ctivp

1. CT Urography
DR. RAJVAGHASIYA
OSR

2. Definition
CT examination of the entire urinary tract before and after the
administration of IV contrast material and includes excretory
phase images.
CT IVP - ANATOMICAL AND FUNCTIONAL INFORMATION.
CT KUB - ANATOMICAL

3. INDICATIONS
 UNKNOWN HEMATURIA
 SUSPECTED UROTHELIAL CANCER
 FOLLOW-UP UROTHELIAL CANCER
 HYDRONEPHROSIS ?ETIOLOGY(CALCULI, TUMOUR ETC..)
 CONGENITAL ANOMALIES
 BLADDER PATHOLOGIES (DIVERTICULA ,FISTULA)
 PROSTATE PATHOLOGIES
 RENAL HYPERTENSION
 UTI

4. BASIC CONCEPT OF URINARY TRACT
IMAGING
IMAGING MUST INCLUDE…
(a) UNENHANCED AXIAL CT OF THE KIDNEYS,
(b) ENHANCED CT OF THE ABDOMEN AND PELVIS
(c)EXCRETORY PHASE ENHANCED IMAGES OF THE URINARY TRACT

5. UNENHANCED CT SCANS USED FOR EVALUATION OF…
• STONE DISEASE
• RENAL PARENCHYMAL CALCIFICATIONS
• PRECONTRAST ATTENUATION MEASUREMENTS OF RENAL MASSES
• EXCLUSION OF HEMORRHAGIC CHANGES.

6. CONTRAST MATERIAL–ENHANCED IMAGING, ESSENTIAL FOR
COMPLETE EVALUATION OF THE URINARY TRACTS.
Nephrographic phase EVALUATION OF RENAL PARENCHYMA
(INFLAMMATION , SCARRING , TUMOURS )
 CORTICOMEDULLARY DIFFERENTIATION – 30-70 SECONDS AFTER
CONTRAST
 LOOK FOR RENAL VASCULATURE AND PERFUSION
 LESS SENSITIVE FOR MEDULLARY MASS
 HOMOGENEOUS NEPHROGRAPHIC ENHANCED PHASE - 90– 180
SECONDS
 MORE SENSITIVE FOR DETECTION AND CHARACTERIZATION OF ALL
RENAL MASSES.

7. EXCRETORY PHASE- 8–10 MINUTES AFTER CONTRAST
EVALUATION OF SUBTLE UROTHELIAL ABNORMALITIES INCLUDING
UROTHELIAL TUMORS
• PAPILLARY NECROSIS
• CALICEAL DEFORMITY
• URETERAL STRICTURE
• INFLAMMATORY CHANGES OF THE RENAL COLLECTING SYSTEMS,
URETERS, AND BLADDER.
THE BLADDER IS SEEN BEST ON 20- MINUTE AND POSTVOIDING
IMAGES.

8. Techniques
 THREEPHASETECHNIQUE.
 SPLITBOLUSTECHNIQUE.
 SUPPLEMENTAL USE OF NORMAL SALINE INFUSION
AND DIURETIC INJECTION.

9. THREE PHASE PROTOCOL
 UNENHANCED PHASE
 NEPHROGRAPHIC PHASE AFTER 90-100 SECS
 PYELOGRAPHIC PHASE AFTER 12-15 MINUTES
 4 PHASE PROTOCOL (5 MIN AND 7.5 MIN)

10. SPLIT BOLUS PROTOCOL
 UNENHANCED PHASE
 NEPHRO-PYELOGRAPHIC PHASE : 30 ML OF NONIONIC
CONTRAST MATERIAL IS INFUSED AND AFTER 10 MIN
ANOTHER 100 ML OF CONTRAST IS INJECTED
ADV: ASSESS TRACT WITH LOW RADIATION EXPOSURE.

11. SUPPLEMENTAL USE OF NORMAL SALINE
INFUSION AND DIURETIC INJECTION.
1. SUPPLEMENTAL INFUSION OF 250 ML OF PHYSIOLOGIC SALINE
IMMEDIATELY AFTER INJECTING INTRAVENOUS CONTRAST
MATERIAL SIGNIFICANTLY IMPROVES OPACIFICATION OF THE
DISTAL URINARU TRACT.
2. LOW-DOSE DIURETICS (10 MG OF FUROSEMIDE)

12. The 7.5-minute delayed excretory phase enhanced CT acquisition
technique resulted in the most significantly increased distention of the
intrarenal collecting system and proximal ureter, followed by the saline
infusion technique.

13. NORMAL ANATOMY

14. NORMAL ANATOMY
FRONTAL(ANTERIOR) VIEW OFVR IMAGES

15. NORMAL VARIANTS AND
CONGENITAL ANOMALIES

16. NORMAL PAPILLARY BLUSH
Backflow into terminal
collecting ducts (papillary
ducts); Produces wedge-
shaped striated area or
blush extending from a
calyx; Usually considered
normal phenomenon.

17. COMPOUND CALYX

18. PTOTIC KIDNEY
Nephroptosis (also called
floating kidney or renal ptosis) is an
abnormal condition in which
the kidney drops down into the pelvis
when the patient stands up. It is more
common in women than in men.

19. ECTOPIC KIDNEY

20. VR IMAGE MIPIMAGE

21. HORSESHOE KIDNEY

22. DOUPLEX LEFT COLLECTING SYSTEM WITH
ECTOPIC UPPER MOIETY URETER
TheWeigert-Meyer rule states that. the
upper pole ureter is the ectopic ureter
and its orifice inserts inferomedially in the
bladder in relationship to the lower pole
normal ureter.

24. BENIGN TUBULAR ECTASIA
The appearance arises from congenital dilatation/ectasia of the distal tubules
of the nephrons in a medullary pyramid.

25. CTU shows a "paintbrush" appearance to the medullary pyramid.
(tubules dilated to ~0.2 mm).
Unlike medullary nephrocalcinosis renal tubular ectasia cannot be seen
ON noncontrast CT.

26. CROSSED FUSED ECTOPIA
Crossed fused renal ectopia essentially refers to an anomaly where the
kidneys are fused and located on the same side of the midline.
Subtypes
type a: inferior crossed fusion
type b: sigmoid kidney
type c: lump kidney
type d: disc kidney
type e: L-shaped kidney
type f: superiorly crossed fused

29. UROLITHIASIS

30. NON ENHANCED CT SHOWING
BILATERAL RENAL PELVIS
CALCULI WITH MARKED
PYELITIS.
ENHANCED CT SHOWING
GOOD ENHANCEMENT.

31. THICK SLAB MIP
BILATERALRENAL
AND UB STONES
CORONALIMAGES SHOWING
MARKED PYELITIS OF THE
BOTH KIDNEY(FOCAL
ATTENUATION)

32. MIP; THE STONES ARE WELL-SEEN WITHIN THE
OPACIFIED RENALPELVIS. MULTIPLE UB STONES.

33. PREAND POST CONTRAST SCANS.
CALCULUS IN RIGHT KIDNEY
WITH MARKED STRANDING OF
THE PERINEPHRIC FAT.

34. ACUTELY OBSTRUCTED
LEFT KIDNEYWITH
PERINEPHRIC COLLECTION
(FORNICEAL/ CALYCEAL
RUPTURE).

35. MEDULLARY NEPHROCALCINOSIS

37. Renal medullary nephrocalcinosis is the commonest form of nephrocalcinosis and
refers to the deposition of calcium salts in the medulla of the kidney.

38. RENAL INFECTIONS

39. MULTI FOCAL
NEPHRONIA
STAGE BETWEEN ACUTE PYLONEPHRITIS -
ABSCESS
POOR PERFUSION

40. RIGHT UPPER POLARABSCESS

41. RIGHT UPPER POLARABSCESS

42. RENALCYST

43. SIMPLE (BOSNIAK TYPE I) RENAL CYST

45. BOSNIOAK TYPE II CYST WITH THIN CALCIFIED
RIMAND INTRACYSTIC SEPTUM

46. RENALMASS

47. SOLID UPPER POLAR MASS
CLEARLY DEMONSTRATED
IN CORONAL IMAGES

48. MALIGNANT LOWER POLAR LEFT RENAL MASS

49. MALIGNAT SUPRARENALMASS

50. INTRARENAL COLLECTING
SYSTEM

51. CASE (1)
PREAND POST CONTRAST MIPIMAGES
TUBULAR DILATATION WITH TINY
CALCULI WITHIN THE DILATED TUBULES
(MEDULLARY SPONGE KIDNEY)

52. Renal papillary necrosis refers to ischemic necrosis of the renal papillae.
CT IVP typically demonstrates multiple small collections of contrast
material in the papillary regions peripheral to the calyces. The entire papilla
may become necrotic. The papillary defects may eventually become
peripherally calcified.

53. ACUTE PAPILLARY NECROSIS
YOUNG FEMALE PATIENT WITH
PAINLESS HEMATURIAAND
HISTORYOFANALGESICABUSE

54. UROTHELIAL NEOPLASM

55. ANOTHER EXAMPLE OF MALIGNANT UROTHELIAL
NEOPLASM OFTHE UPPERE CALYX

56. URETERS
ASARULE;
MALIGNANT URETERIC NEOPLASMS CHARACTERISTICALLY CAUSE
DILATATION OF THE URETER BOTH PROXIMAL AND DISTAL TO THE
LESION.

60. FIBROV
ASCULAR POLYPOFTHE URETER
Fibroepithelial polyp is a benign
mesodermal tumor mainly seen in adults.
Radiologically, the diagnosis is very hard
to make.
Excision is advised if
hydroureteronephrosis is seen or if the
patient is symptomatic since there is an
overlap in appearance with
transitional/urothelial cell carcinoma.

61. URINARY BLADDER

62. Transitional cell carcinoma (TCC) is the most common primary neoplasm
of the urinary bladder, and bladder TCC is the most common tumour of
the entire urinary system.
Bladder transitional cell carcinomas appear as either focal regions of
thickening of the bladder wall, or as masses protruding into the bladder
lumen, or in advanced cases, extending into adjacent tissues.

65. THANK YOU