2: Imaging in obstetrics and gynaecology

Question 1

What is the most common imaging used in gynaecology?

Answer 1

USS

Question 2

What presenting complaints in women would indicate pelvic imaging?

Answer 2

Pelvic pain

Pelvic mass

Dodgy bleeding (intermenstrual, post-menopause)

Infertility

Question 3

Which gland is commonly involved in male/female infertility?

How is it imaged?

Answer 3

Pituitary gland

MRI pituitary

Question 4

What are two ultrasound views used for pelvic imaging?

Answer 4

Transabdominal

Transvaginal

Question 5

Transabdominal ultrasound is (invasive / non-invasive).

Answer 5

non-invasive

Question 6

Transvaginal ultrasound is (invasive / non-invasive).

Answer 6

invasive

It’s inserted

Question 7

Gas appears as which colour on ultrasound?

Answer 7

Black

Question 8

Gas appears black on ultrasound. This presents a problem in transabdominal ultrasound scanning.

How is this solved?

Answer 8

Full bladder

Shifts gas-filled bowel out of the way and acts as a reference point

Question 9

In transvaginal ultrasound, where a probe is inserted into the vagina, the patient’s bladder needs to be (empty/full).

Answer 9

empty

Question 10

Can transvaginal ultrasound be used in patients who haven’t been sexually active?

Answer 10

No

Question 11

What colour does the endometrium appear on ultrasound?

Answer 11

White

Question 12

What colour is free fluid on ultrasound?

Answer 12

Black

Question 13

What imaging is used second-line in more complicated cases or to stage malignancies?

Answer 13

CT scan

Question 14

What are the advantages of CT scanning over X-ray?

Answer 14

Multiple views, can scroll to select different slices

Higher resolution image

Can pick out more structures

Question 15

CT scanning delivers a high dose of ___.

Answer 15

radiation

especially to testes/ovaries

Question 16

Does MRI give the patient a dose of radiation?

Answer 16

No

But there are different risks (metal)

Question 17

What are the two different MRI scans which patients can have?

Answer 17

T1

T2

relearn the difference

Question 18

Which scan is used to stage cervical cancer?

Why?

Answer 18

MRI scan

CT not detailed enough

Question 19

What colour does the endometrium appear on MRI?

Answer 19

White

Question 20

What scan offers the most detailed image of the pelvis?

Answer 20

MRI scan

Question 21

What scan is used to diagnose endometriosis?

Answer 21

MRI scan

As with normal endometrium, abnormal (& bleeding) tissue appears white

Question 22

Which serial X-ray technique can be used to assess a woman’s tubal patency?

Answer 22

Hysterosalpingography (HSG)

Like an angiogram for the uterine tubes

Question 23

Which is injected into the cervix before HSG is carried out?

Answer 23

Contrast

Question 24

What is seen lateral to the uterus and uterine tubes once contrast has been injected in HSG?

Answer 24

Peritoneal spill

If uterine tubes are patent, contrast will pass through them and pass into peritoneal cavity at the distal end

Question 25

Where does ovarian cancer tend to spread?

Why?

Answer 25

Peritoneal cavity

Space between ovaries and start of uterine tubes - continuous with “ “

Question 26

Where in the body does ovarian cancer tend to spread?

Answer 26

Peritoneal cavity

Liver SURFACE (not intrahepatic)

Question 27

What can be used to differentiate bowel from solid deposits on a CT or MRI scan?

Answer 27

Contrast

Question 28

Which specific type of scan is used to identify cervical cancer?

Answer 28

MRI scan

T2-weighted