Information about female pelvis

1. GYNAECOLOGICAL
IMAGING
DR SANA SHAH

12. Bicornuate uterus

19. UTERINE FIBROID (LEIOMYOMA)
Extremely common benign tumor of smooth muscle
Found in several locations
 Intramural (most common)
 Submucosal
 Subserosal
 cervical

23. PEDUNCULATED FIBROIDS

24. On MRI, leiomyomas are T2
hypointense due to the presence
of compact smooth muscles
Internal cystic or myxoid
degeneration increase T2 signal
Calcifications are common

30. ADENOMYOSIS
 Refers to ectopic endometrial tissue within the myometrium
associated with adjacent myometrial hyperplasia
 Considered as spectrum of endometriosis but in contrast to
endometriosis ectopic endometrial tissue is non functional
 It is usually a diffuse process but may form a localized mass or
adenomyoma

35. ENDOMETRIOSIS
The presence of functional endometrial glands outside the uterus
It manifests in three ways;
 Superficial (peritoneal) disease
 Ovarian disease (endometriomas)
 Deep infiltrating endometriosis

43. ENDOMETRIAL HYPERPLASIA
 If premenopausal more than 1.4cm
 And postmenopausal women more than 4mm

45. ENDOMETRIAL CARCINOMA
• It is the most common malignancy of the female
reproductive tract
Risk factors:
• chronic exposure to unopposed estrogen:
tamoxifen
• nulliparity
• obesity
• polycystic ovarian syndrome

46. ULTRASOUND FEATURES
 Heterogeneous and irregular endometrial
thickening
 Polypoid mass lesion
 Intrauterine fluid collection
 Frank myometrial invasion

48. MRI
A dedicated pelvic MRI protocol is recommended for optimal disease extension
assessment and is considered superior to CT for local staging 1,6. Contrast-
enhanced MRI imaging improves accuracy in detecting myometrial invasion.
•T1: hypo- to isointense to normal endometrium
•T1 C+ (Gd)
• carcinomatous tissue will enhance less than normal endometrium
•T2: iso to hypointense relative to normal endometrium, often heterogeneous;
mildly hypointense to myometrium, which forms the basis for assessment of
myometrial invasion

54. CERVICAL CARCINOMA
 Third most common

56. OVARIAN PATHOLOGIES

61. HEMORRHAGIC CYST

64. BENIGN CYSTIC OVARIAN NEOPLASM
 Mature cystic teratoma
 Cystadenoma
Serous
cystadenoma
Mucinous
cystadenoma
 Ovarian fibroma

65. DERMOID CYST
 Contain squamous epithelium and dermal appendages

66. Tip of the iceberg sign acoustic shadowing from the
hyperechoic part of the dermoid cyst

76. MALIGNANT CYSTIC OVARIAN NEOPLASMS
Serous cystadenocarcinoma
• Commonest epithelial carcinoma and are predominantly cystic masses
• Show wall thickening, nodularity, internal solid areas and septations
• Malignant tumors tend to have more nodularity and solid areas as compared to their benign counterpart

80. Mucinous cystadenocarcinoma
• Are large, unilateral and occur in older patients
• Typically presents as multiloculated cystic mass containing mucin rich T1 hyperintense
fluid

82. MICELLANEOUS OVARIAN SYNDROMES
Ovarian Hyperstimulation
Syndrome
Enlarged left ovary (arrows) with multiple adjacent
simple cysts in a patient undergoing invitro
fertilization

83. POLYCYSTIC OVARIAN SYNDROME
PCOS is a clinical symptom of obesity, insulin resistance,
anovulation, hirsutism secondary to excess androgens
Distinguishing features
 Polycystic ovaries
 Large volume > 7.5ml
 More than seven 2-5mm follicles
 Increased stroma
 Large/normal uterus with thick
endometrium

86. THANK YOU