山东第一医科大学（泰山医学院）：《医学影像学》课程教学资源（授课教案）23.Genitourinary 2

Teaching Plan Name:Bin FU Academic Year2012-2013 Term:Two Date:June 14 Period:3-4 2010 MBBS Autumn Textbook Diagnostic Imaging ion Content Genitourinary Diseases 1 Teaching 2 Objectives Images of renal cell carcinoma and Urinary calculus Key points Imaging of renal cell carcinoma Points difficult to under Imaging of renal cell carcinoma and Urinary calculus Content for self study CT、MRI anatomy Teaching equipment multimedia Related knowledge Medical imaging technique,anatomy,pathology,medicine,surgery Teaching methods Heuristic method discuss Outlines,requirements and time allocation Urinary cakuli Most urinary calculi are calcified and show vary ing density on plain x-ray e y are uniformly calcified but some.particularly bladder stones may be laminated X-ray and CT image 10 Only pure uric acid and xanthine stones are radiolucent on plain radiography,but they can be identified at CT or ultrasound. ●Low density calculi ●Small rena calculi are often round oroval ●the larger on are known as staghom Lateral position,Renal calculi and spine overlap Techniques Plain film examination of the urinary tract is more sensitive than ultrasound for detecting opaque renal and uretene calcul

Teaching Plan Name：Bin FU Academic Year2012-2013 Term：Two Date：June 14 Period：3~4 Textbook Diagnostic Imaging Specialty and Stratification 2010 MBBS Autumn (international students) Content Genitourinary Diseases 1 Teaching hours 2 Objectives Images of renal cell carcinoma and Urinary calculus Key points Imaging of renal cell carcinoma Points difficult to understand Imaging of renal cell carcinoma and Urinary calculus Content for self study CT、MRI anatomy Teaching equipment multimedia Related knowledge Medical imaging technique, anatomy, pathology, medicine, surgery Teaching methods Heuristic method \discuss Outlines, requirements and time allocation Urinary calculi ⚫ Most urinary calculi are calcified and show varying density on plain x-ray examinations. ⚫ Many are uniformly calcified but some, particularly bladder stones may be laminated X-ray and CT image ⚫ Only pure uric acid and xanthine stones are radiolucent on plain radiography, but they can be identified at CT or ultrasound. ⚫ Low density calculi ⚫ Small renal calculi are often round or oval; ⚫ the larger ones frequently assume the shape of the pelvicaliceal system and are known as staghorn calculi ⚫ Lateral position，Renal calculi and spine overlap Techniques ⚫ Plain film examination of the urinary tract is more sensitive than ultrasound for detecting opaque renal and ureteric calculi 5’ 10’ 5’

It is essential to examine the preliminary film of an IVU carefully,because even large calculi can be completely hidden within the opacified collecting system once contrast medium has been given Renal simple cyst 10 At last 25%of people over 50 years have renal cysts the si do not communicate with the collecting system Most arise in the renal cortex IVU finds Renal Pelvis and Calices be compressed CT manifestation 10: Intemal homogeneous attenuation of near water density Lack of measurable thickness of the cyst wall Lack of contrast enhancement Smooth interface with the renal parenchyma 10 MR manifestation ●Round or ovoid lesion ·Intemal homo ogeneous conten 。wihsgnalchaactericssimiartourme:lowsgnalntcnsyonTIWM. high signal on T2WI Nearly imperceptible wall thickness Lack of contrast enhancement Smooth interface with the renal parenchyma Renal cell carcinoma 15 Outline:Renal cell carcinoma (RCC)is the most common renal tumor, comprising approximately 85%of all primary malignant renal neoplasms Renal tumors are usually solitary Histologically:the most common type of malignant renal cell cancer is clear cell adenocarcinoma RCCs are relatively slow growing and may be large before they produce RCC can metastasize by lymphatic and haematogenous routes

⚫ It is essential to examine the preliminary film of an IVU carefully, because even large calculi can be completely hidden within the opacified collecting system once contrast medium has been given Renal simple cyst ⚫ At least 25% of people over 50 years have renal cysts ⚫ the size and frequency of cysts increase with age ⚫ contain clear serous fluid ⚫ do not communicate with the collecting system ⚫ Most arise in the renal cortex IVU finds ⚫ Renal Pelvis and Calices be compressed CT manifestation ⚫ Round or ovoid lesion ⚫ Internal homogeneous attenuation of near water density ⚫ Lack of measurable thickness of the cyst wall ⚫ Lack of contrast enhancement ⚫ Smooth interface with the renal parenchyma MR manifestation ⚫ Round or ovoid lesion ⚫ Internal homogeneous content ⚫ with signal characteristics similar to urine ：low signal intensity on T1WI， high signal on T2WI ⚫ Nearly imperceptible wall thickness ⚫ Lack of contrast enhancement ⚫ Smooth interface with the renal parenchyma Renal cell carcinoma ⚫ Outline:Renal cell carcinoma (RCC) is the most common renal tumor, comprising approximately 85% of all primary malignant renal neoplasms ⚫ Renal tumors are usually solitary ⚫ Histologically: the most common type of malignant renal cell cancer is clear cell adenocarcinoma ⚫ RCCs are relatively slow growing and may be large before they produce symptoms ⚫ RCC may be locally aggressive ⚫ RCC can metastasize by lymphatic and haematogenous routes 10’ 10’ 10’ 15’

Imaging of renal cell carcinoma 10 Imaging plays an important part in the detection,characterization and staging of renal cell cancer Imaging plays an important role in renal cancer treatment decision It has been shown that in the presence of a CT-confirmed renal mass. detection by IVU is only 21%when the lesion is smaller than 2 cm,52%when the lesion is 2~3 cm,and 85%when the lesion is 3 cm or more in diameter. Lesion detection on contrast-enhanced MRI (90~97%)equals that of CT (89-99%) 5 CT manifestation ill-defined solid lesion on plain scan alter renal contour or intrarenal architecture when large enough heterogeneous enhancement is characteristic intratumoral haemorrhage or necrosis or calcification ●Metastasis MR manifestation 10 signal intensity can be heterogeneous on both TIWI and T2WI. ●Low signal on TIWI Heterogeneous high signal on T2WI heterogeneous enhancement Carcinoma of urinary bladder 5 IVU:filling defect in bladder (space-occupying lesion irregular shape:cauliflower CT findings 5 Irregular mass arise from the wall of bladder ●Soft tissue density Heterogeneous enhancement ●necrosis

Imaging of renal cell carcinoma ⚫ Imaging plays an important part in the detection, characterization and staging of renal cell cancer ⚫ Imaging plays an important role in renal cancer treatment decision ⚫ It has been shown that in the presence of a CT-confirmed renal mass, detection by IVU is only 21% when the lesion is smaller than 2 cm, 52% when the lesion is 2~3 cm, and 85% when the lesion is 3 cm or more in diameter. ⚫ Lesion detection on contrast-enhanced MRI (90~97%) equals that of CT (89~99%) CT manifestation ⚫ ill-defined solid lesion on plain scan ⚫ alter renal contour or intrarenal architecture when large enough ⚫ heterogeneous enhancement is characteristic ⚫ intratumoral haemorrhage or necrosis or calcification ⚫ Metastasis MR manifestation ⚫ signal intensity can be heterogeneous on both T1WI and T2WI. ⚫ Low signal on T1WI ⚫ Heterogeneous high signal on T2WI ⚫ heterogeneous enhancement Carcinoma of urinary bladder ⚫ IVU：filling defect in bladder（space-occupying lesion ） ⚫ irregular shape：cauliflower CT findings ⚫ Irregular mass arise from the wall of bladder ⚫ Soft tissue density ⚫ Heterogeneous enhancement ⚫ necrosis 10’ 5’ 10’ 5’ 5’