Podcast
Questions and Answers
Which imaging modality is typically the first-line method for visualizing ureters?
Which imaging modality is typically the first-line method for visualizing ureters?
A patient's CT scan reveals a ureteric stone lodged between the sacroiliac joint and the pelvic brim. Which segment of the ureter is affected?
A patient's CT scan reveals a ureteric stone lodged between the sacroiliac joint and the pelvic brim. Which segment of the ureter is affected?
Which of the following would be best visualized using MRI, regarding the urinary tract?
Which of the following would be best visualized using MRI, regarding the urinary tract?
A patient is suspected to have a tumor in their bladder. Which imaging modality is superior for staging bladder cancer?
A patient is suspected to have a tumor in their bladder. Which imaging modality is superior for staging bladder cancer?
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Which of the following is NOT a typical location of a ureteric constriction?
Which of the following is NOT a typical location of a ureteric constriction?
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When using ultrasound to examine the bladder, what would a typical filled bladder appear as?
When using ultrasound to examine the bladder, what would a typical filled bladder appear as?
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Which imaging modality is most useful for assessing the vascularization of bladder tumors?
Which imaging modality is most useful for assessing the vascularization of bladder tumors?
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The ureters typically measure approximately what length?
The ureters typically measure approximately what length?
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What is the typical shape of the adult bladder when distended, as seen on imaging?
What is the typical shape of the adult bladder when distended, as seen on imaging?
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Which imaging modality is considered the gold standard for detecting ureteric stones?
Which imaging modality is considered the gold standard for detecting ureteric stones?
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What is a common finding on ultrasound that suggests ureteric obstruction?
What is a common finding on ultrasound that suggests ureteric obstruction?
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In the context of bladder imaging, what is the significance of the trigone area?
In the context of bladder imaging, what is the significance of the trigone area?
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Which imaging modality is most helpful for visualizing the precise location of a ureteral leak or disruption?
Which imaging modality is most helpful for visualizing the precise location of a ureteral leak or disruption?
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Which of these imaging features best suggest a ureteric tumor on CT urography?
Which of these imaging features best suggest a ureteric tumor on CT urography?
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What is the typical thickness of the bladder wall when distended?
What is the typical thickness of the bladder wall when distended?
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What do radiolucent stones in the bladder require for visualization?
What do radiolucent stones in the bladder require for visualization?
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What imaging feature is most suggestive of a bladder tumor on an MRI?
What imaging feature is most suggestive of a bladder tumor on an MRI?
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Which imaging modality is preferred for evaluating bladder trauma, and what finding is most indicative of a bladder rupture?
Which imaging modality is preferred for evaluating bladder trauma, and what finding is most indicative of a bladder rupture?
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In a case of suspected emphysematous cystitis, what specific imaging finding would be most likely observed on a CT scan?
In a case of suspected emphysematous cystitis, what specific imaging finding would be most likely observed on a CT scan?
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What is the distinguishing feature of bladder diverticula on ultrasound?
What is the distinguishing feature of bladder diverticula on ultrasound?
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Which of the following accurately describes the typical appearance of BPH on T2-weighted MRI images?
Which of the following accurately describes the typical appearance of BPH on T2-weighted MRI images?
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Which imaging modality offers the most accurate measurement of prostate volume in cases of Benign Prostatic Hyperplasia (BPH)?
Which imaging modality offers the most accurate measurement of prostate volume in cases of Benign Prostatic Hyperplasia (BPH)?
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When evaluating for bladder rupture, how does the contrast appear on a retrograde cystography in an intraperitoneal rupture?
When evaluating for bladder rupture, how does the contrast appear on a retrograde cystography in an intraperitoneal rupture?
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Besides prostate size, which of the following is another key finding that can be assessed via ultrasound in BPH?
Besides prostate size, which of the following is another key finding that can be assessed via ultrasound in BPH?
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Flashcards
Ureter
Ureter
Paired tubes transporting urine from kidneys to bladder.
Length of Ureter
Length of Ureter
Approximately 25–30 cm long.
Plain Radiography (KUB X-ray) for Ureter
Plain Radiography (KUB X-ray) for Ureter
Usually not visible unless stones or calcifications present.
Intravenous Urography (IVU)
Intravenous Urography (IVU)
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Key Constrictions of Ureter
Key Constrictions of Ureter
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Urinary Bladder
Urinary Bladder
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CT Imaging for Bladder
CT Imaging for Bladder
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MRI for Bladder
MRI for Bladder
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Cystoscopy
Cystoscopy
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Retrograde Cystography
Retrograde Cystography
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Normal Bladder Anatomy on Imaging
Normal Bladder Anatomy on Imaging
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Ureteric Obstruction Causes
Ureteric Obstruction Causes
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Imaging Features of Ureteric Stones
Imaging Features of Ureteric Stones
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Urothelial Carcinoma
Urothelial Carcinoma
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Bladder Stones Imaging Techniques
Bladder Stones Imaging Techniques
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Bladder Tumors Types
Bladder Tumors Types
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Ultrasound Features of Bladder Tumors
Ultrasound Features of Bladder Tumors
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CT Cystography Findings
CT Cystography Findings
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MRI Staging of Tumors
MRI Staging of Tumors
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Types of Bladder Trauma
Types of Bladder Trauma
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Retrograde Cystography in Trauma
Retrograde Cystography in Trauma
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Cystitis Imaging Features
Cystitis Imaging Features
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Bladder Diverticula Imaging
Bladder Diverticula Imaging
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BPH Diagnostic Imaging
BPH Diagnostic Imaging
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Study Notes
Introduction
- Dr Syed Faizan Raza Jafri is an MBBS, MD specializing in medicine.
Radiology of Ureter and Urinary Bladder
- The ureters are paired tubes carrying urine from the renal pelvis to the bladder.
- They measure approximately 25-30cm in length.
- Anatomical landmarks and constrictions are clinically significant.
Imaging Features
Plain Radiography (KUB X-ray)
- The ureter is typically not visible unless calcifications/stones are present.
- Intravenous urography (IVU/IVP): contrast highlights the ureters.
Intravenous Urography (IVU)
- Outlines the ureters after contrast administration
- Demonstrates normal peristaltic contractions
Ultrasound
- Non-invasive, but limited for visualizing normal ureters unless dilated.
- Appears as tubular, anechoic structures with posterior acoustic enhancement.
CT
- Provides detailed cross-sectional imaging of the ureter.
- Identifies stones, strictures, and tumors.
- Three segments are identifiable:
- Proximal: Renal pelvis to the sacroiliac joint
- Middle: Sacroiliac joint to the pelvic brim
- Distal: Pelvic brim to bladder insertion
MRI
- Rarely used for ureter imaging but provides excellent soft-tissue contrast.
- Helpful in identifying congenital anomalies or masses.
Key Constrictions of the Ureter
- Ureteropelvic junction (UPJ): Where the renal pelvis narrows into the ureter.
- Pelvic brim: Where the ureter crosses the iliac vessels.
- Ureterovesical junction (UVJ): Where the ureter enters the bladder wall.
Bladder
- A hollow, muscular organ located in the pelvis, primarily responsible for storing urine.
Imaging Features
Plain Radiography
- Only visible with contrast (e.g., cystography).
- Outlines bladder shape, detects filling defects (e.g. diverticula/ruptures)
Ultrasound
- Appears as an anechoic structure when filled with urine.
- Evaluates bladder wall thickness, and intraluminal masses/stones.
- Doppler can evaluate vascularization in tumors.
CT
- Excellent visualization of the bladder wall and surrounding structures.
- Helps delineate tumors and inflammatory conditions.
- Differentiates bladder tumors from surrounding tissues.
MRI
- Superior for soft-tissue contrast, useful for staging bladder cancer.
- Allows differentiation between tumors and surrounding tissues
Cystoscopy and Retrograde Cystography
- Invasive procedures.
- Allow direct visualization of the bladder.
- Retrograde cystography helps detect ruptures / fistulas with contrast.
Normal Anatomy on Imaging
Shape
- Pyramid-like in infants
- Ovoid in adults (when distended).
Wall Thickness
- Normally 3-5mm when distended.
- Thickening occurs in conditions like infection, inflammation or neoplasms.
Trigone Area
- Located between ureteric orifices and internal urethral opening
- Smooth compared to the rest of the bladder on imaging
Radiopathology of the Ureter and Urinary Bladder
Ureteric Obstruction
- Causes: Stones, strictures, tumors, or external compression.
- Imaging features: includes ultrasound (hydroureter and hydronephrosis - anechoic dilation of the renal pelvis/calyces) and echogenic shadowing of possible stones; CT (best for detecting ureteric stones, dilated ureter upstream from obstruction), strictures, and IVU/IVP (delayed contrast excretion, tapering at the site of obstruction),
Ureteric Stones
- Imaging Features:
- KUB X-ray: Radio-opaque calculi (calcium, struvite) in the ureter's course
- Radiolucent calculi (uric acid, cystine): require other imaging modalities like CT
- CT (Non-contrast): Gold standard for stone detection (hyperdense focus with acoustic shadowing)
Ureteric Tumors
- Types: Urothelial carcinoma (most common), metastases
- Imaging Features include Irregular filling defects in contrast-filled lumen and wall thickening/irregular enhancement (CT); soft-tissue masses with hyperintense signal on T2-weighted images, and filling defects with delayed excretion (MRI and IVU, respectively)
Ureteric Trauma
- Imaging Features:
- Extravasation of contrast from ureter, CT Urography
- Associated Perirenal Hematoma/urinoma
- Retrograde pyelography: precise location of the leak/disruption
Bladder Stones
- Imaging Features
- KUB X-ray: Radiopaque stones in bladder (calcium-based)
- Radiolucent stones require CT or ultrasound for evaluation
- Ultrasound: Hyperechoic structures with posterior acoustic shadowing
- CT: Clear visualization of stones, including radiolucent ones
Bladder Tumors
- Types: Urothelial carcinoma (most common), squamous cell carcinoma, adenocarcinoma
- Imaging features Include:
- Ultrasound: hypoechoic or mixed echogenic masses projecting into lumen (with CT cystography showing irregular, enhancing masses)
- MRI: Soft tissue masses with hyperintense signals in T2 weighted images, with irregular wall thickening and infiltration into adjacent fat
Bladder Trauma
- Types: Intra/extraperitoneal rupture
- Imaging Features:
- Retrograde cystography
- Contrast extravasation in intraperitoneal rupture; contrast only limited to perivesical spaces in extraperitoneal rupture; outlines bowel loops in intraperitoneal ruptures
- CT cystography: preferred for trauma evaluations (clearly shows extravasation patterns)
- Retrograde cystography
Bladder Infections (Cystitis)
- Causes: Bacterial, tuberculosis, fungal
- Imaging Features
- Ultrasound: thickened irregular bladder walls; echogenic debris in severe cases (emphysematous cystitis)
- CT: wall thickening, stranding in perivesical fat
- MRI: diffuse wall thickening, increased signal intensity on T2 weighted images
Bladder Diverticula
- Imaging Features
- Ultrasound: Anechoic outpouchings from bladder
- CT cystography: Contrast-filled diverticula; assess for stones / tumors within diverticula
Radiology of Benign Prostatic Hyperplasia (BPH)
- Non-cancerous prostate gland enlargement, often causing LUTS.
- Radiologic evaluation assesses prostate size, bladder effects, and complications (obstruction / infections).
Ultrasound (US)
- Transabdominal: Enlarged prostate ( >30 mL volumes); median lobe protrusion into bladder (intravesical protrusion); post-void residual volume to assess obstruction severity
- Transrectal (TRUS): more accurate measurement of prostate volume; hypoechoic or heterogeneous nodules in transition zone; detects complications (bladder wall thickening, stones)
MRI
- Best for detailed anatomy/staging, if needed.
- Features: Enlarged prostate predominantly in transition zone; T2-weighted images: heterogenous signal intensity due to nodules; compression of peripheral / central gland by hypertrophy
CT
- Rarely used specifically for BPH but may show enlarged prostate gland with bladder wall thickening/trabeculations, secondary findings like hydronephrosis from chronic obstruction
- Voiding Cystourethrography (VCUG): demonstrates bladder outlet obstruction (elongated, narrowed prostatic urethral, post-void residual urine)
Key Findings
- Enlarged prostate (>30g)
- Secondary changes in the bladder (wall thickening, trabeculations, diverticula, retained urine (postvoid residual
- Complications: bilateral hydronephrosis or hydroureter from chronic obstruction
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Description
This quiz explores the radiological features of the ureter and urinary bladder, focusing on imaging techniques such as plain radiography, intravenous urography, ultrasound, and CT scans. You'll learn about the anatomical significance and practical applications of these imaging modalities in clinical settings.
