Checklist

Kidneys • Anatomy:

— Smooth and sharp Width of parenchyma Density (see below)

Normal relation of cortex to medulla Renal pelves:

— Structure and shape of caliceal groups

— Bilateral symmetry

— No expansion Ureters:

— No obstruction

Peri- and pararenal spaces:

— Fat attenuation

— No increase in soft-tissue structures

Adrenal glands

Retroperitoneal space Intestinal structures

Vessels

Soft tissues

Peri- and pararenal fasciae:

— Width (no diffuse or circumscribed thickening)

Shape

Size (see below) Slender crura

No circumscribed expansion No mass, fluid, or increased density

Colon haustrations, small bowel Wall thickness

Homogeneous contrast enhancement

No free extraintestinal or intra-abdominal air or fluid

Course

Size (see below)

No lymphadenopathy (see below)

Density

Symmetry

Muscles (size, internal structure, borders) Fat (density, no soft-tissue or fluid infiltration)

Important Data

1

Distance between renal poles:

• Superior poles: ca. 10 cm (4-16 cm) apart

• Inferior poles: ca. 13 cm (9-18.5 cm) apart

2

Transverse renal axis:

• Posteriorly divergent angle of 120°

3

Transverse renal diameter at level of hiliim:

• 5-6 cm (a, transverse) x 3-4 cm (b, anteroposterior)

4

Width of cortex:

• 4-5 mm

5

Width of ureter:

• 4-7 mm

6

Gerota fascia (thickness):

• 1-2 mm

Position of superior poles of kidneys:

• Right: superior border of L1

• Left: inferior border of T12 (variable; note that the differ-

ence does not exceed 1.5 vertebral body heights)

Renal dimensions:

• Craniocaudal (= highest to lowest section!) 8-13 cm

Right-left disparity in renal sizes:

• Craniocaudal < 1.5 cm

Renal attenuation values:

• 35-45 HU without contrast medium

• Renal cortex ca. 140 HU after contrast administration

Time to corticomedullary equilibrium:

• 1 minute

Contrast excretion into the pyelocaliceal system:

• 3 minutes

7

Size of adrenal glands (variable):

• Crural thickness <10 mm

Density of normal adrenal glands: 25-40 HU without contrast

medium

8

Abdominal aorta:

• Transverse diameter ca. 18-30 mm

9

Inferior vena cava:

• Transverse diameter up to 2.5 cm

Vascular density: ca. 40-55 HU without contrast medium

Lymph nodes larger than 1 cm are suspicious for pathology.

Early bolus phase
Late phase with corticomedullary equilibrium and opacification of the renal pelvis
Late phase with ureteral opacification

Adrenal Glands

Both adrenal glands present normal size and position with normally developed crura. There is no evidence of a mass and no circumscribed expansion.

The adrenal compartment is unremarkable.

Postcontrast scans show normal adrenal enhancement characteristics and dynamics.

Other visualized upper abdominal organs, especially the kidneys, show no abnormalities.

Interpretation

Both adrenal glands appear normal at CT. Checklist

Adrenal glands • Paired

• Position (superior and anterior to the kidneys)

• Slender adrenal crura showing no circumscribed hypodense, isodense, or hyperdense expansion

• No calcifications

• Adrenal compartment:

— Fat attenuation

• Enhancement characteristics:

— Uniform increase in density

— No hypodense or hyperdense lesions within the adrenal crura

• Homogeneous internal parenchymal structure

• Intrahepatic and extrahepatic bile ducts

• Costophrenic sinus clear and aerated on each side

Liver

Size (see below)

Spleen

• Smooth outer contours

• Homogeneous internal structure

• Pancreatic duct

Pancreas

Kidneys

Stomach and bowel

Major vessels

Lymph nodes Diaphragm

Vertebral bodies Soft tissues

Paired

Position (see below) Size (see below) Smooth contours Position Size

No masses No infiltration Transverse diameter Flow

No lymphadenopathy

No circumscribed widening

Lungs in the costophrenic sinus (no effusion or opacities)

Margins, bony structure

Important Data Dimensions

1 Adrenal glands (variable):

• Crural thickness <10 mm

• Density (without contrast medium): 25-40 HU Position of superior poles of kidneys:

• Right: superior border of L1

• Left: inferior border of T12 Transverse renal axis:

• Posteriorly divergent angle of 120° Renal dimensions:

• Transverse: 5-6 cm Gerota fascia (thickness):

• Length: 11-15 cm Diameter of abdominal aorta:

• Approximately 18-30 mm

Female Pelvis

The pelvic inlet appears normal, with normal configuration of the iliac wings and iliopsoas muscles.

Imaged bowel structures, especially the cecum and rectum, show no abnormalities with no evidence of wall thickening or mass lesions. The perirectal fat and ischiorectal fossa are unremarkable. The uterus is or-thotopic with smooth borders. It displays a normal configuration and appropriate development for age. The myometrium shows homogeneous density. The uterine cavity is normally developed, and the adnexa are unremarkable. The vaginal fornix is normal. The adequately distended urinary bladder has smooth outer contours and normal wall thickness. The vessels of the lesser pelvis are normal in course and caliber. There are no signs of lymphadenopathy. The appearance of the pelvic skeleton, especially the femoral heads, sacroiliac joints, and symphysis pubis, is normal. There are no significant soft-tissue abnormalities.

Interpretation

The lesser pelvis appears normal at CT.

Checklist

Pelvic inlet • Configuration

• Iliopsoas muscles:

— Symmetry Intestinal • Position structures • Wall thickness (when normally distended, see

(especially the below)

cecum and • No circumscribed wall thickening rectum) • Well-opacified lumen with no soft-tissue mass

Perirectal fat • Density (fat attenuation)

• No infiltration

• No masses Ischiorectal fossa • Bilateral symmetry

• No lymphadenopathy

Uterus

Cervix, vagina

Ovaries

Urinary bladder

Vessels

Lymph node stations Pelvic skeleton

Subcutaneous tissue and muscles

Position Size

Borders (smooth outer contours) Density (see below) Uterine cavity:

— Configuration

— Contents Position Size Borders Position Size Density Symmetry

No masses of soft-tissue or fluid density

Adequate distention

Smooth outer contours

Wall thickness (see below)

Caliber

Course

No significant intimal calcifications No nodal enlargement (>1 cm)

Configuration

Margins (cortex smooth and sharp with no discontinuities) Bony structures

No circumscribed hypo- or hyperdense areas Femoral heads are rounded and centered in acetabula

Sacroiliac joints are smooth and of normal width

Symphysis pubis (see below)

Density

Extent

Borders

Symmetry

Important Data

1 Sacroiliac joint spaces:

• Cartilage thickness 2-5 mm (anterior and inferior: 2-3 mm)

2 Uterus:

• Size (variable): Prepubescent: length up to 3 cm, transverse diameter ca. 1 cm

• Nullipara: length up to 8 cm, transverse diameter ca. 4 cm

• Multipara: length up to 9.5 cm, transverse diameter ca. 5.5 cm

• Postmenopausal: length up to 6 cm, transverse diameter ca. 2 cm a Transverse diameter of upright uterus (= well-distended bladder) < 5 cm b Uterine cervix: transverse diameter < 3 cm

3

Ovaries:

• Prepubescence: a, length up to 2.5 cm; b, transverse diame-

ter ca. 2.5 cm

• Sexual maturity: a, length up to 4 cm; b, transverse diame-

ter ca. 2.5 cm

• Postmenopausal: a, length up to 3 cm; b, transverse diame

ter ca. 1.5 cm

4

Urinary bladder:

• Wall thickness (of well-distended bladder): ca. 3 mm

5

Rectum:

• Wall thickness < 5 mm

S

Symphysis pubis:

• Width < 6 mm

7

Pelvic dimensions:

• Pelvic outlet: anteroposterior (= coccyx to posterior edge of

symphysis): ca. 9 cm

Male Pelvis

The pelvic inlet appears normal, with normal configuration of the iliac wings and iliopsoas muscles.

Imaged bowel structures, especially the cecum and rectum, show no abnormalities with no evidence of wall thickening or mass lesions. The perirectal fat and ischiorectal fossa are unremarkable. The adequately distended urinary bladder has smooth outer contours and normal wall thickness. The seminal vesicles are of normal size. The angle between the bladder and seminal vesicle is clear and normal on each side. The prostate shows normal size and configuration and a homogeneous internal structure.

The vessels of the lesser pelvis are normal in course and caliber. There are no signs of lymphadenopathy.

The appearance of the pelvic skeleton, especially the femoral heads and sacroiliac joints, is normal.

There are no soft-tissue abnormalities.

Interpretation

The lesser pelvis appears normal at CT.

Checklist

Pelvic inlet • Configuration

• Iliopsoas muscles:

— Symmetry Position

Wall thickness (when normally distended, see below)

No circumscribed wall thickening Well-opacified lumen with no soft-tissue mass Density (fat attenuation)

• No infiltration

• No masses Ischiorectal fossa • Bilateral symmetry

• No lymphadenopathy

Intestinal structures (especially the cecum and rectum)

Perirectal fat

Urinary bladder

Seminal vesicles

Prostate

Vessels

Lymph node stations Pelvic skeleton

Subcutaneous tissue and muscles

Adequate distention Smooth outer contours Wall thickness (see below) Position (behind the bladder) Size (see below) Symmetry

Angle between bladder and seminal vesicle (see below) is clear on each side Position (central at bladder outlet) Configuration (rounded) Size (see below)

Density (homogeneous, see below) No calcifications

No unilateral nonhomogeneity after contrast administration Caliber Course

No significant intimal calcifications No adenopathy

Configuration

Margins (cortex smooth and sharp, no discontinuities) Bony structures

No circumscribed hypodense or hyperdense areas

Femoral heads are rounded and centered in acetabula

Sacroiliac joints are smooth and of normal width

(see below)

Symphysis pubis

Density

Extent

Borders

Symmetry

Important Data

1

Sacroiliac joint spaces:

• Width 2-5 mm (anterior and inferior: 2-3 mm)

2

Urinary bladder:

• Wall thickness (of well-distended bladder): ca. 3 mm

3

Seminal vesicles:

• Size (highly variable):

a Length up to 5 cm

b Width up to 2 cm, height up to 2.5 cm

c Angle between bladder and seminal vesicle: clear on each

side

4

Prostate:

• Size (varies with age, 20-70 years):

a Anteroposterior diameter 2.5-3 cm

b Lateral (and craniocaudal diameter) 3-5 cm

Attenuation value: 40-65 HU

5

Rectum:

• Wall thickness < 5 mm

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