Ultrasonography of the urinary system - Revision history

Mikael Häggström: /* Solid renal masses */ Forked

2019-08-02T07:56:33Z

Solid renal masses: Forked

Mikael Häggström: /* Basic screening */ +Image

2019-05-18T13:47:14Z

Basic screening: +Image

Mikael Häggström: /* CEUS, image fusion and elastography */ Too preliminary

2019-04-11T06:47:11Z

CEUS, image fusion and elastography: Too preliminary

Mikael Häggström: /* Basic screening */ Wording

2019-04-10T11:43:39Z

Basic screening: Wording

Mikael Häggström: /* Findings in the normal kidney */ to gallery

2019-04-10T11:42:44Z

Findings in the normal kidney: to gallery

Mikael Häggström: /* Basic screening */ Sized

2019-04-10T11:41:54Z

Basic screening: Sized

Mikael Häggström: +Normal

2019-04-10T11:41:05Z

+Normal

Mikael Häggström: +Basic screening

2019-04-10T11:38:27Z

+Basic screening

Mikael Häggström: /* Hydronephrosis */ Moved

2019-01-12T13:30:17Z

Hydronephrosis: Moved

Mikael Häggström: +Planning

2018-12-06T16:27:17Z

+Planning

@@ Line 55: / Line 55: @@
 ==Solid renal masses==
 [[File:Cortical solid mass of renal cell carcinoma.jpg|thumb|Figure 8. Cortical solid mass, which later was shown to be renal cell carcinoma. Measurement of the solid mass on the US image is illustrated by ‘+’ and a dashed line.<ref name="Hansen2015" />]]
-[[File:Renal cell carcinoma with both cystic and solid components.jpg|thumb|Figure 9. Renal cell carcinoma with both cystic and solid components located in the cortex. Measurement of tumor on the US image is illustrated by ‘+’ and a dashed line.<ref name="Hansen2015" />]]
+{{Main|Ultrasonography of renal tumors}}
 ==Hydronephrosis==

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 *Evaluate the '''echogenicity''' of the kidneys, comparing to the liver on the right side, and to the spleen on the left side if possible. A hyperechoic renal cortex indicates chronic kidney disease ([[#Chronic kidney disease|see section below]]).
 *Have at least a quick glance at the '''bladder''' for excessive distension or obvious pathology.
 ==Findings in the normal kidney==

← Older revision		Revision as of 06:47, 11 April 2019
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	Image fusion of ultrasound with a previously recorded dataset of CT or other modalities is rarely used in renal US. Reports on image fusion using CEUS or US combined with CT or MRI in the examination of renal lesions and in difficult US-guided renal interventions have been published (Figure 31). However, no recommendations have been published so far.<ref name="Hansen2015" />		Image fusion of ultrasound with a previously recorded dataset of CT or other modalities is rarely used in renal US. Reports on image fusion using CEUS or US combined with CT or MRI in the examination of renal lesions and in difficult US-guided renal interventions have been published (Figure 31). However, no recommendations have been published so far.<ref name="Hansen2015" />
−
−	[[Elastography]] is a US method to visualize the elasticity of tissue. Preliminary reports on US elastography used on transplanted kidneys to evaluate cortical fibrosis have been published showing promising results (Figure 32).<ref name="Hansen2015" />

	<gallery widths="320" heights="180">		<gallery widths="320" heights="180">

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 *Measure '''renal size''': The length of the adult kidney is normally 10–12 cm, and the right kidney is often slightly longer than the left kidney. The adult kidney size is variable due to the correlation with body height and age; however, normograms for pediatric kidney size are available.<ref name="Hansen2015" />
 *Measure '''cortical thickness''': Cortical thickness should be estimated from the base of the pyramid and is generally 7–10 mm. If the pyramids are difficult to differentiate, the parenchymal thickness can be measured instead and should be 15–20 mm (Figure 1). The echogenicity of the cortex decreases with age and is less echogenic than or equal to the liver and spleen at the same depth in individuals older than six months. In neonates and children up to six months of age, the cortex is more echogenic than the liver and spleen when compared at the same depth.<ref name="Hansen2015" />
-*Compare the '''echogenicity''' of the kidneys, comparing to the liver on the right side, and to the spleen on the left side if possible. A hyperechoic renal cortex indicates chronic kidney disease ([[#Chronic kidney disease|see section below]]).
+*Evaluate the '''echogenicity''' of the kidneys, comparing to the liver on the right side, and to the spleen on the left side if possible. A hyperechoic renal cortex indicates chronic kidney disease ([[#Chronic kidney disease|see section below]]).
 *Have at least a quick glance at the '''bladder''' for excessive distension or obvious pathology.

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 ==Findings in the normal kidney==
 In the longitudinal scan plane, the kidney has the characteristic oval bean-shape. The right kidney is often found more caudally and is slimmer than the left kidney, which may have a so-called dromedary hump due to its proximity to the spleen. The kidney is surrounded by a capsule separating the kidney from the echogenic perirenal fat, which is seen as a thin linear structure.<ref name="Hansen2015" />
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 <gallery heights="200" widths="200">
 File:Normal pediatric kidney.jpg|Figure 3. Normal pediatric kidney. * Column of Bertin; ** pyramid; *** cortex; **** sinus.<ref name=Hansen2015/>
 </gallery>

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 ==Basic screening==
 *'''Scan''' through the renal volumes in two projections, looking for focal changes or hydronephrosis.
-[[File:Measures of the kidney.jpg|thumb|Figure 1. Measures of the kidney. L = length. P = parenchymal thickness. C = cortical thickness.<ref name=Hansen2015/>]]
+[[File:Measures of the kidney.jpg|thumb|130px|Figure 1. Measures of the kidney. L = length. P = parenchymal thickness. C = cortical thickness.<ref name=Hansen2015/>]]
 *Measure '''renal size''': The length of the adult kidney is normally 10–12 cm, and the right kidney is often slightly longer than the left kidney. The adult kidney size is variable due to the correlation with body height and age; however, normograms for pediatric kidney size are available.<ref name="Hansen2015" />
 *Measure '''cortical thickness''': Cortical thickness should be estimated from the base of the pyramid and is generally 7–10 mm. If the pyramids are difficult to differentiate, the parenchymal thickness can be measured instead and should be 15–20 mm (Figure 1). The echogenicity of the cortex decreases with age and is less echogenic than or equal to the liver and spleen at the same depth in individuals older than six months. In neonates and children up to six months of age, the cortex is more echogenic than the liver and spleen when compared at the same depth.<ref name="Hansen2015" />

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 In cases of decreased renal function, the most relevant assessments in a renal ultrasound are renal sizes, [[echogenicity]] and any signs of [[hydronephrosis]]. Renal enlargement usually indicates [[diabetic nephropathy]], [[focal segmental glomerular sclerosis]] or [[myeloma]]. Renal atrophy suggests longstanding chronic renal disease.<ref name="thorp2004">{{cite journal|title=An Approach To The Evaluation Of An Elevated Serum Creatinine|url=http://ispub.com/IJIM/5/2/10525|author=M Thorp|journal=The Internet Journal of Internal Medicine|year=2004|volume=5|issue=2}}</ref>
 ==Findings in the normal kidney==
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 The kidney is divided into parenchyma and renal sinus. The renal sinus is hyperechoic and is composed of calyces, the renal pelvis, fat and the major intrarenal vessels. In the normal kidney, the urinary collecting system in the renal sinus is not visible, but it creates a heteroechoic appearance with the interposed fat and vessels. The parenchyma is more hypoechoic and homogenous and is divided into the outermost cortex and the innermost and slightly less echogenic medullary pyramids. Between the pyramids are the cortical infoldings, called columns of Bertin (Figure 1). In the pediatric patient, it is easier to differentiate the hypoechoic medullar pyramids from the more echogenic peripheral zone of the cortex in the parenchyma rim, as well as the columns of Bertin (Figure 2).<ref name="Hansen2015" />
 [[File:Doppler ultrasound of systolic velocity (Vs), diastolic velocity (Vd), acceleration time (AoAT), systolic acceleration (Ao Accel) and resistive index (RI) of normal kidney.jpg|thumb|350px|Figure 4. Doppler ultrasound (US) of a normal adult kidney with the estimation of the systolic velocity (Vs), the diastolic velocity (Vd), acceleration time (AoAT), systolic acceleration (Ao Accel) and resistive index (RI). Red and blue colors in the color box represent flow towards and away from the transducer, respectively. The specrogram below the B-mode image shows flow velocity (m/s) against time (s) obtained within the range gate. The small flash icons on the spectrogram represent initiation of the flow measurement.<ref name="Hansen2015" />]]

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 ==Hydronephrosis==
-One of the primary indications for referral to US evaluation of the kidneys is evaluation of the urinary collecting system. Enlargement of the urinary collecting system is usually related to urinary obstruction and can include the pelvis, the calyces and the ureter. [[Hydronephrosis]] is seen as an anechoic fluid-filled interconnected space with enhancement within the renal sinus, and normally, the dilated pelvis can be differentiated from the dilated calyces.<ref name="Hansen2015" />
+<gallery>
+File:Ultrasonography of hydronephrosis due to ureteropelvic junction obstruction.jpg|link=Ultrasonography of hydronephrosis|[[Ultrasonography of hydronephrosis|Ultrasonography of '''hydronephrosis''']]
 </gallery>

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 |author2=Authors of Creative Commons article<ref name=Hansen2015>Content initially copied from: {{cite journal|last1=Hansen|first1=Kristoffer|last2=Nielsen|first2=Michael|last3=Ewertsen|first3=Caroline|title=Ultrasonography of the Kidney: A Pictorial Review|journal=Diagnostics|volume=6|issue=1|year=2015|pages=2|issn=2075-4418|doi=10.3390/diagnostics6010002}} [https://creativecommons.org/licenses/by/4.0/ (CC-BY 4.0)]</ref>
 }}
-Renal ultrasound (US) is a common examination, which has been performed for decades. Using [[B-mode imaging]], assessment of renal anatomy is easily performed, and US is often used as image guidance for renal interventions. Furthermore, novel applications in renal US have been introduced with contrast-enhanced ultrasound (CEUS), elastography and fusion imaging. However, renal US has certain limitations, and other modalities, such as CT and MRI, should always be considered as supplementary imaging modalities in the assessment of renal disease.<ref name="Hansen2015" />
+==Planning==
 ==Technique==