Radiology.Academy.Sk

Neuro Review
Appendix
Spleen
Stomach
Kidneys
Kidney
Pancreas
Pelvic congestion syndrome
Liver
Biliary
CT Abd Epiploic Appendagitis
Fractures Wrist
Wrist
Diffuse periosteal reaction
Signs in Uroradiology
Male breast
MRI Breast Indications
CT Head Cerebellar Mass
Biopsies
Diagnostic mammography
Screening mammography
Mammo Pearls
ACR Appropriateness Criteria Breast Cancer Screen
AVM types
CT Orbits
CT Abd NL
Chiari Malformations
Vesicoureteral Reflux (VUR)
Elbow
XRAY Abdominal Series

Abdomen
Cardio
Chest
Dictation Templates
General
GU
Mammography
MSK
neuro
Neuroradiology
NM
Nuclear Medicine
Pediatric
Physics
Ultrasound
Upload

Kidney

Anterior Pararenal Space

Pancreas, C loop of duodenum, Ascending and Descending colon

Perirenal Space

Kidney, Renal pelvis, Proximal ureter, Perirenal fat, Adrenal gland

Posterior Pararenal Space

2 layers (may be separated by pacreatitis), fat continues to the flank as properitoneal fat stripe

CT

Precontrast, Corticomedullary phase (70s), Nephrogram phase (120s), Pyelogram (5m)

CT-IVP

Eval of hematuria: Precontrast (stone protocol), Nephrogram, Pyelogram and Urogram (5m)

Horseshoe kidney

Congenital fusion of lower poles, isthmus across the aorta at the level of IMA (prevents normal ascent to the renal fossae) → low positioned, malrotated → increased risk for stones, infections, TCC 4 x higher

Renal Masses

Evaluate calcifications, attenuation before and after contrast, margin, septas and its thickness, wall thickness


Renal Cell Carcinoma (RCC)

90%, large (> 3 cm) are heterogeneous, multilobulated, internal hemorrhage, necrosis, coarse, irregular calcs, hypervascular enhancement, 5% cystic - thickened and enhancing wall and septas or solid tumor nodule. Look for renal vein and IVC tumor thrombus, LN > 2 cm in short axis always contain mets → periaortic, pericaval, renal hilum

Staging:
  • T1: tu confined to the kidney
  • T2: growth through the capsule into the perirenal space - A: involves main renal vein; B: involves regional LN; C: A+B
  • T3A: through renal fascia into adjacent organs; T3B: mets

Oncocytoma

Benign tumor from proximal tubule, 60 yo men, similar imaging characteristics as RCC, unable to differentiate from RCC ⇒ nephrectomy

AngioMyoLipoma (AML)

Bng tu from vessels, muscle and fat; hemorrhage, aneurysms; middle-aged females and Tuberous Sclerosis. Dx feature on CT is fat HU < -20 (black), no need for contrast.

TCC

Uroepithelial cells of renal pelvis, ureter or bladder (90%). Multiple filling defects in the renal pelvis, infundibulum (w/ dilated calyces), absent or decreased contrast excretion and hydronephrosis (obstruction at UPJ).

Renal Lymphoma

Homogeneous hypodense masses (DDx: Infarct, Pyelo, Lymphoma) on contrast enhanced parenchyma, usually bilateral, retroperitoneal LA in 50%, renal artery and vein encasement

Renal Medullary Carcinoma

From collecting tubules, Sickle Cell Trait, arises from the medulla, growths into the renal sinus and may protrude into collecting system, if large - undistinguishable from RCC, much worse prognosis

Renal mets

Lung, Breast, GI adenoca, Melanoma

Cystic Renal Masses


Simple Renal Cyst

50% incidence at 50 yo, sharp margination with renal parenchyma, no perceptible wall, homogeneous attenuation water density (HU: -10 to +20), no enhancement

Complicated Simple Cyst

Hemorrhage, Infection, Calcifications. Thin, smooth septas, thin calcs. Small cyst uniformly hyperdense (HU: 25-90) on non-contrast study

Renal abscess

Thick enhancing wall, low density fluid collections within the renal parenchyma sometimes w/ gas

Multicystic Renal Cell Carcinoma

RCC w/ multiple fluid filled cysts

Multilocular Cystic Renal Nephroma (MCRN)

bng, cysts of varying sizes; male infants 2mm - 3yo and women 40-60 yo; Unilateral, solitary, arises from the upper pole, septas enhance

Localized Renal Cystic Disease

bng, resembles MCRN, not assoc. w/ renal insufficiency - leave it alone; multiple cysts of varying size separated by non-enhancing septas, one kidney, may resemble unilateral autosomal dominant PKD

Bosniak Classification

  • Category I: simple cyst
  • Category II: < 3 cm, thin septations (1-2 mm thick), thin calcifications in the wall or septum, high density cysts (60-100 HU)
  • Category IIF: likely benign but need f/u in 3, 6, 12 mm; many thin septas, minimal smooth thickening of the walls or septa but without measurable contrast enhancement; thick or nodular calcifications in the wall or septa; nonenhancing, high density intrarenal cysts
  • Category III: indeterminate lesions; thick, irregular calcifications, irregular margins, thick or enhancing septa, nodularity, thick walls, multilocular mass - Multilocular Cystic Nephroma, Multilocular clear cell RCC, complex benign hemorrhagic or chronically infected cysts
  • Category IV: clearly malignant necrotic cystic neoplasms that arise in the wall of a cyst; irregular solid nodules, irregular thick shaggy walls, nodular septations