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Senior - GU Test 1 > 5 - Imaging > Flashcards

5 - Imaging Flashcards

1
Q

Imaging types?

A 
US
Intravenous pyelogram
CT
MRI
Voiding cystourethrography
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2
Q

why we like US?

A

Simple
Non-invasive
Cheap
Safe

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3
Q

US can ID?

A

Size and symmetry of kidneys

  • <9cm in adult = sig irreversible disease
  • size difference - unilateral disease

Thickness and echogenicity of renal cortex, medulla, pyramids

Distended urinary collecting system

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4
Q

Normal kidney? (US)

A

Less dense than liver
9(ish) cm
Can distinguish cortex from medulla

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5
Q

Kidney disease (US)

A

More dense than liver
Small (<7cm)
Cannot distinguish cortex from medulla

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6
Q

US is 1st choice for?

A

Discover various degrees of hydronephrosis

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7
Q

US is useful for

A 
Obstruciton
Cystic disease
Bladder tumor
Characterize masses (solid/cystic)
GU screening (preg pts)
Localized kiendy biops
Post-void residual volume
Congenital abnormalities
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8
Q

More “exciting” US of bladder?

A

Transrectal US (TRUS)

  • prostate
  • guide biopsy

Color doppler

  • flow eval
  • vascularity of prostate tumor
  • acute testicular pain (torsion vs epididymitis)
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9
Q

IVP (intravenous pyelogram)

A

Aka IVU - intravenous urogram or excretory urography

Contrast injection

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10
Q

IVP is contraindicated in pts w?

A

H risk of ARF
CKD
Multiple myeloma

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11
Q

IVP good for?

A

– pelvicaliceal system
– renal size & shape
– renal stones (typically done now w/ helical CT)

Particularly good for:
– medullary sponge kidney
– papillary necrosis
– hydronephrosis

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12
Q

Before IVP?

A

Serum creatine (make sure its <2mg/dL)

Alternate is US

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13
Q

CTU?

A

CT urogram

- combonitation of IVP and abdominal CT

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14
Q

CTU is preferred radiograph for?

A

for upper GU tract evaluation:
• Hematuria
• Renal masses
• Stones

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15
Q

RUG?

A

Retrograde urethrogram

  • suspected urethral trauma
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16
Q

Get a RUG if?

A

− Inability to void
− Blood at urethral meatus
− Perineal ecchymosis
− “High-riding” prostate

17
Q

RUG technique?

A 
• Inject contrast into urethra
toward bladder 
• If urethra is normal:  insert
catheter into bladder 
• If urethra is NOT normal:  No
catheter insertion
− Instead:  suprapubic catheter
18
Q

Cystogram?

A

Contrast study specifically for bladder eval

19
Q

Cystogram procedure?

A 
– Bladder is catheterized
– Urine is drained
– Inject contrast into bladder
(~400 cc of contrast to completely fill)
– Images are obtained
– Oblique view is also needed
to see entire length of urethra
20
Q

VCUG?

A

Voiding cystourethrogram

Preferred method for urinary reflux eval

21
Q

Who gets a VCUG?

A

Any child who presents w/
UTI prior to toilet training

– reflux results in recurrent
infection → significant,
scarring/narrowing of
ureters

22
Q

VCUG process?

A 
• Catheter inserted into urethra 
• Contrast instilled into bladder
– Fluoroscopy imaging →
visualization of lower GU tract → eval for reflux into ureter(s) or extravasation of contrast
• When bladder is full, catheter
removed 
• Imaging continued while patient
voids
23
Q

Non-contract helical CT is used for?

A

Detect renal stones (95% sensitive 98% specific) in pts w acute flank pain

24
Q

CT has a definitive role in?

A

Definitive role in staging renal neoplasms
– For renal mass work-ups
• Obtain with & without contrast & compare images
• Enhancing renal masses are often malignant

25
Q

CT angiogram offers?

A

Increasing utility in diagnosis of renovascular HTN due to renal artery stenosis

26
Q

MRI easily?

A

Distinguishes renal cortex vrom medulla

27
Q

MRI is good for?

A 
Loss of corticomedullary
function
– Glomerulonephritis 
– Hydronephrosis 
– Renal vascular occlusion 
– Renal failure

Also - stage renal cell carcinoma

Also - renal mass eval (if CT is contraindicated)

28
Q

MR angiography?

A

MRI study of blood vessels

- w/ w/o contrast

29
Q

MRA and renal artery stenosis?

A

Nearly 100% sensitive
& 96-98% specific for
diagnosis of renal
artery stenosis

30
Q

Advantages/Disadvantages of MRA?

A 
Less costly &amp; invasive
than catheter
angiography, but
images not quite as
clear
– Also:  potential for renal
injury due to gadolinium
contrast
31
Q

Gold standard for renal artery stenosis?

A

Renal arteriogram

32
Q

Other options for imaging?

A

– Prostascint scan
• Eval of patients already diagnosed w/ prostate cancer – for
staging…used along w/ MRI

– Bone scan
• Bone metastases evaluation – Renal scan (renography)
• Quantifies renal function
• Assesses renal blood flow – Captopril scan used to diagnose

– Renal Cell Carcinoma, Prostate Cancer
renovascular hypertension • Identifies presence of renal obstruction

33
Q

Why does a kidney with stones stop working?

A

Because it’s between a rock and a hard place

Senior - GU Test 1 (13 decks)

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