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Flashcards in Renal Imaging Tutorial Deck (32):
1

Hilum of the left kidney is at which vertebral level?

L1

2

Right kidney hilum level?

L1-L2

3

Contents of renal hilum

Posterior - renal pelvis
Middle - renal artery
Anterior - renal vein

Lymphatics
Nerves
Renal sinus fats

4

Which renal vein is longer? Why?

Left

Passes across aorta anteriorly to join right side IVC

5

Pre contrast phase of CT is good for imaging of?

Calculi

6

Corticomedullary phase of CT is good for imaging of?

Cortex of kidney.

25-70 seconds after IV injection

7

Nephrographic

80-180 secs after IV injection

Renal medulla and cortex enhance equally

8

Excretory phase of CT

5-15 mins after IV injection

Opacification of the renal collecting system and ureters.

9

Fundamental spaces in the peritoneum around the kidney (3)

What are these separated by?

1. Anterior pararenal
2. Perirenal - enclosed by renal fascia
3. Posterior pararenal

Separated by renal fascia:
- anterior renal fascia (Gerota's fascia)
- Posterior renal fascia - Zuckerland's fascia

10

CT contrast induced nephropathy

What is there a rise in?

Risk factors?

Risk reduction

Impairment of renal function occurring within 3 days following Intravascular administration of a contrast medium in absence of alternative aetiology.

Rise in serum creatinine ad urea
Peaks 72-96 hours post contrast

Risk factors//
> renal impairment - +/- diabetes mellitus
> dehydration
> congestive heart failure
> LV ejection fraction < 40%
> acute MI (within 24 hours)
> nephrotoxic drugs

Risk reduction//
> eGFR <60 recommended

> Hydration protocols
-- 1-1.5ml/kg/h 0.9% normal saline 12 or 6 hours before and after contrast administration
-- sodium bicarbonate instead of sodium chloride - urine alkalinisastion - prevention of O2-free radicals (administered 1 hour pre- and 6 hours post-procedure)

> Ask about renal function prior to requesting CT scan

11

Nephrogenic Systemic fibrosis

It is a disease of fibrosis of the skin and internal organs.

It is caused by exposure to gadolinium-containing contrast medium, used in imaging in patients who have renal insufficiency.

Skin erythema, pruritus, pain

Involvement of other organs
- neuropathic symptoms
- joint contractures
- respiratory insufficiency
- muscular atrophy

skin thickens and hardens over time.

RISK FACTORS
- renal impairment

12

T1 signal

Appearance of CSF

longitudinal relaxation time) is the time constant which determines the rate at which excited protons return to equilibrium. It is a measure of the time taken for spinning protons to realign with the external magnetic field.

CSF is DARK.

13

T2 signal

T2 (transverse relaxation time) is the time constant which determines the rate at which excited protons reach equilibrium or go out of phase with each other. It is a measure of the time taken for spinning protons to lose phase coherence among the nuclei spinning perpendicular to the main field.

CSF is LIGHT

14

Parts of the ureter (3 mains sections)

> Abdominal ureter (along medial aspect of psoas)

> Pelvic ureter (enters pelvis at bifurcation of common iliac artery. anterior and medial to SI joint. turns medially at level of ischial spines. enters the posterolateral bladder)

> Intravesical portion

15

Excretion of urine pathway

Papillae --> minor calyces --> major calyces --> renal pelvis --> pelvis-ureteric junction --> ureter --> bladder (at vesico-ureteric junction)

16

3 anatomical constrictions of the ureters

1. Pelvis-Ureteric junction
2. Pelvic Brim
3. Vesico-ureteric junction

17

IVU - intravenous urography

Dated. no longer used at nine wells.

CT urogram has replaced it.

18

CT urogram

Good for assessing?

GOld standard for?

Inadequate for?

> Good for assessing collecting system, ureters and bladder.

> Pre-contrast and 5-15 minute excretory phase obtained after IV contrast

> GOLD standard for nodal/metastatic disease staging

> Planar reconstructions

> Inadequate for local staging of bladder wall tumours.
- MR gold standard for local staging

19

Lymphatic drainage of right kidney

Anterior
A. Paracaval
B. Precaval
C. Interaortocaval a. Retrocaval

Posterior
A. Paracaval
a. Retrocaval
C. Interaortocaval - thoracic duct

20

Lymphatic drainage of left kidney

Anterior
Pre-aortic
Para-aortic

Posterior
D. Para-aortic
b. Retroaortic
- thoracic duct

21

Base of bladder is anterior or posterior?

Posterior

22

Trigone

qtriangular smooth area of bladder between ureters and urethra

23

Commonest technique to image bladder?

Ultrasound

Requires a full bladder.

24

Crystography for bladder.

Gold standard to see leak through bladder wall tear

Retrograde filling of bladder via urinary catheter

25

Bladder wall tumours gold standard imaging?

MR gold standard for local staging

26

Pouch of douglas is also know as

Recto-uterine pouch

27

Where does urethra originate

Bladder neck

anterograde-inferior wall of bladder

28

Male urethra sections

Bladder neck

--> prostatic urethra (transitional epithelium)

--> membranous urethra (transitional epithelium)

--> bulbous urethra (pseudo stratified columnar)

--> penile urethra (squamous)

29

Urethrogram

useful for imaging of?

Retrograde filing of urethra

Strictures
Trauma
Diverticula

30

Best imaging for genitals?

Ultrasound
- testes/scrotum
- uterus and ovaries
- prostate biopsies

31

Hysterosalpingogram

Infertilty - tubal patency
Uterine abnormalities

32

MRI of genitals

Prostate cancer - local staging

Troubleshooting for adnexal /uterine/ovariian abnormalities not characterisable by ultrasound