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Paediatric Surgery
Imaging of the Urinary Tract
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
10 sections · 88 slides
Principles of Urinary Tract Imaging
What we image, and why we choose one test over another
- Imaging is about function, not just anatomy
- The imaging toolbox
- Radiation matters most in children
- General anaesthesia is a real cost
- CAKUT: the commonest thing we image for
- Where imaging is heading
Ultrasound: The Cornerstone
No radiation, fast, cheap — and nearly always first
- Why ultrasound leads the way
- How the scan is done
- The physics that makes urine easy to see
- Calcification and the acoustic shadow
- Autosomal recessive polycystic kidneys on ultrasound
- Left pelvic kidney with gross hydronephrosis
- Ultrasound also shows movement
- Ureteric stone at the vesicoureteric junction
- The twinkle sign: an artefact that helps
- Deflux implant mimicking calcification
- Right duplex kidney with two ureters on ultrasound
- Ultrasound for urinary stones
- Why a common language was needed: the UTD system
- Ultrasound parameters in the UTD classification
Radiographs and Fluoroscopy
Still and moving X-ray pictures
- The plain abdominal film
- Severe bilateral renal stone disease
- How fluoroscopy works
- The micturating cystogram (MCUG)
- Posterior urethral valves on a voiding cystourethrogram
- Y-duplication of the urethra
Computed Tomography
Exquisite anatomy, but the highest radiation dose
- What CT measures
- Why CT is used cautiously in children
- Speed is a big advantage
- Turning slices into 3D pictures
- When to give contrast
- Late posterior urethral valves after renal trauma
- Malrotated and hydronephrotic kidneys
Magnetic Resonance Imaging
Best tissue contrast, no ionizing radiation
- How MRI makes an image
- T1, T2 and why water glows
- MR urography (MRU)
- Duplex kidney with an ectopic upper-pole ureter on MRU
- Gadolinium contrast and its rare danger
- CT versus MRI — the core trade-off
- CT versus MRI in the urinary tract — practical points
Angiography and Intervention
Imaging the blood vessels — and treating them
- The role of angiography
- Bilateral renal artery stenosis
- Renal artery stenosis in a transplant kidney
- Transplant renal artery stenosis in 3D
- Interventions guided by imaging
Static Cortical Scintigraphy (DMSA)
Tracers that map kidney function
- Nuclear medicine — trusted too little
- The DMSA tracer
- Acquiring a DMSA scan
- Reading it: differential renal function
- Xanthogranulomatous pyelonephritis
- Horseshoe kidney: mapping damaged from working tissue
- DMSA for scarring after infection
- DMSA to guide reflux and anomaly management
- Bilateral Wilms tumour
Dynamic Radionuclide Renography
Watching the kidney take up and drain the tracer over time
- What a renogram is for
- Choosing the tracer
- Getting a good renogram
- Reading function and drainage
- The renogram in antenatal hydronephrosis
- What ‘obstruction’ really means
- Combined pelviureteric and vesicoureteric obstruction
- Assessing the vesicoureteric junction (VUJ)
- Renography in congenital renal anomalies
- Bilateral duplex kidneys
- Horseshoe kidney with a duplex left moiety
Cystography and Tumour Imaging
Low-dose reflux and staging scans
- The direct isotope cystogram (DIC)
- The indirect radionuclide cystogram (IRC)
- MAG3 with indirect cystogram showing right-sided reflux
- What the IRC also tells us
- Nuclear medicine in tumour imaging
Summary and Future Directions
Non-invasive, prognostic imaging is the goal
- Numbers worth remembering
- Take-home messages
- Where renal imaging is going
- References (1/3)
- References (2/3)
- References (3/3)
- Pediatric Surgery and Pediatric Urology