CT scan of urinary system

The urinary system CT examination can not only show the renal pelvis, renal pelvis and bladder lumen, but also the kidney parenchyma and bladder wall. Do not take heavy metal drugs within 1 week, do not check for gastrointestinal sputum. Patients who have been tested for expectorant need to wait for the sputum to empty; if they are eager to have a CT examination, they should be treated with a cleansing enema or oral laxative to sputum. Basic Information Specialist classification: Urological examination classification: CT Applicable gender: whether men and women apply fasting: not fasting Tips: Check the process with the doctor's password to do the action, do not arbitrarily move to ensure the clarity of the angiography. Normal value The kidney is normally enhanced by ct. The urinary system should be scanned before the ct scan. The normal supine position scans the whole kidney. If you need to observe the ureter and bladder at the same time, expand the scanning range, enhance the examination method, and quickly inject the contrast agent 60---100ml. 2min, 5-10mm scan of the kidney area, called the third phase of the kidney examination, considerable renal skin, changes in the degree of medullary enhancement and filling of the renal pelvis and ureter, strengthening, if the application of multi-slice spiral ct, can be carried out Various reconstructions, including ctu. The normal kidney cross-section is round or oval, the outer edge is smooth, and the middle part of the kidney has the largest cross-sectional area. When comparing the two kidneys, the plane position and the kidney axis should be noted. The normal renal parenchyma ct value is about 40 hu, flat. The normal renal cortex and medulla density were observed at the time of scanning. The normal manifestations of the three-phase scan of the kidney were as follows: 1. Early enhancement, increased density of renal cortex and renal column, and medulla had not been strengthened, and the junction between the two was clear; 2. Substantial phase, pith Quality development, density is increasing, and finally with the cortical density or slightly more than the renal cortex, cortex, medullary boundary gradually disappear; 3. Renal pelvic excretion, renal pelvis, renal pelvis and ureter density uniformity, renal parenchyma density decreased, should Observation and description of the characteristics of the strengthening of the two kidneys, cortical enhancement, parenchymal enhancement and renal pelvic excretion and development, the focus is to strengthen the time and extent, should be bilateral observation. Clinical significance Abnormal result 1. Kidney dysplasia Congenital renal dysplasia is caused by the development of renal tissue or posterior renal tubules during embryonic development and the abnormal supply of blood to the kidneys. The kidney volume is significantly reduced, usually only 1/6 of the normal kidney. 1/3, most of them are unilateral, the more 3/4 of the ipsilateral adrenal gland is absent, the contralateral kidney is multi-generation and the hypertrophy is large. If both kidneys are underdeveloped, the side is often heavier, and the affected side is more small and the lower end is lower. It can be ectopically opened. Enhanced ct scan showed that the dysplastic kidney was smaller overall, the renal cortex and renal pelvis and renal pelvis were reduced in proportion, and the renal arteries and veins were correspondingly thinned. The early enhancement of renal parenchyma was lower than that of the contralateral side. Hypertrophy, at the same time should pay attention to observe other malformations and diseases of dysplastic kidney, such as double renal pelvis and ureteral malformation. 2, horseshoe kidney Horseshoe kidney is caused by the accumulation of fusion between the two umbilical arteries in the early stage of the embryo. The fusion site is mostly in the lower part of the two kidneys. Most of the kidneys are directly fused by the kidneys to form the isthmus. Sometimes there are only fibrous bands. The connection and the connection are mostly located in front of the inferior vena cava and the abdominal aorta. The position of the horseshoe kidney is lower than that of the normal kidney. The two kidneys are vertically inward and downward, often with poor rotation. Ct is a bilateral renal axis transposition. The lower poles of the kidneys are connected at a lower level with a solid or a cord-like fibrous tissue. The three-dimensional reconstruction of ct can show the overall appearance of the u-shape. Special attention should be paid to other malformations that may be combined, such as Side or both sides of the double renal pelvis and ureter, stenosis at the junction of the fistula. 3, chronic pyelonephritis Chronic pyelonephritis is more common in women than in men. The infection path is hematogenous and ascending, the latter accounting for 70%. The main pathological manifestations are renal interstitial inflammation and fibrosis. Fibrosis begins in the medulla, and the scar of the renal papilla first occurs. In turn, a renal cortical limitation or extensive scar contraction is formed, and the renal pelvis and renal pelvis can be atrophied or expanded accordingly. Pay attention to the changes in the shape of the kidney, most of which are reduced, the contour is not smooth, unilateral or bilateral onset, the local cortex of the kidney is thin, especially in the enhanced scan cortical enhancement period, the local medulla may not change, the renal pelvis is not changed. Often mild water swelling, sometimes thinning of the renal cortex with calcification. 4, kidney abscess and perirenal abscess Renal and perirenal abscesses are often caused by Gram-negative bacilli. The early stage of renal abscess is acute renal glomerulonephritis. The lesion is confined to the renal parenchyma. It is cellulitis. As the disease progresses, the lesion can invade and metastasize to the kidney.盏, the outer can break through the renal capsule, involving the back muscles and the back muscles of the psoas muscle, and the liquefaction of the lesion develops into a kidney and perirenal abscess. Renal and perirenal abscesses can be large or small, and perirenal abscess can exist alone. It should be known about the patient's medical history, acute infection symptoms, waist and abdomen pain, elevated blood levels, etc. The characteristics of the lesion should be noted, and the plain scan is a low-density lesion. Honeycomb changes or larger abscesses, enhances the scanning capsule wall, especially the inner layer is ring-enhanced and interval-enhanced. Perirenal abscess can invade the perirenal fat sac, the anterior and posterior collaterals, the psoas muscle, and the upper to the transverse Under the septum, the lower axillary fossa can be used, the perirenal fascia is thickened, and the density of the strip-like mesh strip appears in the adjacent fat. The pleural effusion and localized intestinal stagnation can occur on the affected side. 5, kidney tuberculosis Renal tuberculosis is a common disease of the urinary system. It is usually spread from the primary pulmonary tuberculosis to the kidney. The renal tuberculosis can be roughly divided into pathological renal tuberculosis, early renal tuberculosis, middle and late stage renal tuberculosis, and pathological renal tuberculosis. Urinary system symptoms, most can be self-healing, early renal tuberculosis can appear painless hematuria, only in the advanced stage, renal parenchymal tuberculosis and renal pelvis and renal pelvis, and then involving the ureter and bladder, typical clinical symptoms appear; urinary system symptoms are Urgency, dysuria, hematuria, even pyuria, generalized hypothermia, fatigue, anemia, weight loss, etc. For patients with diagnosing difficulties, especially those with poor iuv imaging, ct examination should be performed. The ct scan can specifically observe and describe the tuberculosis of the kidney tuberculosis. The cheese cavity is characterized by low density of the kidney. The edge of the necrotic cavity of the cheese is blurred, and the edge of the dilated renal pelvis is clear. 2. The pus kidney type is the whole kidney. The lobulated and divided large cystic cavity is replaced by a thin renal cortex; 3. The tuberculous globule is characterized by a focal high-density mass with a slightly low-density cheese necrotic area; 4. The whole kidney is calcified, and the renal pelvis should be noted. Other changes in ureteral tuberculosis, such as thickening of the renal pelvis wall, stenosis of the ureter, extensive thickening of the ureteral wall, and tuberculous inflammatory contracture of the bladder, ct reconstruction is better for lesions. 6, kidney cyst Simple renal cyst originates from the renal tubule, and the wall thickness is 1--2mm. It occurs mostly on the surface of the unilateral renal parenchyma. It can also be located in the deep cortex or medulla of the cortex, but it is not connected with the renal pelvis and is gradually enlarged under the renal capsule. Compression of adjacent normal tissue, the size of the cyst is not equal, the cystic fluid is serous, 5% of the month is bloody, and the cyst fluid contains glucose, a small amount of protein, lipids, cholesterol and chloride. There may be calcium salt deposition, which can be complicated by infection, stones and tumors. Renal cyst ct plain scan showed single or multiple round low-density foci, generally uniform density, varying sizes, ct enhanced scanning boundary is clearer, no wall or thin wall. Should pay attention to the description of the location, size, number of cystic lesions, large lesions should be measured diameter, pay attention to its thin wall or no wall, no strengthening characteristics, see a higher density of cystic fluid during plain scan, may be combined with bleeding or infection The wall of the capsule can be linearly calcified. 7, renal angiomyolipoma Angiomyolipoma is the most common benign tumor of the kidney. It is single or multiple, middle-aged, and common in women. The tumor originates from the mesoderm and is composed of smooth muscle, fat and abnormal blood vessels. Their content varies greatly. Most of them are mainly fat components, a few are mainly smooth muscles, expansive growth, lack of elastic fibers in the tumor vascular wall, leading to frequent bleeding in tumors or kidneys, causing hematuria, renal angiomyolipoma 20% combined with tuberous sclerosis . The main feature of ct is the fat component in the tumor, the ct value is negative, and the substantial part of the enhancement is more moderate than the scan. The tortuous deformed blood vessels in larger tumors are obviously enhanced during the enhanced scan. Generally, there is bleeding or hematoma in the tumor or on the edge of the tumor, and the flat scan density is high. Attention should be paid to the description of the number, size, and extent of perirenal invasion of the tumor. Smaller tumors should pay attention to the characteristics of benign non-invasive tumors, and the sign of the cup of the normal renal cortex. 8, kidney cancer Renal cancer is the most common malignant tumor of the renal parenchyma. It is derived from renal tubular epithelial cells. It is mostly unilateral and originates from the kidney. The kidney cancer is mostly round, and there are fake kidneys and fibrous tissue. Membrane, tumor texture is hard, most with fibrotic plaque or calcification, internal bleeding, necrosis, cystic changes, most of the renal cancer is clear cell carcinoma, can destroy all kidneys, and can directly invade neighboring tissues and organs, also Can grow into the kidney and involve the renal pelvis and renal pelvis, can form a renal vein, inferior vena cava tumor thrombus. The characteristics of ct are 1. The shape of the kidney changes, the limitation is prominent or the whole is enlarged; 2. The flat mass can be equal, slightly lower or slightly higher density, tumor necrosis, cystic variable area density is lower, and calcification and hemorrhage Increased regional density; 3. Enhanced scanning, the arterial phase of the tumor is obviously enhanced but not uniform, the general density of the parenchyma and the renal pelvis development period is reduced, the boundary is clearer, this fashion can observe the invasion and destruction of the renal pelvis and renal pelvis, and should pay special attention to the tumor. The extent of perirenal invasion and lymph node metastasis, the renal vein and the inferior vena cava tumor thrombus were observed in the parenchyma, and finally the ct staging of renal cell carcinoma was performed. 9, renal pelvic cancer Renal sputum cancer is a renal pelvis or renal pelvis mucosa occurs in malignant tumors, mostly transitional epithelial cancer, 8% of cases of ureteral cancer and bladder cancer are diagnosed earlier than renal pelvic cancer, squamous cell carcinoma accounts for about 7---------- Stones, inflammation and other stimulating transitional epithelium, causing metaplasia and tumor formation, its high degree of malignancy, easy to invade the periorbital tissue, kidney, ureter, and even renal parenchyma are extensively destroyed, adenocarcinoma is rare, high degree of malignancy, A distant transfer occurred earlier. There are two types of renal pelvic cancer changes, ct should pay attention to observe its different characteristics, the intrarenal type is a soft tissue mass in the renal pelvis, the renal sinus fat gap is narrowed or disappeared, often accompanied by pyelectasis, hydronephrosis, moderate reinforcement of the mass The development of renal pelvis shows a filling defect in the renal pelvis, and the infiltration of the renal pelvis is renal pelvis. The irregular thickening or flat mass of the adjacent ureteral wall may be strengthened. At the same time, the renal parenchymal invasion should be observed. The report should mention whether there is any Ureteral bladder implantation, extensive scan and ct reconstruction show good changes in tumor range and secondary hydrops, which should be emphasized and described. 10, kidney stones Calcium oxalate in the urinary calculi, calcium phosphate is a positive stone, uric acid stone is a negative stone, kidney stones occur in 35--50 years old, causing obstruction of the renal pelvis and renal pelvis, injury and infection, if the greater calculus in the renal pelvis is active Small obstruction and symptoms are not heavy. The flat scan ct is mainly characterized by high-density calcification of the renal pelvis and renal pelvis positive stones. A few positive stones can be located in the renal parenchyma, mainly small stones in the renal tubules of the medulla. It should be observed to describe the high density in the renal pelvis or renal pelvis. The size and number of shadows, attention to the combined renal pelvis hydronephrosis and renal perfusion reduction, combined with ct reconstruction and ivu to observe the presence of primary obstructive lesions, to determine the possibility of secondary stones, for combined pyelone inflammation, Stones incarcerated at the junction of the renal pelvis, renal medullary stones should also be noted. 11, ureteral stones Ureteral calculi are most common in urinary calculi, most of which are caused by lower kidneys. The pathological changes of ureters caused by stones are mainly mucosal hemorrhage, edema, infection, ureteritis and ureteral inflammation, and renal obstruction caused by stone obstruction. Water, which in turn can damage the renal parenchyma, stones often stay in the physiological stenosis, stones with a diameter of ≥1cm often stop at the junction of the renal pelvis, and stones with a diameter of <5mm generally stop at the entrance of the bladder or 2---3cm above it. At the office. The main symptoms caused by ureteral stones are pain and hematuria. If colic is more common than kidney stones, it is more intense and more obvious. Plain scan ct is mainly characterized by high-density calcification of positive stones in the ureteral region. When suspected ureteral stones, it should be scanned extensively or according to recent ultrasound or ivir positioning. The obstruction should be observed under the multi-layered ureter with water expansion. The high-density shadow in the ureteral cavity and the marginal signs of ureteral edema around the ureteral cavity can be seen. Multi-slice spiral ct surface reconstruction can show the location of ureteral calculi and the secondary urinary tract hydronephrosis and inflammatory thickening of the ureteral wall. 12, ureteral cancer Ureteral cancer accounts for the majority of transitional cell carcinoma, mostly in the lower ureter, squamous cell carcinoma is rare, showing invasive growth, often invading the ureteral layer, early and extensive metastasis, adenocarcinoma is more rare, ureteral cancer can be around the ureter Infiltration or metastasis to adjacent lymph nodes, can also be transferred to the distant by blood or lymphatic circulation, of which liver metastasis is the most common, the ratio of male to female is 21, the average age of onset is 60 years old, the most common symptom is hematuria, due to cancer Swelling often causes ureteral obstruction, leading to hydronephrosis. The characteristics of ct are 1. Different degrees of ureteropelvic hydronephrosis; 2. Continuous observation of all levels, you can find the intraluminal mass of the ureteral obstruction end, invading the extraluminal mass, the ureteral ring unevenness thickening, etc.; 3. Enhanced scanning, Especially in the arterial phase, the lumps or localized thickening of the ureter can be obviously strengthened. The delayed period shows the filling defect in the official cavity. It should be observed whether the size of the mass is invaded outside the cavity, and whether the renal pelvis and the bladder should be observed simultaneously in a wide range of scans. There is a tumor lesion, ct surface reconstruction can be fully visualized for the tumor itself and secondary obstruction, and the report should describe the above situation. 13, bladder cancer Bladder malignant tumors account for about 1%---3% of total systemic malignant tumors. Men are more than women. Bladder cancer is pathologically divided into papillary carcinoma and non-papillary carcinoma. The former is derived from epithelial cells of the bladder mucosa, accounting for 90%- --95%, the latter accounted for a small number, such as squamous cell carcinoma and adenocarcinoma, all bladder cancer originating from epithelial cells have multiple, recurrence tendency, the most important clinical manifestations of bladder cancer are non-specific, recurrent episodes of gross hematuria, ct Can find the extent and extent of early bladder cancer and tumor invasion, and can better show the tumor invasion of adjacent structures and whether there is lymph node metastasis, tumor staging. Bladder cancer ct plain scan is generally characterized by a medium-density mass protruding into the bladder cavity, injection contrast enhancement, tumor pedicle, no pedicle or plaque growth, and some only see local bladder wall thickening, larger tumor Due to necrosis, liquefaction makes the density uneven; when the tumor invades the fat layer around the bladder, the outer wall of the bladder is blurred, and the density of the strip is increased in the fat layer. The staging principle of bladder cancer is that the tumor in the t1 phase is confined to the mucosa, and the tumor in the t2 phase Invasion and superficial muscle layer; t3a stage tumor invasion and deep muscle layer, but did not invade the surrounding tissues of the bladder; t3b stage tumor penetrating muscle layer involved in the surrounding tissues of the bladder; t4a stage involved adjacent organs; t4b stage involved pelvic cavity. However, ct is limited to the previous staging of t3b. Pay attention to the description of the size, number and location of bladder cancer mass, determine the extent and extent of tumor infiltration, whether there is any invasion of adjacent structures and whether there is lymph node metastasis, and stage, pay attention to tumor invasion. At the entrance of the ureter and ureter, the presence or absence of tumor lesions in the lower ureter and secondary expansion of the upper urinary tract were observed. 14, adrenal hyperplasia Adrenal hyperplasia is often caused by hypothalamic pituitary dysfunction or excessive secretion of acth in pituitary tumors. A few are caused by ectopic acth syndrome, but in aldosteronism, adrenal hyperplasia only accounts for 20%, and 80% is caused by aldosterone. Adenoma caused by adrenal hyperplasia can be divided into general thickening and large nodular type, often bilateral. On the ct cross-section, the medial and lateral branches of the normal adrenal gland are uniform in thickness, not exceeding the thickness of the same level of the same level of the iliac crest, and are concave, and some normal adrenal glands are larger and dense, but the width is <1 cm. Adrenal gland bulges outward when adrenal hyperplasia, the width often exceeds the ipsilateral diaphragmatic muscle, and some present with limited round or elliptical nodules, but should pay attention to about 50% of Cushing's syndrome, ct shows normal adrenal gland, so it should be combined Clinically relevant biochemical tests. Adrenal hyperplasia can be divided into general and giant nodular type, should pay attention to the differentiation of nodular hyperplasia and adenoma, generally bilateral nodules, multiple unilateral nodules combined with adrenal gland general thickening should be diagnosed as hyperplasia. 15, adrenal adenoma Adrenal adenomas account for 15%-20% of Cushing's syndrome, generally slow onset, often single, adult, male more common, mostly round or oval, mostly 2---3cm in diameter, The texture is uniform, the capsule is intact, and there is little bleeding or necrosis. High-function adenomas are usually detected as small, and non-functioning adenomas can be very large. Ct is characterized by nodules or masses of different sizes in the adrenal gland. It should be observed to describe the different characteristics of some adenomas as follows. 1. The diameter of aldosterone adenoma is often below 1cm, mostly uniform low density, half is negative, and the tumor is enhanced. No enhancement; 2. A large amount of fat deposition in the retroperitoneum of patients with cortisol adenoma, the tumor showed uniform medium density, smooth contour, mild uniform enhancement after enhancement, a small number of tumors containing more lipid-like and low density, contralateral adrenal or The ipsilateral residual adrenal gland may have atrophy; 3. The non-functioning adenoma is generally larger, and there is no endocrine symptoms in the clinic. 16, pheochromocytoma The main clinical manifestations of pheochromocytoma are paroxysmal hypertension, a few without hypertension, more than 90% occur in the adrenal medulla, and a few occur in the adrenal sympathetic ganglion chain; about 10% are bilateral or multiple; 10 % is malignant, and occasionally ectopic occurs in the bladder and the like. Pheochromocytoma is often large, with an average diameter of 5-6 cm. Most of the edges are clear and smooth. The smaller the mass is uniform, and the larger ones often have cystic changes. It should be observed to describe the edge of the tumor, density, and attention to larger tumors. There are cystic changes and hemorrhage. Enhanced scans are often strengthened and the cystic areas are not strengthened. Note that the masses are large, the edges are irregular, and adjacent organs are invaded to suggest malignant transformation. If the clinical symptoms are typical and there is no mass in the adrenal gland, the retroperitoneal should be observed. Ectopic pheochromocytoma in other areas such as the bladder. For huge pheochromocytoma, ct is mistaken for liver lesions. Note that the linear low-density interval between the tumor and the liver and the lower-level mass are separated from the liver. Crown and sagittal reconstruction can be further identified. 17. Adrenal neuroblastoma Adrenal neuroblastoma is more common in children, especially in children under 4 years old. Tumors can occur in the adrenal medulla. They can also occur in the chest, abdominal sympathetic or peripheral sympathetic nerves. Children often have larger abdomen. Block visits, tumor calcification is more characteristic. Adrenal neuroblastoma ct features large mass, often uneven density, can grow across the midline, common calcification plaque with diagnostic features, ct coronal and sagittal reconstruction can show that the tumor is separated from the kidney, pay attention to observe the adjacent vessels Whether there is invasion and whether the tumor invades the spinal canal. 18, prostate hypertrophy Prostatic hyperplasia, also known as benign prostatic hyperplasia, is one of the common diseases in older men. Testosterone and aging are two conditions for bph, and are also associated with chronic prostatitis. Bph originated from the gut of the prostate and moved to the prostate. When the prostate hypertrophy, the urethral pressure and resistance increased, gradually causing mechanical and dynamic obstruction of the bladder outlet. At the same time, the intravesical pressure increased, and the ureteral end lost its flap function. Bladder ureteral reflux, obstruction and reflux cause hydronephrosis and renal dysfunction, can be complicated by stones, infection. The normal upper boundary of ct is no more than 10mm above the upper edge of the pubic symphysis. The upper boundary of the prostatic hyperplasia is more than 20mm above the upper edge of the pubic symphysis. It is generally spherical, relatively symmetrical, with smooth edges, uniform density, enhanced scanning, and the central region of the venous phase is diffuse. Uniform enhancement, the peripheral zone is not strengthened, and sometimes the anterior part of the lobes of the gland is bicuspid symmetry protruding forward with the median sulcus as the boundary, increasing the pressure of the prostate or protruding into the posterior part of the bladder, but the bladder contour is complete and the edge is smooth. To measure and describe the size of the prostate, chronic patients, especially those with urinary retention, should be observed at the same time to describe bladder inflammation and pseudoventricular changes, or even bilateral upper urinary tract hydronephrosis. 19, prostate cancer Prostate cancer is one of the most common male tumors, and its incidence is second only to lung cancer, which is the second leading cause of cancer death in men. Prostate cancer often occurs in the surrounding area of ​​the prostate. It is usually associated with bph. The direct metastasis of prostate cancer, blood transfer and lymphatic metastasis, can invade the urethra, seminal vesicle, bladder, bone metastasis is the most common blood dissemination, and its parts are pelvis, lumbar vertebrae, femur, thoracic vertebrae, ribs often Osteogenic metastasis. The ct scan showed an increased density of the prostate or a low-density nodule, or a nodular protrusion around the prostate. The enhanced arterial nodules were generally not enhanced, and the venous cancer nodules were equal, slightly lower density. Should pay attention to this period of observation, in order to staging prostate cancer, should pay attention to observe the fat layer around the prostate, seminal vesicles, bladder, pelvic floor muscles, lymph node involvement, pelvis and lumbar spine with or without metastasis. 20, uterine leiomyoma Uterine leiomyomas occur in women aged 30--50 years. They are divided into submucosal type, intermuscular wall type, subserosal type according to the growth site. Most patients have menstrual changes, which are characterized by a large amount of menstruation and a long duration. Short interval, submucosal fibroids and large interstitial fibroids are common, subserosal fibroids can be no menstrual changes, pathologically, uterine fibroids consist of smooth muscle tissue and a small amount of fibrous tissue, fibroids themselves do not include Membrane, the uterine muscle wall tissue compressed around the fibroid forms a pseudo-envelope. Different types of uterine fibroids on ct have different characteristics. The uterine fibroids between the muscle walls are narrowed and displaced. The subserosal fibroids grow outward and connect with the uterus with narrow pedicles. Submucosal fibroids protrude into the uterine cavity. Narrow, flat scan mass is generally unclear, showing a relatively uniform density, can be associated with calcification, enhanced scanning significantly enhanced, clear boundary, cystic deformation and necrotic areas are not enhanced, the report should first describe the uterus enlargement and contour changes, specific tumor attention The above characteristics should be reflected to describe the number, size and location of tumors. 21, cervical cancer Cervical cancer ranks third in the cause of death in gynecological malignancies. The average age of onset is about 50 years old, and it is bimodal distribution around 35 years old and 60 years old. The most common clinical symptom of cervical cancer is vaginal bleeding. And vaginal discharge, other non-specific symptoms are frequent urination, difficulty urinating, pelvic pain, constipation and blood in the stool. Further development of the course of the disease can cause urinary tract or intestinal obstruction and other symptoms, ct can be staged for cervical cancer, assessment of prognosis and review after treatment. Ct is characterized by cervical enlargement, a substantial mass of >3.5cm in diameter is of diagnostic significance, and necrosis in the mass is characterized by irregular low-density areas. Special attention should be paid to cervical cancer invading the uterus, para-uterine tissue, pelvic lymph nodes, bladder and rectum. Description, it should be understood that the main purpose of ct examination is the staging of cervical cancer and understanding of whether there is recurrence after surgery or radiotherapy. 21, ovarian cystadenoma Ovarian cystadenoma is divided into serous cystadenoma and mucinous cystadenoma, accounting for about 1/4 of the primary ovarian tumor, bilateral incidence is 15%, serous cystadenoma and mucinous cystadenoma can coexist Serous cystadenoma is a single or multiple room change, mucinous cystadenoma often changes in multiple rooms, the age of good hair is 20--50 years old. Clinical symptoms include abdominal discomfort or dull pain, abdominal mass, etc., a few with menstrual disorders, patients with mucinous cystadenoma sometimes have ascites, pathological findings, tumor nodules are cystic, single or multi-atrial, smooth or have a wall Papillary processes, serous cystadenoma wall epithelial monolayer cube or short columnar epithelium, mucinous cystadenoma wall epithelium is a single layer of mucous columnar epithelium. The characteristic of ct is that the single atrial serous cyst adenoma is generally larger, and the wall of the cyst can be thickened locally. There may be short strip spacing, wall nodules and cyst wall calcification; mucinous cystadenoma is often larger, showing multiple rooms. Sexual, internal linear separation, generally liquid density of mucinous cystadenoma is higher than serous cyst adenoma, should be observed to describe the shape, size, density of pelvic cysts, attention and entrapment effusion, dermoid cysts and other identification. 22, ovarian cancer In the female reproductive system malignant tumor, the incidence of ovarian cancer is second only to cervical cancer. In most patients, most patients have asymptomatic or mild symptoms in the early stage. The pelvic cavity is often metastasized at the time of treatment. The ovarian cancer is derived from the epithelium and its tissue types are diverse. Among them, serous cystadenocarcinoma accounts for a large proportion, accounting for about 42%. Tumor dissemination is mainly through tumor cell surface implantation and lymphatic metastasis, and blood dissemination is rare. Ct is characterized by pelvic or lower abdomen size, irregular or solid cysts on the margins, and calcifications in serous cystadenocarcinoma. Attention should be paid to the observation of the size, shape and location of solid or solid masses. Multi-faceted and multi-directional reconstruction images can be used to observe the relationship between tumor and ovarian attachment. Others should pay attention to the appearance of ascites, omental peritoneum and retroperitoneal lymph nodes. Metastasis, liver metastasis, abdominal implant metastasis, etc., especially emphasis on peritoneal pseudomyxoma, is the rupture of cystic lesions of ovarian mucinous adenocarcinoma and the formation of the peritoneal cavity can reach the outer edge of the liver and spleen. Patients with lesions such as renal pelvis, renal pelvis, bladder lumen, renal parenchyma, and bladder wall that need to be examined. Precautions Taboo before inspection: 1. Before the examination, the CT doctor should be informed of the detailed medical history and various examination results. If you have your own saved X-ray film, magnetic resonance film and previous CT film, you need to submit it to CT doctor for reference. 2, to explain to the doctor whether there is drug allergy, whether it has asthma, urticaria and other allergic diseases. 3, remove the inspection site clothing including underwear with metal materials and various items: such as headwear, hairpins, earrings, necklaces, jade, coins, belts and keys. 4, if CT enhanced scan or children, unconscious, need to be accompanied by healthy people. 5, CT enhanced scan If you use ion contrast agent, you need to do intravenous injection of contrast agent iodine allergy test, no response after 20 minutes, before you can check. 6, do not take heavy metal drugs within 1 week, do not do gastrointestinal tincture examination. Patients who have been tested for expectorant need to wait for the sputum to empty; if they are eager to have a CT examination, they should be treated with a cleansing enema or oral laxative to sputum. Requirements for inspection: 1, the inspection process with the doctor's password to do the action, do not arbitrarily move to ensure the clarity of the angiography. 2. The CT machine is equipped with a walkie-talkie. If there is any discomfort during the examination or an abnormal situation occurs, the doctor should be informed immediately. Inspection process First, the kidney Kidney CT scans do not require special preparation. The upper bound of the scan range should be slightly higher than the upper pole of the kidney, the lower to the lower pole of the kidney, the layer thickness is 1cm. Scan the 12-14 level. Oral contrast agents are generally not required. In addition to suspected kidney stones and contrast allergies and renal insufficiency, general enhanced scans should be performed. The use of bolus injection method to show renal artery, vein and renal parenchyma, the effect is better. The renal pelvis is typically developed approximately 2 minutes after the contrast agent is injected. MRI generally uses cross-section and coronal or sagittal plane, spin echo T1WI, to display the anatomical structure and cross-section T2WI to determine the nature of the lesion. The kidney has a circular or elliptical soft tissue shadow with a clear edge and a smooth outline on the CT image of the cross section. The renal hilum is invaginated with renal movements, veins, and ureters. In plain scan, the density of renal parenchyma is uniform, and the cortex and medulla cannot be distinguished. The CT value is 30-50 Hu. When the diuretic effect is strong, the density is reduced, only about 15Hu. Enhanced scanning, increased renal parenchyma density, CT value of 80 ~ 120Hu. When the renal pelvis and the renal pelvis were swept, the water density was increased, and the enhanced scanning density was significantly increased. The size of the renal pelvis is variable. The ureter is plainly scanned with a point-like shadow, which enhances the scanning density and is easy to identify. The renal fascia can be developed in 50% of cases, showing a thin line of dense shadows before and after the kidney. (1) Kidney tumor: CT is quite accurate in showing kidney cancer and renal pelvis cancer. Tumor size, extent of infiltration, and distant and distant lymph node metastasis can also be determined, which contributes to staging. 1. Kidney cancer: CT scan shows a mass with a density slightly lower than or equal to the renal parenchyma, sometimes slightly higher density. The edge of the tumor is smooth or irregular, and the boundary between the kidney and the parenchyma is unclear, which can be prominent outside the kidney. Necrosis or sac inside the tumor becomes a low-density area, and calcification and hemorrhage are high-density areas. Enhanced scanning, abnormal blood vessels and tumor enhancement in the multi-vascular tumor, half a minute after the injection, tumor blood vessels and enhancement disappeared, while the renal parenchyma was strengthened, the tumor showed a low density. Less vascular cancer is not strengthened. 2. Renal sputum cancer: CT enhanced scan shows filling defects in the renal pelvis. Through its CT value and morphology, it can help to exclude fresh blood clots, cysts and stones. When the tumor infiltrates the renal parenchyma, it needs to be differentiated from kidney cancer. Tumors often deform the renal sinus and occlude normal renal sinus fat. Because the tumor can be transferred to the ureter or bladder, the CT scan should include the ureter and bladder. Small calcium spots are visible in the tumor. (B) renal cyst: CT diagnosis of renal cysts is quite reliable. In simple renal cysts, the rate of discovery in the body is improved after the application of CT. In the plain scan, the lesions in the renal capsule are round or round, the edges are smooth, the density is uniform, and the density of the water sample is thin. The wall of the capsule is thin, and the boundary with the normal renal parenchyma is clear. Enhanced scanning, no enhancement. Typical performance, not difficult to diagnose. The wall of the capsule can be calcified. Sometimes cyst density is high or the wall thickness is thick, it needs to be differentiated from tumor necrosis and abscess. Polycystic kidney disease can be seen in both kidneys, showing a lobulated shape with multiple cysts, varying sizes and thin walls. Calcification is visible in the renal parenchyma. Can also find cysts of the liver, pancreas, and spleen. A flat scan can confirm the diagnosis. (C) hydronephrosis: when the hydronephrosis function is lost, IVP can not be developed, CT is easy to display. It can be seen that the renal pelvis and renal pelvis are enlarged, the kidney shadow is enlarged, and the renal parenchyma is thin in severe cases. Enhanced examination, renal parenchyma density is lower than normal. If the contralateral side is normal, it is easier to compare. When the ureteral obstruction is incomplete or early in the obstruction, after the contrast agent is injected, it can be seen that the urine containing no contrast agent forms an interface with the contrast agent. CT can not confirm the hydronephrosis, and it is possible to identify the cause. MRI can also be displayed. The difference in renal medulla of renal function is not obvious. (D) kidney, ureteral stones: positive stones, easy to find flat, for the kidney, ureter size and shape of high-density shadows, negative stones are also high-density shadow. When the filling defect is found on the IVP, it is difficult to judge the negative stones, clots and renal pelvis cancer, CT has a differential significance. Stone or calcification, MRI value is lower. (5) Renal trauma: CT and MRI are used to diagnose trauma and staging. Can show renal parenchymal insufficiency and intrarenal hematoma, complete renal laceration, renal disconnection, subcapsular hematoma, perirenal space or other interstitial hematoma, fresh bleeding, CT scan can be seen local density increased. When the hematoma is liquefied, the density is reduced. Enhanced scanning, density of intraparenchymal hemorrhage or hematoma area is often lower than the density of enhanced normal renal parenchyma. The renal pelvis may be poorly filled due to the occupation of blood clots. MRI can better show bleeding and evaluate the stage of bleeding. (6) Nephritis disease: acute kidney infection, such as renal abscess, CT scan can show a slightly lower density than normal renal parenchyma, but the increase of kidney is not significant. Enhanced scanning lesions have clear edges and low density. The inner side is the abscess wall, which is thick and uneven. The center of the abscess is not enhanced and is a necrotic and liquefied area. Generally not large, about 1 to 2 cm in diameter. Need to be distinguished from renal cysts or tumors, combined with history and clinical manifestations, diagnosis is not difficult. As seen by MRI, it is similar in morphology to CT. Kidney tuberculosis is a chronic inflammation. Early CT scans were lighter and easier to ignore. In the advanced stage, hydronephrosis, abscess and renal parenchymal atrophy can be seen. Second, the adrenal gland The adrenal CT scan does not require special preparation, short scan time, thin layer and magnified scan, showing better adrenal gland and its lesions. The back includes the plane above the upper pole of the kidney to the renal hilum. No need for oral preparation. Enhanced scanning helps to observe the structure of the blood vessels in the tumor and to determine whether there is liver metastasis. CT images of the adrenal cross-section, normal inverted V-shaped, inverted Y-shaped, triangular or linear, cusp forward, internal and external limbs extended. The edges are smooth and no nodular contours appear. Enhanced scanning, uniform enhancement. (a) pheochromocytoma: pheochromocytoma is derived from adrenal medullary chromaffin cells. Tumor diameter is often greater than 2cm, CT can be detected. Since 10% to 15% can occur outside the adrenal gland, if no adrenal tumor is found, other parts, especially the abdomen, should be scanned. 10% in adults and 20% in children are bilateral. The clinical manifestations are mainly paroxysmal or persistent hypertension, and the seizure lasts for a few minutes to a few hours. CT showed a lumps with clear edges, uniform density, and a diameter of 2 to 4 cm. Necrosis in the tumor is characterized by low density and calcification. Enhanced scan visible enhancement. 10% to 15% of pheochromocytoma is malignant, and the tumor is large. It is difficult to distinguish between benign or malignant by CT. However, if there is retroperitoneal lymph node metastasis, adjacent tissue infiltration and liver metastasis, it can be diagnosed as malignant. (b) Adrenal adenoma: Adrenal adenomas CT can be seen as smooth, round or elliptical tumors with uniform density, equal to or lower than the density of the kidney. Enhanced scanning has a uniform enhancement. The contralateral adrenal gland atrophy becomes smaller, but it can also be normal. Adrenal cortical tumors have different properties of secreted hormones, but have primary aldosteronism and hypercortisolism. The former adenoma is small. About 0.5 to 0.3 cm. The latter adenoma is larger, about 2 to 8 cm. Both appear as round or oval bumps. The former is small, often only involving a certain part of the adrenal gland. Two functional abnormalities in addition to adenoma can also be caused by the corresponding adrenal hyperplasia. (C) adrenal hyperplasia and atrophy: adrenal hyperplasia, CT showed bilateral adrenal gland enlargement, full contour, or with multiple nodules. However, the size and shape of the adrenal glands are not uncommon. Chronic adrenal insufficiency, namely Addison's disease. Due to autoimmune abnormalities caused by idiopathic adrenal atrophy. Also seen in tuberculosis, amyloidosis and bilateral adrenal metastases. CT showed atrophy of the adrenal glands on both sides. Tuberculosis can be seen on one or both sides of the adrenal calcification. Third, the bladder and prostate Both CT and MRI are suitable for the diagnosis of bladder and prostate diseases. However, for displaying the invasion of the lesion to the adjacent adipose tissue of the organ, MRI is superior to CT for displaying the intrinsic tissue structure of the prostate, for example, showing the central region and the surrounding region as well as the transition region. Therefore, MRI is better for the diagnosis of bladder and prostate diseases. The CT examination of the bladder requires proper inflation to distinguish the bladder wall from the lumen. Drinking more water, not urinating to inflate the bladder, the method is simple, but not accurate enough. Intravenous infusion of low concentration iodine preparation, saline, air or CO2 gas into the bladder is easy to show lesions. Conventional cross-sectional scan, from the pubic symphysis up to the upper edge of the pelvis, layer thickness 1cm. Tumor or prostate cancer at the top or bottom of the bladder invades the bottom of the bladder and is preferably reconstructed with a crown. Enhanced scanning can visualize the ureter and help identify enlarged lymph nodes, but scanning the bladder is early in the bladder filling contrast agent, because too late, the contrast agent in the bladder is too thick, prone to artifacts. (1) Bladder cancer: CT diagnosis of bladder cancer is relatively simple and accurate. It can be seen that the soft tissue mass protruding from the bladder wall into the bladder cavity can also infiltrate into the wall, showing local thickening. Infiltration and lymph node metastasis of adjacent tissues can also be found by CT. Therefore, CT is helpful for the staging of bladder cancer. (B) prostate hypertrophy and prostate cancer: the size of the prostate is related to age, but generally its diameter does not exceed 5cm. Prostatic hypertrophy can be seen, see the prostate into the bottom of the bladder. The edges are smooth and the density is uniform. Generally, the sides are symmetrical, and the side can be enlarged. The coronal display is clearer. When prostate cancer grows in the capsule, CT is difficult to diagnose, and it is only possible to diagnose when the invading capsule infiltrates into the surrounding adipose tissue. The performance of the prostate is irregular and the density is uneven. The anterior rectal wall and bladder wall can be infiltrated and the seminal vesicles disappear. CT can also detect lymph node metastasis and pelvic metastases. CT is helpful for the staging of prostate cancer. Not suitable for the crowd Inappropriate crowd: 1, allergic constitution or ionic contrast agent allergic history (such as the use of ionic contrast agents also need to do iodine allergy test). 2, heart, lung, liver, kidney dysfunction.