 Hello everyone, I'm Dr. Niyati Mistry, second year resident of radio diagnosis at Vithara VK particle medical college and hospital Ahmednagar. So my topic today for paper presentation is the evaluation of obstructive uropathy using CT urography. Coming on to the aims and the objective is to discuss the current role of urologic imaging in evaluation of patients with obstructive uropathy, identifying the key imaging features of urethral diseases at the CT urography and the purpose of this study is to comprehensively review the role of CT urography in evaluation of urinary tract obstruction, depiction of complex congenital or post surgical urinary tract anatomy and any clinical scenarios where comprehensive evaluation of urinary tract is needed. So coming on to the introduction, obstructive uropathy can be defined as a blockage of urinary drainage of urine drainage from the kidney ureter bladder. There are many types of obstructive uropathy, however the most common causes include the stones in the kidney that is nephrolithiasis, urourotrolithiasis that is stones in the ureter or anywhere in the urinary tract that is urolithiasis. Other causes of obstructive uropathy include health conditions such as pregnancy, prostate cancer in males, retroperitoneal, fibrosis, spinal cord injury, then ureteral structures, congenital anomalies, etc. CT urography has essentially become superior to the intravenous urography as the first line imaging modality since it has more accuracy and sensitivity particularly for the imaging of hematuria. Major advantages of CT urography is that it is not only superior in visualization of the urinary tract but also assessment of adjacent structures and other organs of the abdomen where intravenous urography phase. CT urography provides a detailed anatomical depiction of each of the major portions of the urinary tract. Then these are the phases that we use for CT urography. First we take a plane scan, then after 30 seconds of contrast injection, we take a cortical medullary phase and after 100 seconds of the injection, we take contrast injection, we take nephrogenic phase and after 8 minutes we take excitatory phase. So here we can see this is the normal appearance of three phases of CT urography provided for the references. Image A is a non-contrast azure image through the kidneys where no renal calcification or high urinary masses are noted. Image B is of nephrogenic phase showing symmetrical parankymal enhancement without any parankymal mass lesion. Then the image C is excretory phase through the kidneys showing symmetrical excreted contrast in bilateral renal pelvises. Then symmetrical contrast or pacification of the ureters are noted at the level of the bladder. Then image D, the conal reformatted images of excretory phase image and image E is the excretive phase azure image at the level of the ureteral insertion at the bladder. Then coming on to the methods and material. The study includes all the patient being deferred to the Department of Radio Diagnosis of our tertiary care hospital for the CT urography with clinical suspicions of clinical suspicion of obstructive neuropathy. Informative concern of the participating individuals were taken. Detailed history was taken. Then CT urography was done using Philips 16 flight CT machine. Tri-clinic images were obtained which includes a non-contrast enhanced and the delayed images in agile societal and coordinate planes. Afterwards through examination of the images was done at ICOM Bureau was used and the study was done in random 46 patient coming for the CT urography. This is the machine that we use that is Philips 16 flight CT. Coming on to the cases. This is the case number one where we can see this is the CT urography reformatted coronal image showing the right-sided duplication, duplicating collecting system. Image B is a reformatted image of CT urogram demonstrating a duplicating collecting system on the right side with two ureters. At the insertion of the right ureter there is circular correction of contrast characteristic of a ureter C. Then image C is agile CT urography image shows the right double collecting system. Sorry the net is a little slow. Coming on to case number two. This is agile CT urography images showing horseshoe shaped kidney. A is an enhanced image B is nephrogenic phase which shows multiple cystic lesions throughout the real paradigm. Coming on to the case number three. This is the CT urography agile unenounced image showing moderate dilatation of the left renal pelvis and colisus secondary to the thinking of the proximal ureter. And B is the coronal excretory phase image showing delayed enhancement of the left renal pyronechyma is compared to the right. Coming on to case number four. This is the agile CT urography image showing mild hydronephrosis with tiny intra renal non-obstructive calculus. And B image shows agile image showing the left distal ureter calculus. This is a reconstructed image showing bilateral multiple intra renal calculus of variable sizes with mild hydroneph, left hydronephrosis secondary to the distal ureter calculus. Case number five is the CT urography image showing the left intra renal non-obstructive calculus with proximal ureter calculus causing moderate left hydronephrosis and hydro ureter proximal to the calculus. C is the agile image, the CT agile image showing a large vesicle calculus and D is a reconstructed image showing the above findings. Case number six. This is CT urography image showing agile unenounced image showing the left gross hydronephrosis and the thinning of the cortex. B is the agile nephrogenic phase showing gross hydronephrosis again. C is the agile delayed phase imaging showing normal right kidney and delayed excretion of the left. D is the 3D image showing left-sided gross hydronephrosis secondary to the proximal ureter structure. Coming on to the results, this is a gender-wise distribution of the patients in the present study. The female correspondence was seen in about 31 patients who were male, 15 were females. Male to female ratio was 2.06 is to 1. This is the PI diagram showing the gender-wise distribution of the patients. This is the age-wise distribution of the patient when majority of the patients were in the age group of 25 to 60 and followed by the age group of 51 to 75, which were 43%. Coming on to the distribution of the patient according to the shape of the kidney, about 93.5% of the patients showed maintained rheniform shape of the kidney. However, one showed distorted kidney and about 4.3% cases showed horseshoe-shaped kidneys. This is the distribution of the patient according to the filling defects observed in the kidney. About 76% patient had no filling defect in the renal pelvicalizal system. However, it was observed in only 24% of the patient. And the number of ureters which were involved in 10, the majority of the patient had single ureter in about 98% while we observed a double ureter involvement in single patient out of 46 patients. Then this is the distribution of patients according to the ureter and the urinary bladder filling defect. 24 patients showed the ureter filling defect while two patients showed filling defect in urinary bladder. This is, again, the distribution of patient according to the size and the shape of the calculus. Out of 46 patients, 30 patients showed calculus in the urinary system. The calculus was of variable size and shape. 20% showed calculus rheniform 1.122 centimeters, followed by five patients showing the calculus size rheniform 2.123 centimeters. Then 93% of the patients amongst the positive ones for the calculus showed a round calculus and the rest 7% showed stagonship calculus. Then this is the distribution of the patients according to the location of the calculus. Most common location of the calculus was the ureter which was observed in 19% of the patients followed by the intrapelvic calculus in 7%. Four patients showed a calculator which were intranenal, which were intranenal. And UJ calculus and intravacycal calculus were observed in signal patient respectively. Then this is the distribution according to causes for obstructive ureopathy. Most common pathology causing obstructive ureopathy was the ureter calculus observing 30% of the patients followed by ureteric structure followed by 11%. 11 patients, that is 23%. Again, distribution of the patient according to the HU value. HU value of the calculus was seen in the range of 650 to 1,708 patients for HU value of 1,401 followed by 1,001 to 1,001,201 to 1,306 patients. Coming on to the discussion, then obstructive ureopathy is defined as a narrowing of the ureteric tract necessitating elevation of the proximal pressure to enable the urein flow. The CT urograph examination was able to diagnose the cause and the level of obstruction beginning from the intrapalic obstruction to the Puget obstruction. In our study, the cause of obstruction was the urinary tract stones, which represented 65.21% of all the patients. Second most common cause of obstructive ureopathy was the ureteric structure. Then the CT urography enabled the detailed evaluation of obstructive ureopathy, crucial disease characteristics causing it and differentiating between the urinary calculus and other pathological processes such as structure, secondary to iatrogenic procedure of ureteric involvement in the metastase-sized cervical cancer. In our study, we were able to suggest the chemical composition of the diagnosed calculus with the help of measuring household units. Most of the cases with urinary tract calculus were advised the urography in the presence of hydronephrocyl detector by ultrasonography examination or non-conclusive IVU examination. CT urography with high spatial resolution and multiband reconstruction is able to diagnose the site and the cause of obstruction. And in most cases, it also provides the functional information about the kidney, which is important in the decision making for management. Then coming on to the conclusion, with the introduction of CT urography, it is possible to accurately image the urinary tract non-invasively, very easily, and in very less time. It is to the study of anatomy, which depicts the normal anatomic variations preoperatively and to study the pathologies. Hence, based on our cross-sectional observer study, the following conclusions can be made. CT urography serves as an accurate and non-invasive imaging methods for evaluation of urinary tract anatomy and pathology. It is also very helpful in preoperative evaluation of urinary tract anatomy and variations or any obstructions or functioning of the kidneys. Then CT urography was found to be very sensitive and specific in finding the level of obstruction and the cause of obstruction. Then CT urography was, again, useful as there were no artifacts due to the bowel gases or overlapping structures in the study. CT urography's potential useful in patients having obstructive urology with the cause other than urinary calculus. Though ultrasound still remains the primary investigation, imaging modality of choice in identifying the grade of hydronephrosis, CT urography has its own advantage as it is able to evaluate the anti-unit system from kidney to urethra and is very helpful in obvious patients. Drawbacks are the recent exposure, risk of serious contrast reactions. Pregnant women are contraindicated with this study as risk of potential risk to the fetus. Again, CT urography is becoming the primary method for evaluating many patients with obstructive urology with many diagnostic advantages and it is now replacing the intravenous urography. There is no enough evidence to suggest the efficacy of CT urography is at par with that of existing investigation can be considered as a gold standard for evaluation of obstructive urology. These are my references. Thank you.