8 Genitourinary Tract

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Genitourinary Tract Imaging

Zie | Grace | Yen | Cons

Outline:A. Retroperitoneum, Adrenals, Kidneys, Ureters, and

Urinary BladderB. Uterus, Ovaries, and Adne aeC. !estis, "pididymis, and #rostate

O$%ectives1. Review anatomy of the genitourinary organs2. Evaluate the radiologic studies used in imaging thegenitourinary tract (GUT)3. how the normal images of each organ using availa!lemodality". how some a!normal imaging findings in each organ usingavaila!le modality

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

B*A))"R

A. Retroperitoneal Space

• #erirenal space #R+-• Anterior pararenal space A#+-

• #osterior pararenal space ##+-

• Retromesenteric anterior inter ascial spaceR(+-

• Retrorenal posterior inter ascial space RR+

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 ad%acent to &1Ct/rou0/out its e tent

• *e t adrenal lies ad%acent to splenic vesselsat its cep/alad mar0in

• C! is t/e ima0in0 modality o c/oice

• (R& provides /i0/ 8uality ima0es oadrenal lesions and c/emical s/i tc/aracteri9es $eni0n adrenal adenoma

• Ultrasound is e cellent or screenin0adrenal 0lands in in ants and c/ildrenespecially to detect /emorr/a0e

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

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:

• > to 3 lum$ar verte$ral $odies in len0t/?;@2;3 cm lon0

• *e t and ri0/t 7idney si9e s/ould not varymore t/an ; cm

• Ri0/t 7idney is ;2@ cm lo er t/an le t7idney and sli0/tly more lateral

• Renal a is parallels a is o psoas muscles

Imaging Methods

• &ntravenous pyelo0rap/y &1#-, /as $eent/e traditional met/od o ima0in0 t/e7idneys

• U+, C!, and (R all provide $etter ima0es ot/e renal parenc/yma

• (ultidetector C! ()C!- it/ &1 contrast iscurrently t/e $est ima0in0 study to detectand evaluate suspected renal tumors

• #recontrast scans are o$tained todetect urinary stones andcalci ications

• Arterial2p/ase scans t/rou0/ t/e7idneys s/o early en/ancemento renal tumors

• At appro imately @ minutes t/e

renal parenc/yma is normallyuni ormly en/anced nep/ro0ramp/ase-

• At > to 4 minutes pyelo0ramp/ase-, contrast ills t/e collectin0system and ureters

Introduction to Radiology

Christine Sababan-Sagpao, ! 1

August 23, 2011TUESDAY Page 1 of 5



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Figure ". U!Z o normal 7idney, corte andmedulla delineated.

Figure #. Coronal (R& o normal 7idneys

Figure $. Renal mass in ()C!

# parenc/yma dense, posterior- ! tumoranterior and middle- ' necrosis lucent,

anterolateral-

Classi%ication o% Renal asses:

Figure &. )uplication anomaly. Upper moietyinserts a$normally to tri0one and is prone too$struction lo er moiety is normal $ut prone tore lu .

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

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

!. *reters

• ; cm in diameter 5 @4 cm lon0

• Course t/rou0/ t/e posterior a$dominalall

• > 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.








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Figure1). Comparison o pre2menopausal le t-and post2menopausal ri0/t- ovary. !/e olliclescan $e appreciated in t/e premenopausal ovary.

!/e post2menopausal ovary is atrop/ied and /asno ollicles.

Figures 2+. "ndometrial cyst. 'ote t/in alls and/omo0enous anec/oic density.Figure 21. emorr/a0e or endometrioma. Asa0ainst Ji0ure @<, t/is is /ypoec/o0enic and/etero0enous.

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

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

Figure 2#. !/e le t picture is t/e color lo dupleo a normal testis. !/e ri0/t picture s/o s a testisit/out spectral lo as represented on t/e 0rap/on t/e lo er part. !/is may $e indicative o

testicular torsion.B. #rostate

• Composed o t/e perip/eral 9one and aninner 0land composed o t/e central andtransitional 9ones

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

Figure 2&. Beni0n #rostatic ypertrop/y B# - onU!Z. !/e centromedial 9one is enlar0ed. !/eprostate is impin0in0 t/e $ladder nec7.




Appendi/ 1. Radio0rap/ic or72Up or Genitourinary Conditions



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8 Genitourinary Tract