Genitourinary - Learning Modules - CTisus.com CT Scanning

Learning Modules ❯ Genitourinary

Papillary Necrosis

Renal medulla and papillae are vulnerable to ischemic necrosis because of unique arrangement of their blood supply and the local interstitial hypertonicity.
Risk factors:
- Diabetes mellitus
- Analgesic abuse
- High-dose nonsteroidal anti-inflammatory drugs
- Sickle cell anemia
- Chronic infection (such as tuberculosis and pyelonephritis)
- Others: Acute urinary obstruction, Renal vein thrombosis, Chronic alcoholism
Compromised perfusion: Vascular spasm, Compression, Vasculitis, Hemoglobinopathy
Varies greatly in severity and rate of progression
+/- Hematuria, decreased renal function

Papillary Necrosis

Papillary Necrosis with Sloughed Papilla

Bladder Cancer: Facts

Estimates of 72,570 new cases and 15,210 deaths in the US in 2013
Most cancers are transitional cell carcinoma while others are squamous cell carcinoma and adenocarcinoma
Data from NCI (National Cancer Institute)

“The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) for bladder cancer detection were 79% (117 of 149), 94% (649 of 689), 91% (766 of 838), 75% (117 of 157), and 95% (649 of 681) for CT urography and 95% (142 of 149), 92% (634 of 689), 93% (776 of 838), 72% (142 of 197), and 99% (634 of 641) for cystoscopy. The NPV of CT urography was higher in patients evaluated for hematuria alone (98%, 589 of 603).”
Bladder cancer detection with CT urography in an Academic Medical Center.
Sadow CA et al
Radiology. 2008 Oct;249(1):195-202

Bladder Cancer

“The presence of a discrete bladder mass or nodule should be considered suspicious for malignancy . In many cases, such lesions may be better appreciated on early phase images when surrounded by low-attenuation urine, particularly when the lesion is avidly enhancing, although a discrete filling defect may not be difficult to appreciate on delayed images when the nodule is large.”
Bladder Malignancies on CT: The Underrated Role of CT in Diagnosis
Raman SP, Fishman EK
AJR 2014; 203:347–354

Bladder Cancer-Subtle Enhancement

Bladder Cancer in Patient with hematuria

Active Bleed in Bladder: Dx

Blood Clot in Bladder

Hematuria Following Catheterization

Active Bleed in Bladder Following Cath

Renal Cell Carcinoma: Presentation

Hematuria (40%)
Flank pain (40%)
Palpable mass in flank or abdomen (25%)
Weight loss (33%)
Fever (20%)
Hypercalcemia (5%)

Microscopic vs Macroscopic Hematuria

In patients with microscopic hematuria neoplasm is uncommon and in the largest study upper urinary tract TCC was found in 0.2%, RCC in 1% and bladder cancer in 3.7% (exact frequency depends on age of population studied)
In patients with macroscopic hematuria the risk for malignancy is high and can be found in 10-28% of cases overall and in up to 10% of patients younger than 40 years of age (exact frequency depends on age of population studied)

Functional MDCT Imaging of the Kidneys

corticomedullary phase (25-45 seconds)
parenchymal or nephrographic phase (60-90 seconds)
excretory phase (240-300 seconds)

“ In the corticomedullary phase, attenuation values of renal clear cell carcinoma were significantly higher than those of renal papillary carcinoma. In renal clear cell carcinoma the mean attenuation value was 152.6 HU (range 90-256 HU); in renal papillary carcinoma, the value was 61.8 HU (range 38-123 HU).”
Differentiation of Renal Clear Cell Carcinoma and Renal Papillary Carcinoma Using Quantitative CT Enhancement Parameters
Ruppert-Kohlmayr AJ et al.
AJR 2004; 183:1387-1391

Clear Cell Renal Cell Carcinoma

Clear Cell RCC