X-ray of the kidneys

It is difficult to imagine a modern urological clinic without radiation research. In essence, it is thanks to them that urology has become one of the most accurate medical disciplines. This does not have to be surprised, since radiation methods allow the doctor to study in detail both morphology and the function of the separation organs and detect pathological changes in the early stages of development in them.

Indications for radiation research are very wide. They are prescribed for every patient who involves damage or kidney disease, ureters, bladder, prostate gland. The appointment is carried out by the attending physician.

The head of the radial department or a doctor in the field of radiation diagnostics chooses the research methods and the sequence of their application. Qualified urologists, as a rule, are well prepared for the radiation diagnosis of damage and diseases of the kidneys and urinary tract and can in contact with the radiologist to establish the order and volume of radiation studies.

Radiation research methods of the urinary system

Sight radiograph of the abdomen. At the first stage of the examination or after sonography, many urological patients are performed by a review of the kidneys and urinary tract. For this, the patient must be prepared - clean the intestines the day before and morning on the day of the study. The patient should come to the X-ray cabinet on an empty stomach. The exception is patients with acute renal colic: they have to be examined without intestinal cleansing. The patient is laid on his back and a picture is performed on a large film so that both kidneys, large lumbar muscles and pelvis are displayed on it to the level of longitudinal art.

The kidneys throughout the observation picture are far from always, in approximately 60-70 % of the subjects. Normally, they look like two bean-shaped shadows located at the level of ThXII-LII on the left and Li-LII on the right. Thus, the left kidney is located slightly higher than the right. The upper poles of the kidneys are normal closer to the midline of the body than the lower ones. The shape of the kidneys is normal, their shadow is homogeneous. An individual option is the arcuarding stab of the outer circuit (the so-called humpbacked kidney). The ureters on the overview radiograph of the abdominal cavity are not visible. The bladder filled with urine can determine an oval or rounded shadow in a pelvis. Normal prostate gland in the pictures does not give a shadow. The main purpose of viewing radiography is the identification of calculi, calcification and gas.

Intravenous urography. This is one of the main radiological studies conducted by patients with lesions of the urinary system. Intravenous urography is based on the physiological ability of the kidneys to grab iodized organic compounds from the blood, concentrate them and secrete in urine. During conventional urography, a patient on an empty stomach, after preliminary cleansing of the intestine and emptying of the bladder, intravenously administered 20-60 ml of one of the urotropic contrasting substances - ion or, more preferably, neion.

Intravenous urography

Direct pyelography. Exciting urography in most cases ensures the study of the cup-lobe system. However, in individual patients, especially with a weak removal of a contrast matter, if it is necessary to examine the cups and a pelvis in detail, it is necessary to directly contrast the upper urinary tract. It is carried out retrograde, through the catheter installed in the ureter (retrograde pyelography), or anti-Generally, through the needle or nephrostomy tube (anti-General pyelography). On the obtained radiographs, all the details of the structure of cups and pelvis are clearly visible, you can detect minor changes in their contours and shapes. The limited use of direct pyelography is associated with the need to catheterization of the urinary tract and the danger of their infection. This study is contraindicated in acute inflammatory processes in the kidneys and urinary tract, as well as in macrohematuria.

Angiography of the kidneys. Distinguish between the general and selective arteriography of the kidneys. In the first case, the catheter is carried out from the femoral artery to the abdominal aorta and its end is installed over the place of the renal arteries. If, due to the occlusal lesion of the aorto-illegal-man segment, the aortic catheterization through the femoral artery is impossible, resort to translumbal puncture by the aorta with a lumbar puncture. With the help of a special injector, 40-60 ml of a water-soluble contrast agent, a series of radiographs, is introduced through the puncture needle or catheter, using a special injector into the lumen of the aortic.

At a series of radiographs, the aortic image and large branches departing from it are initially obtained, including the renal arteries (early arterial phase), then the shadow of minor intodorgan arteries (late arterial phase), then a general increase in the intensity of the shadow of the kidneys (nephrographic phase), the weak shadow of renal veins (venogram) and finally,, finally,, finally,, finally,, finally,, finally,, finally,, finally,, finally The image of cups and pelvis, since the contrast agent is released in the urine.

The renal arteries depart from the aorta almost at a right angle at the level of L, or the disk between it and LV. The diameter of the stem part of the renal artery is 1/3-1/4 of the aortic diameter at this level, the length of the right artery is 5-7 cm, and the left is 3-6 cm. The contours of the arteries are even, their shadow is homogeneous and intense. A more detailed study of renal vessels is possible with their selective contrast. The catheter is installed directly into the renal artery and a contrast matter is introduced through it under pressure. On arteriograms, all the phases of kidney contrast contrast marked above are recorded. If necessary, the aiming radiographs are performed. The renal arteriography is performed in case of suspicion of renovascular hypertension (atherosclerosis, arteritis of the renal artery) and planning operations for an anomalous kidney. Arteriography is also performed as the first stage for intravascular interventions, such as cylinder dilatation, embolization, and the establishment of stent. As with other types of angiography, with a contrasting study of renal vessels, they prefer to use the technique of digital subtitiation angiography (DSA). In order to perform selective venography, the catheter is introduced into the renal vein from the lower hollow vein.

Computed tomography. CT significantly expanded the framework of morphological examination of the kidneys, bladder and prostate gland. The study of the kidneys is performed without special training in people of any age. On tomograms, a normal kidney has the shape of an irregular oval with even and sharp outlines. In the anterior department of this oval, an renal sinus is loosened at the level of Li-LII. At the same level, renal arteries and veins are visible. To improve the visualization of the renal parenchyma and the differential diagnosis of volumetric formations, they produce a bite CT.

CTE is currently the most informative method of identifying and differential diagnosis of volumetric processes in the kidney.

With its help, the stage of malignant kidney tumors is determined. The method has high accuracy in the diagnosis of calculi (including x-ray), calcifications of parenchyma and pathological formations, in the recognition of the peropopic, periwood and pelvic processes. CT is also effective when recognizing traumatic kidney damage. Three-dimensional reconstruction on a spiral computer tomograph provides a urologist and X-ray surgeon with a demonstrative picture of the renal vessels. Finally, CT is the main method of visualization of the adrenal glands and the diagnosis of their pathological conditions - tumors, hyperplasia.

Magnetic resonance tomography. This method, unlike CT, allows you to get layered images of kidneys in various projections: sagittal, frontal, axial. The image of the kidneys resembles the one that is available on CT, but the boundary between the cortical and brain layers of the organ is better visible. The cups and pelvis containing urine are distinguished as a low density formation. With the introduction of a paramagnetic contrast agent, the intensity of the image of the parenchyma increases significantly, which facilitates the identification of tumor nodes. With an MRI, the bladder is clearly visible, including such departments such as the bottom and upper wall, poorly distinguishable on CT. In the prostate gland, capsule and parenchyma are determined. The latter is normal in uniform. Near the gland, in the output-free fiber, you can see more dense formations - seed bubbles.

Radionuclide study of the kidneys. Radonuclide methods have firmly entered the practice of urological and nephrological clinics. They allow you to detect kidney function disorders in the initial stages, which is difficult to carry out using other methods. The clinicians are attracted by the physiologicity of the radioindication method, its relative simplicity and the possibility of repeated studies during the treatment of the patient. It is also important that radionuclide compounds can be applied in patients with increased sensitivity to radiomatic substances. Depending on the tasks of the study from the group of nephrotropic RFP, one of the radionuclide indicators is chosen.

Radionuclide study of the kidneys

Radiometric determination of the volume of residual urine. With a number of diseases, especially often in case of obstacle to the outflow of urine from the bladder, in the latter, after urination, part of the urine, which is called residual urine, remains. A simple measurement method is a radionuclide study. After 1 1/2-2 hours after intravenous administration of the RFP, dedicated to the kidneys, the radiation intensity over the bladder is measured. After the patient has emptied the bladder, the volume of dedicated urine is determined and the radiation intensity over the bladder is measured.