Flashcards in Renal Imaging Tutorial Deck (32):
Hilum of the left kidney is at which vertebral level?
Right kidney hilum level?
Contents of renal hilum
Posterior - renal pelvis
Middle - renal artery
Anterior - renal vein
Renal sinus fats
Which renal vein is longer? Why?
Passes across aorta anteriorly to join right side IVC
Pre contrast phase of CT is good for imaging of?
Corticomedullary phase of CT is good for imaging of?
Cortex of kidney.
25-70 seconds after IV injection
80-180 secs after IV injection
Renal medulla and cortex enhance equally
Excretory phase of CT
5-15 mins after IV injection
Opacification of the renal collecting system and ureters.
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
CT contrast induced nephropathy
What is there a rise in?
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
> renal impairment - +/- diabetes mellitus
> congestive heart failure
> LV ejection fraction < 40%
> acute MI (within 24 hours)
> nephrotoxic drugs
> 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
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.
- renal impairment
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.
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
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
Excretion of urine pathway
Papillae --> minor calyces --> major calyces --> renal pelvis --> pelvis-ureteric junction --> ureter --> bladder (at vesico-ureteric junction)
3 anatomical constrictions of the ureters
1. Pelvis-Ureteric junction
2. Pelvic Brim
3. Vesico-ureteric junction
IVU - intravenous urography
Dated. no longer used at nine wells.
CT urogram has replaced it.
Good for assessing?
GOld standard 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
Lymphatic drainage of right kidney
C. Interaortocaval a. Retrocaval
C. Interaortocaval - thoracic duct
Lymphatic drainage of left kidney
- thoracic duct
Base of bladder is anterior or posterior?
qtriangular smooth area of bladder between ureters and urethra
Commonest technique to image bladder?
Requires a full bladder.
Crystography for bladder.
Gold standard to see leak through bladder wall tear
Retrograde filling of bladder via urinary catheter
Bladder wall tumours gold standard imaging?
MR gold standard for local staging
Pouch of douglas is also know as
Where does urethra originate
anterograde-inferior wall of bladder
Male urethra sections
--> prostatic urethra (transitional epithelium)
--> membranous urethra (transitional epithelium)
--> bulbous urethra (pseudo stratified columnar)
--> penile urethra (squamous)
useful for imaging of?
Retrograde filing of urethra
Best imaging for genitals?
- uterus and ovaries
- prostate biopsies
Infertilty - tubal patency