radiology.Gynecology.(dr.nasreen)

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radiology.Gynecology.(dr.nasreen)

  1. 1. Female genital tract <ul><li>Imaging techniques are US , CT & MRI. </li></ul><ul><li>US is usually the principle examination. </li></ul><ul><li>Conventional radiology plays always no major part , the major exception of HSG . </li></ul><ul><li>US either T- Abdominal or T- Vaginal . </li></ul><ul><li>See the uterus size, shape, direction, endometerium & the ovaries . </li></ul><ul><li>The normal US findings , the vagina appear as a tubular structure with centeral echogenic line , the body of the uterus lie behind the urinery bladder . </li></ul><ul><li>The ovaries are suspended by broad ligament . </li></ul><ul><li>fallopian tubes are too small to be visualized by US . </li></ul>
  2. 2. Female genital tract <ul><li>During child birth years the ovaries measure 2,5 cm – 5 cm in greatest diameter , but in menopause it often atrophy . The endocrine changes occorring during the menistrual cycle have a great effect on the appearance of the ovaries . </li></ul><ul><li>At time of ovulation the follicles rapture give rise to corpus luteum it degenerate if there is no intervening pregnancy . </li></ul>
  3. 3. CT & MRI <ul><li>The quality of pelvic CT has improved with faster , spiral or multislice CT . The diagnostic quality of pelvic scans is also improoved with ues of oral & IV contrast . . </li></ul><ul><li>The fallopian tubes & broad ligaments are not visible , the ovaries cannot be usually identified . </li></ul><ul><li>Oral contrast media is used in pelvic examination to differentiate between the bowel and adjacent structures , & IV contrast media used for blood vessels, mass & lymph nodes . </li></ul><ul><li>MRI is excellent soft tissue contrast afforded & images usually taken in sagital, coronal,& axial. </li></ul><ul><li>The ovaries & the broad ligament can also visualized . </li></ul><ul><li>The cervix show a low signals on T2 waited , the myometerium show intemediate signals , the endo m eterium show high signals, the ovaries show intermediate signals with m u l l i tple follicles of high signala seen in it . </li></ul>
  4. 4. Female genital tract <ul><li>Pelvic masses </li></ul><ul><li>Imaging techniques US , CT & MRI. </li></ul><ul><li>But US sometimes it is difficult to determine from which organ the mass arises . </li></ul><ul><li>Ovarian masses </li></ul><ul><li>Cyst : a – follicular cyst are mostly asymptomatic & regress spontaneously b - corpus luteum cysts are most often seen in first trimester of pregnancy, they usually resolve, but may rapture or twisted . </li></ul><ul><li>Hemorrhagic cyst give characteristic appearance in MRI </li></ul>
  5. 5. Female genital tract <ul><li>Ovarian tumours </li></ul><ul><li>The commonest is cystadenoma & cystadenocarcinima. </li></ul><ul><li>They are cystic , solid or mixed , the cyst may be multilocular . </li></ul><ul><li>Diagnosis by US, CT & MRI , but this cannot differentiate between benign & malignant unless there is local invasion & distal spread , </li></ul><ul><li>A malignant nature is suggested if the septa are thick or a solid nodules are visible within or adjacent to the cyst . </li></ul><ul><li>US, CT& MRI may show </li></ul><ul><li>Hydronephrosis from ureteric obstruction . </li></ul><ul><li>Enlarges lymph nodes . </li></ul><ul><li>Liver metastasis . </li></ul><ul><li>Ascitis. </li></ul><ul><li>Omental & peritoneal metastases are difficult to be visible because of there small size . </li></ul><ul><li>Treatment is surgical removal but staging should be carried out befor surg. </li></ul><ul><li>The main role of post operative imaging is for follow up </li></ul>
  6. 6. Female genital tract <ul><li>Dermoid cyst </li></ul><ul><li>Are some time confidently diagnosed because of the fat within it & it contain various calcified components of which teeth are the commonest . T he findings can be recognized on US, CT & MRI & some time on plain radiography , other wise only a very large tumours are recognizable on plain film as soft tissue mass occasionaly containing calcium arising from pelvis . </li></ul>
  7. 18. Female genital tract <ul><li>Uterine tumours </li></ul><ul><li>Fibroid ( leiomyoma ) are common in women over 30 years . </li></ul><ul><li>Are usually asymptomatic . </li></ul><ul><li>May cause menorrhagia or presented as palpable mass </li></ul><ul><li>If it is large may seen on plain film as soft tissue may contain multiple irregular but well defined calcification. </li></ul><ul><li>US & CT show spherical or lobular mass </li></ul><ul><li>US show either hypoechoic or echogenic or mixed . </li></ul><ul><li>CT give same density as myometerium . </li></ul><ul><li>MRI give different signal characteristic from normal uterus. </li></ul><ul><li>Very rarely leiomyoma under go malignant changes to leiomyosarcoma it is less than 1,0 % it is of about 0,2 % </li></ul>
  8. 23. Female genital tract <ul><li>Ca of the cervix & body of the uterus diagnosed by physical examination , biopsy & cytology . </li></ul><ul><li>Ca of the endometerium is suspected on US when there is widening of the end-stripe, but confirmation done by cytology & biopsy . </li></ul><ul><li>MRI is useful to assess Ca of the cervix & for staging because it dermined whether surgery , radiotherapy or combined of two . </li></ul><ul><li>CT is less accurate than MRI for local extend </li></ul><ul><li>CT & MRI enable detection of enlarged l y mph nodes & dilatation of the u re t e rs in u re teri c obst. </li></ul>
  9. 24. Pelvic inflammatory diseases <ul><ul><li>May be due to the venereal infection, commonly gonorrhea, which in the acute stages give rise to tubo-ovarian abscess . </li></ul></ul><ul><ul><li>Pelvic inflamation & abscess formation may also occur following pelvic surgery ,child birth, or abortion or may be seen in association with IUCD ,appendicitis or diverticular disease. </li></ul></ul><ul><ul><li>The usual imaging technique is US which show a hypoechoic or complex mass in the adnexa or in the pouch of douglas ( cul-de-sac). Blokage of fallopian tube may cause a hydrosalpinx appear as hypoechoic adnexal mass which is often tubular in shape . </li></ul></ul><ul><ul><li>DD from endoeteriosis & ectopic pregnancy . </li></ul></ul>
  10. 25. Female genital tract <ul><li>Endometeriosis present of endometerial tissue out side the uterus in the pelvis . </li></ul><ul><li>Causes . </li></ul><ul><li>US show a cystic or hypoechoeic mass in the adnexal region or in pouch of douglas . </li></ul><ul><li>It is chocolate cyst found in pathology . </li></ul><ul><li>Age incidence 25 – 35 ys. </li></ul><ul><li>Complications . </li></ul><ul><li>MRI give characteristic appearance because of recurrent bleeding , if the endometeriosis has bled in peritoneal cavity as it commonly does at the time of the menstruation, fluid may be detected in the pouch of douglas . </li></ul><ul><li>Detection of IUCD . US & Plain X-Ray . </li></ul>
  11. 28. Hysterosalpingography ( HSG ) <ul><li>Contrast study of uterus , fallopian tubes . </li></ul><ul><li>Indications </li></ul><ul><li>1- Infertility .2- recurrent abortion .3- monitor the effect of tubal surgery . </li></ul><ul><li>Contraindication </li></ul><ul><li>1- acute pelvic infection . </li></ul><ul><li>2- sever renal or cardiac disease . </li></ul><ul><li>3- sensitivity to contrast . </li></ul><ul><li>4- recent dilatation or curettage . </li></ul><ul><li>5- pregnancy . </li></ul><ul><li>Week prior & week following menstrual cycle . </li></ul>
  12. 29. HSG <ul><li>Complications : </li></ul><ul><li>1- pain . </li></ul><ul><li>2- Intravasation . </li></ul><ul><li>3- exacerbation of infection . </li></ul><ul><li>Normal HSG . </li></ul><ul><li>Congenital anomalies : </li></ul><ul><li>1- uterus didelphys . </li></ul><ul><li>2- uterus bicornis bicollis . </li></ul><ul><li>3- uterus bicornuate unicolies . </li></ul><ul><li>4- septate uterus ( arcuate uterus ) & complete septation . . </li></ul><ul><li>5- infantile uterus . </li></ul><ul><li>6- Unicornis unicollis uterus . </li></ul><ul><li>Fibroid can be detected b y HSG . </li></ul><ul><li>Abnormalities in the fallopian tubes 1- hydrosalpinx 2- TB. </li></ul>

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