Renal Tract Imaging Plain Radiographs: • Calculi screening • Diffuse abdominal pain • Control for procedures and fluoroscopy Intravenous Pyelogram (IVP) • Demonstrates renal, ureteral and bladder anatomy • Gross estimation of function • Ionizing radiation • Requires IV contrast Ultrasound • Excellent at showing renal and bladder anatomy • Differentiates between solid and cystic masses • Can assess blood flow using Doppler function • Can use TRUS to evaluate prostate/guide biopsies • Poor ureteral anatomy • No functional information CT • Excellent anatomical detail • High dose ionizing radiation • KUB CT: non-contrast • Renal CT: IV contrast o Pre-contrast o Corticomedullary phase o Nephrographic phase o Excretory phase • IVP CT: IV contrast • CT angiogram Nuclear Medicine • DMSA: dimercaptosuccinic acid o Assessing renal morphology: structure, size, scarring. Non-functional. • Tc99m-DTPA (diethylene triamine pentacetic acid) and Tc99m-MAG3 (mercaptoacetyltriglycine) o Measures renal blood flow, renal function such as GFR, assesses obstruction with frusemide, assesses renal artery stenosis with captopril Catheter Angiography • Evaluate renal vasculature  Treat renal artery stenosis • Embolic renal haemorrhage or tumour Percutaneous Interventions • Percutaneous nephrostomy • Renal biopsy • Ureteric stenting MRI • Excellent anatomical detail • No ionizing radiation • Tissue characterisation • MR angiography Renal Cysts • Ultrasound determines if lesion is cystic or solid • 2 types of renal cysts o Simple: spherical, echo-free fluid collection with a thin surrounding wall, shows good sound wave transmission o Complicated: echoes within cyst, thick/calcified wall o If lesion is solid, CT is then used Imaging Strategies for Microscopic Haematuria Strategy 1 • KUB to detect stones • Ultrasound to identify masses • Cystoscopy and retrograde if KUB and ultrasound are normal Strategy 2 • Renal ultrasound and CT IVP • Cystoscopy if needed Transitional Cell Carcinoma • Most common malignancy of ureters and bladder • <10% of renal malignancies • Present with gross haematuria • CT scan for surgical planning • Treatment: radical nephrectomy and/or cystectomy Renal Adenocarcinoma • 90% of renal malignancy • 15-30% have metastasized at time of diagnosis • Haematogenous and lymphatic spread • 10% have venous invasion • CXR or pulmonary metastases • CT on abdomen: local invasion, lymphadenopathy, venous extension • MRI on abdomen: renal failure, contrast allergy