KAZAKH NATIONAL MEDICAL UNIVERSITY NAMED AFTER S.D.

ASFENDYAROVA

Radiological semiotics of urolithiasis

Almaty - 2023
 Radiological semiotics of urolithiasis

Definition

Urolithiasis (UCD) is a chronic systemic disease resulting from metabolic disorders and/or the
influence of environmental factors and manifested by the formation of stones in the upper
urinary tract.

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 Radiological semiotics of urolithiasis
urolithiasis classification
1. By localization in the organs of the urinary system
a. in the kidneys (nephrolithiasis)
b. in the ureters ( ureterolitiasis )
c. in the bladder ( cystolithiasis )
2. By type of stones
a . urates
b . phosphates
c. oxalates
d. cystine stones, etc.
3. According to the course of the disease
a. primary stone formation
b. recurrent (repeated) formation of stones
4. Special forms of urolithiasis
a. coral kidney stones
b. solitary kidney stones
c. urolithiasis in pregnant women

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 Radiological semiotics of urolithiasis

CLASSIFICATION

By size
Large stones – more than 2 cm in maximum diameter
Medium stones – from 1 to 2 cm in maximum diameter
Small stones – less than 1 cm in maximum diameter

according to the radiopacity of stones:

 Radiopaque ;
Poorly radiopaque ;
X-ray non-contrast

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 Radiological semiotics of urolithiasis

TYPES OF STONES

Cystine stones
X-ray positive
They contain sulfur and are yellow in color.
Triple phosphate stones
X-ray positive
More often in women and patients with catheters - sources of
bacteria that produce urease .
The stones are large in size and act as pelvises and cups.

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 Radiological semiotics of urolithiasis
TYPES OF STONES
Calcium stones
– They grow on the renal papillae.
– Ultrasound or radiographic studies reveal multiple calcifications -
nephrocalcinosis .
– Typically occur with severe hypercalciuria .
Putty
– Cystine and uric acid in high concentrations precipitate as “putty.”
– May cause ureteral obstruction
– 1 g of uric acid and 400-800 mg of cysteine can fall out per day.
– Oxalates do not form putty

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 Radiological semiotics of urolithiasis

TYPES OF STONES

•Phosphates - white, formed in alkaline urine, x-ray positive .

•Oxalates – dense with spikes, x-ray positive . These are the hardest, most difficult
to crush stones.
•Urats – yellow-brown, hard, X-ray negative . Formed by overeating and excess
uric acid.
•Carbonate stones - formed from calcium salts of carbonic acid, X-ray negative .
•Protein stones are formed mainly from fibrin mixed with salts and bacteria. They
are white, X-ray negative , and soft.

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 Radiological semiotics of urolithiasis
URATES

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 Radiological semiotics of urolithiasis

OXALATE STONES

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Radiological semiotics of urolithiasis

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coral kidney stone Fri KazNMU named after . S.D.ASFENDIYAROVA 10

 Radiological semiotics of urolithiasis

Radiation diagnostics
Ultrasonography;

Survey radiography;

Excretory urography;

Retrograde (ascending) ureteropyelography ;

Antegrade pyelography;

CT scan;

Magnetic resonance urography;

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 Radiological semiotics of urolithiasis

Ultrasound examination

kidney stone (in the renal sinus)

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 Radiological semiotics of urolithiasis

SURVEY RADIOGRAPHY

Survey radiograph . a —
stone of the left kidney
pelvis in a 10-year-old child;
b — coral stone on the left
in an 8-year-old child

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 Radiological semiotics of urolithiasis

a — multiple stones in
the right kidney and a
coral stone in the left
kidney in a 6-year-old
child;
b — coral stone on the
right and a single pelvic
stone on the left in a 14-
year-old child

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 Radiological semiotics of urolithiasis

Overview photo. Woman 48 years old. In

the area of the right kidney there are
shadows of triangular faceted stones,
characteristic of gallstones. Calculous
cholecystitis.

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 Radiological semiotics of urolithiasis

Indications for radiopaque diagnostic methods

Presence of stones according to previous studies

X-ray negative stones
Ureterohydronephrosis
Bilateral nephrolithiasis
Relapse of the disease
Pathological changes in the other kidney
Doubts about the genesis of renal colic

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 Radiological semiotics of urolithiasis

Excretory urography
is based on the ability of the kidneys to
secrete a contrast agent administered
intravenously, and on the ability to
thereby obtain images of the kidneys and
urinary tract using x-rays

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 Radiological semiotics of urolithiasis

Left renal pelvis stone. Hydrocalycosis

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 Radiological semiotics of urolithiasis

Retrograde (ascending) ureteropyelography

The method is based on obtaining shadows of the upper

urinary tract in an x-ray image after retrograde filling with a
contrast agent. Thanks to the use of high concentrations of
contrast agents, it is possible to obtain a clear image of the
calyces, pelvis and ureter on retrograde pyeloureterograms .

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 Radiological semiotics of urolithiasis

Antegrade pyelography

Antegrade pyelography is an x-ray method for

studying the upper urinary tract, based on the
direct introduction of a contrast agent into the
renal pelvis either by percutaneous puncture
or through pyelostomy drainage . Therefore,
there are two types of antegrade pyelography:
antegrade percutaneous pyelography and
antegrade pyelography with the introduction
of a contrast agent through the pyelo- (nephro)
stoma .

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 Radiological semiotics of urolithiasis

CT scan

The most informative and sensitive method

for urolithiasis is native (without contrast
enhancement) spiral computed tomography
(SCT) - the sensitivity of the method is 96%,
the specificity is up to 100%. It makes it
possible to determine the number, size,
location, structure and density of the stone,
while knowledge of the latter makes it
possible to predict the effectiveness of
extracorporeal lithotripsy .

MSCT - coral stone of the right kidney (parenchymal phase, after

administration of a contrast agent)
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 Radiological semiotics of urolithiasis

CT SCAN

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 Radiological semiotics of urolithiasis

MSCT - coral stone of the right kidney

MSCT - coral stone of the right kidney (cross section) native (parenchymal phase, after administration of contrast agent)
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 Radiological semiotics of urolithiasis

MAGNETIC RESONANCE IMAGING

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KAZAKH NATIONAL MEDICAL UNIVERSITY NAMED AFTER S.D. ASFENDYAROVA

Thank you for attention!

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