plain x-ray (film, fluoroscopy, tomography)plain x-ray (film, fluoroscopy, tomography)• contrast enhanced examinations contrast enhanced examinations • catheter angiography (DSA)catheter angiography (DSA)• ultrasound (B-mode, Doppler-mode, color, duplex)ultrasound (B-mode, Doppler-mode, color, duplex)• computed tomography (CT, CTA)computed tomography (CT, CTA)• nuclear magnetic resonance imaging (MRI, MRA)nuclear magnetic resonance imaging (MRI, MRA)• x-ray-, US-, CT-, MR-guided interventionsx-ray-, US-, CT-, MR-guided interventions• nuclear medicine nuclear medicine

Plain film:Plain film:

Contrast enhanced study:Contrast enhanced study:

DSA:DSA:

Ultrasonography:Ultrasonography:

Computed tomography:Computed tomography:

MRI:MRI:

Nuclear medicine:Nuclear medicine:

Diseases of the kidneyDiseases of the kidney

• Developmental variations, disordersDevelopmental variations, disorders• Collecting system (Obstruction, stone, Collecting system (Obstruction, stone,

hydronephrosis)hydronephrosis)• Acute and chronic inflammationAcute and chronic inflammation• Circulation disorders (renovascular hypertension, Circulation disorders (renovascular hypertension,

function failure)function failure)• (Diseases of the parenchyma)(Diseases of the parenchyma)• InjuriesInjuries• Space occupying lesions (cystic, solid)Space occupying lesions (cystic, solid)

Normal variations and congenital Normal variations and congenital disorders (abnormality)disorders (abnormality)

• fusion anomalies (Bertini-columna, lobulated kidney, fusion anomalies (Bertini-columna, lobulated kidney, dromedary-kidney, horseshoe-kidney)dromedary-kidney, horseshoe-kidney)

• extrarenal pyelonextrarenal pyelon• congenital malposition (dystopy, congenital malposition (dystopy, crossed dystopy, crossed dystopy,

malrotation)malrotation)• agenesis, hypoplasiaagenesis, hypoplasia

Other genital disorders !Other genital disorders !

DystopyDystopy

Horseshoe-kidneyHorseshoe-kidney

Obstruction, stone, hydronephrosisObstruction, stone, hydronephrosis

• acute: enlarged kidney, slow perfusion and excretion, acute: enlarged kidney, slow perfusion and excretion, moderate dilatation of the pyelon, stone, other causesmoderate dilatation of the pyelon, stone, other causes

• chronic: dilated collecting system, thin parenchyma, chronic: dilated collecting system, thin parenchyma, pure excretion, stone, other causespure excretion, stone, other causes

Ureter stone, acute hydronephrosisUreter stone, acute hydronephrosis

Chronic hydronephrosisChronic hydronephrosis

Acut and chronic inflammationsAcut and chronic inflammations

• autoimmun: large/small kidney autoimmun: large/small kidney • acute pyelonephritis (acute focal bacterialacute pyelonephritis (acute focal bacterial

nephritis, etc) nephritis, etc) • emphysematous pyelonephritis: large kidney, emphysematous pyelonephritis: large kidney,

hypodensity, decreased contrast uptake, space hypodensity, decreased contrast uptake, space occupation, thikening of the renal fascia, gas in the occupation, thikening of the renal fascia, gas in the parenchymaparenchyma

• Pyonephros : hydronephrosis, thik wall of the pyelonPyonephros : hydronephrosis, thik wall of the pyelon• abscess: APN abscess: APN + + abscess cavityabscess cavity• segmental, polar, global atrophy segmental, polar, global atrophy

Calcified lesionCalcified lesion

Surgical preparateSurgical preparate

Surgical towels

Chronic inflammationChronic inflammation

Circulation and function abnormalityCirculation and function abnormality

• infarction (partial, complete): no enhancement, infarction (partial, complete): no enhancement, absence of excretionabsence of excretion

• Renal vein thrombosis: large kidney, slow Renal vein thrombosis: large kidney, slow perfusion, venous filling defect, perirenal perfusion, venous filling defect, perirenal collaterals, no excretioncollaterals, no excretion

• Renal artery stenosis, renovascular hypertensionRenal artery stenosis, renovascular hypertension• aneurysmaaneurysma• Kidney failure: parenchyma destruction, Kidney failure: parenchyma destruction,

calcification, pure excretion calcification, pure excretion (contrast material?!?)(contrast material?!?)

Kidney infarctionKidney infarction

Renal vein thrombusRenal vein thrombus

Renal artery stenosis on both sidesRenal artery stenosis on both sides

PosttraumPosttraumaticatic A-V shunt A-V shunt

Kidney injuriesKidney injuries

• blount or penetrating injuries, contusionblount or penetrating injuries, contusion• haematoma (subcapsular/perirenal), urinoma, haematoma (subcapsular/perirenal), urinoma,

parenchyma laceration, artery/vein injuries, ureter parenchyma laceration, artery/vein injuries, ureter rupturerupture

Subcapsular haematomaSubcapsular haematoma

„„Spontaneos” ruptureSpontaneos” rupture

Space occupying lesionSpace occupying lesion

cysticcystic - simple (solitaer, multiple)- simple (solitaer, multiple) - hereditary (polycystic disease)- hereditary (polycystic disease) - atipical (closed calix, diverticula, cystic tumor, - atipical (closed calix, diverticula, cystic tumor,

abscess, echinococcus, multilocular cysticabscess, echinococcus, multilocular cysticnephroma)nephroma)

• solidesolide - benign (AML, adenoma, oncocytoma, etc.)- benign (AML, adenoma, oncocytoma, etc.) - pr. malignances (RCC, TCC, Wilms-tumor)- pr. malignances (RCC, TCC, Wilms-tumor) - sec. malignances (HL, NHL, metastasis)- sec. malignances (HL, NHL, metastasis)

CystCyst

Cystic tumor in a horseshoe kidneyCystic tumor in a horseshoe kidney

AngiomyolipomaAngiomyolipoma

Hypernephroid carciomaHypernephroid carcioma(Grawitz-tumor)(Grawitz-tumor)