Genitourinary and Pelvic Imaging
Core concepts
Know renal masses: RCC (enhancing, heterogeneous), angiomyolipoma (fat), oncocytoma (central scar), and the Bosniak classification of cystic lesions. Understand urolithiasis (CT KUB, stone size/location, obstruction signs) and hydronephrosis grading. Learn prostate MRI (PI-RADS, T2/DWI/DCE) and adnexal masses (simple cyst vs complex, ovarian torsion, ectopic pregnancy). Know uterine pathology (fibroids, adenomyosis, endometrial cancer staging) and testicular disease (torsion vs epididymitis). Understand bladder cancer staging and the role of CT urography.
Traps
- Bosniak III/IV cysts need surgery; do not call a complex cyst simple.
- Angiomyolipoma contains macroscopic fat-differentiate from RCC.
- Ovarian torsion may show an enlarged oedematous ovary with peripheral follicles-do not wait for Doppler.
- Ectopic pregnancy must be excluded in any woman of reproductive age with pelvic pain.
- PI-RADS scores depend on the sequence-know the dominant sequence by zone.
Worked example / rule of thumb
A 3 cm renal cyst with thickened enhancing septa: Bosniak III-surgical referral. Rule of thumb: fat in a renal mass = angiomyolipoma; enhancement = solid tumour. For adnexal masses, simple cyst = benign; complexity (septa, solid components) = further evaluation.
Key points
- Bosniak classification guides management of renal cysts.
- Fat in a renal mass suggests angiomyolipoma.
- Stone size and obstruction guide urolithiasis management.
- PI-RADS: know the dominant sequence by prostatic zone.
- Always exclude ectopic pregnancy and torsion in acute pelvic pain.