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3rd Edition
Editors
Niranjan Khandelwal MD DNB FICR
Professor and Head Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research,
Chandigarh, India
Veena Chowdhury MD
Director Professor and Head Department of Radiodiagnosis Maulana Azad Medical College,
New Delhi, India
Arun Kumar Gupta MD MAMS
Professor and Head Department of Radiodiagnosis All India Institute of Medical Sciences,
New Delhi, India
Associate Editor
Anupam Lal MD
Associate Professor Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research,
Chandigarh, India
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Diagnostic Radiology: Genitourinary Imaging
© 2009, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 1996
Second Edition: 2003
Third Edition: 2009
9788184486827
Typeset at JPBMP typesetting unit
Printed at
5CONTRIBUTORS
- Ajay Gulati md
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Ajay Kumar md
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Alpana Manchanda md
- Associate Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi
- Anjali Prakash dmrd dnb mnams
- Assistant Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi
- Anju Garg md
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi
- Anupam Lal md
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Arun Kumar Gupta md mams
- Professor and Head
- Department of Radiodiagnosis
- All India Institute of Medical
- Sciences, New Delhi
- Ashu Seith Bhalla md
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical
- Sciences, New Delhi
- Atin Kumar md
- Assistant Professor
- Department of Radiodiagnosis
- (Trauma Centre)
- All India Institute of Medical
- Sciences, New Delhi
- Deep Narayan Srivastava md mams
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical
- Sciences, New Delhi
- Hina Arif Mumtaz md, dnb
- Senior Research Associate
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Kusum Joshi md, phd
- Professor and Head
- Department of Histopathology
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Mahesh Prakash md
- Assistant Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Manavjit Sandhu md
- Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Mandeep Kang md
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Manphool Singhal md, dnb
- Senior Research Associate
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Naveen Kalra md
- Associate Professor
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Niranjan Khandelwal md, dnb
- Professor and Head
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Paramjeet Singh md
- Additional Professor
- Department of Radiodignosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Radhika Srinivasan md, phd
- Additional Professor
- Department of Cytology and
- Gynaec-pathology
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Raju Sharma md
- Additional Professor
- Department of Radiodiagnosis
- All India Institute of Medical
- Sciences, New Delhi
- Rakesh Kumar md
- Associate Professor
- Department of Nuclear Medicine
- All India Institute of Medical
- Sciences, New Delhi
- Rama Mohan Reddy md
- Department of Radiodiagnosis
- All India Institute of Medical
- Sciences, New Delhi
- Rashmi Dixit md
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi
- Sameer Vyas md
- Senior Research Associate
- Department of Radiodiagnosis
- Postgraduate Institute of Medical
- Education and Research
- Chandigarh
- Sanjay Thulkar md
- Associate Professor
- Department of Radiodiagnosis (BRA IRCH)
- All India Institute of Medical
- Sciences, New Delhi
- Sapna Singh md dnb mnams
- Assistant Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi
- Shamim Ahmed Shamim md
- Department of Radiodiagnosis
- All India Institute of Medical
- Sciences, New Delhi
- Shivanand Gamanagatti md
- Assistant Professor
- Department of Radiodiagnosis (Trauma Centre)
- All India Institute of Medical
- Sciences, New Delhi
- Smriti Hari md.
- Assistant Professor
- Department of Radiodiagnosis
- All India Institute of Medical
- Sciences, New Delhi
- Sumedha Pawa md
- Professor
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi
- Veena Chowdhury md
- Director Professor and Head
- Department of Radiodiagnosis
- Maulana Azad Medical College
- New Delhi
The last few decades have seen tremendous advancement in the field of medical imaging leading to a significant change in the perception of many diseases. The advent of sonography and computed tomography (CT) was a breakthrough in the history of medical imaging and had changed the outlook of many diseases. With the ever-increasing advancement in the field of technology and the advent of MRI, PET and specialized fluoroscopy units, the management of many urological diseases has also altered significantly. There is a close inter-relationship between the advancement of knowledge and complexity of research technology required. The field of uroradiology has benefited significantly from these technological advances in recent past taking the management of many urological diseases to a new platform.
The new generation of imaging procedures namely MRA, MRS and PET are superior to currently available technologies. These have been used to investigate a wide spectrum of urogenital disorders. The development of DSA and identification of percutaneous/endovascular routes for access to the kidneys, ureter and bladder has lead to the firm establishment of interventional radiology as an important subspeciality of radiology.
The present volume on genitourinary imaging is the Third edition in the series of diagnostic radiology courses organized by the Departments of Radiodiagnosis and Imaging PGIMER Chandigarh, AIIMS and MAMC, New Delhi. A number of dedicated workers from these institutes have contributed to this volume. They have not only covered major recent advances in the field of genitourinary radiology but have also dealt with more conventional forms of imaging.
These volumes would be a valuable addition to the libraries of all Medical Practitioners not only in this country or the subcontinent but all over the world. Dr N Khandelwal, Dr Veena Chowdhury and Dr Arun Kumar Gupta deserve to be congratulated for their continuing vision and efforts in promoting these invaluable courses on diagnostic radiology.
Vinay Sakhuja
MD, DM(Neph), MNAMS(Neph), FISN, FAMS
Dean, PGIMER Chandigarh, India
8PREFACE TO THE THIRD EDITION
The first edition of Diagnostic Radiology on “Genitourinary Imaging” was published in 1996 and the second edition in 2003. Encouraged by the response to the previous editions and to keep up the pace of advances in imaging, we decided to update the third edition. We are very hopeful that this edition will be more comprehensive for residents, practicing radiologists, nephrologists and urologists.
We wish to take this opportunity to thank our faculty from AIIMS, MAMC and PGIMER for their active contribution and support without which this endeavor would not have been possible.
We would also like to thank Shri Jitendar P Vij (Chairman and Managing Director) along with Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi and other staff for their professional help and cooperation in publishing this book in a very short time.
Niranjan Khandelwal
Veena Chowdhury
Arun Kumar Gupta
Anupam Lal
9PREFACE TO THE FIRST EDITION
Urogenital radiology is practised today quite differently in many ways than a decade ago. This is mainly due to the technological advances in ultrasound, computed tomography and magnetic resonance imaging. With the ever-increasing number of diagnostic techniques, the radiologists and the referring clinicians are faced with the dilemma of determining the most appropriate test or tests for a given clinical problem.
Keeping this in view, the present book aims to present the most current information on the role of various techniques, viz conventional radiology, ultrasound, computed tomography and magnetic resonance imaging in the urogenital practice, their merits and limitations and to determine the approach to complex problems in this decade. The comprehensive discussion on the indications of various imaging techniques in urogenital practice are presented throughout this text. Recommendations are offered regarding the role of each technique in various clinical situations based on the collective experience of the faculty of radiology at the All India Institute of Medical Sciences, Maulana Azad Medical College, Postgraduate Institute of Medical Education and Research and other renowned Indian radiologists.
We hope this book will help the postgraduate students, practising radiologists and internists develop an indepth understanding and appreciation of the contemporary radiologic evaluation of the urogenital tract.
We wish to take this opportunity to thank the authors for their cooperation and prompt submission of their contributions to this volume.
Manorama Berry
Sushma Vashisht
Veena Chowdhury