22- Imaging of reproductive tracts Flashcards
What is used to image the reproductive tract (from most common to least common):
- *
- Ultrasound
- MRI
- Fluoroscopy
- CT
Don’t tend to use CT unless
- staging cancers
- Greyscale not enough detail
imaging the prostate is clearest on
MRI
imaging female repro tract is clearest on
MRI- but less practical
Why we don’t really use CT much to image the repro tracts
- Not enough detail
- Testes and ovaries are VERY sensitive to radiation
- Therefore don’t want to be using this unless necessary
Ultrasound visualisation of female reproductive system can be
Transabdominal- through the abdomen
Transvaginal- through the vagina
Transabdominal- through the abdomen
*
- We start with this
- Full bladder best
- Uterus in right position
Transvaginal- through the vagina
May give better visualisation of the ovaries
visualising the ovaries on a transbdominal US
Transvaginal imaging
MRI imaging of the female repro system used to
- Used to look for cancers
- Placental imaging
- Anatomical assessment
Hysterosalpingogram (HSG) imaging of the female repro system used to
- Assess fertility
- Assess tubal patency
- If the fallopian tubes aren’t patent (e.g. due to scarring) the dye wont spill into the peritoneum -à hard to get pregnant
- Can either use
- Contrast into uterus which will pass out into the fallopian tube which will pass out into the peritoneum
- Ultrasound contrast
which imaging do we mainly use in men
MRI
e. g. of prostate and penis
- dont use musch US of male pelvis (can use to looked at testes)
prostate ultrasound use to do
a biopsy
- Put a rectal US probe in and do biopsy of prostate via the rectum
- However MRI is now replacing a lot of biopsy
Testes on ultrasound
- can look for:
- Can look for
- Varicocele
- Tumours
- Evidence of infection
Ovulation and imagining
- Normal ovary contains over 2 million primary oocytes at birth
- 10 of which mature each menstrual cycle
- of the 10 graafian follicles that begin to mature, only one becomes the dominant follicle and grows to a size of 18-20mm by mid-cycyle, when it ruptures to release the oocyte
- after the release of the oocyte, the dominant follicles collapses and the granulosa cells in the inner lining proliferate and swell to form the CL of menstruation
- over the course of 14 days the CL degenerates, leaving the small scared corpus albicans
what is a follicular cyst
- A dominant graafian follicle sometimes fails to ovulate and does not involute
- When it becomes larger than 3cm, it is called a follicular cyst
- Usually 3-8cm but may be much large
- On US follicular cysts present as simple unilocular, anechoic cysts with a thin, smooth wall
Follicular cysts will usually resolve spontaneously on follow-up
Corpus luteal cyst
- CL may seal and fill with fluid or blood forming a CL cysts
- Characteristic circular doppler appearance is called the ‘ring of fire;
- Remember that women who are on birth control pills usually wont have CL, as pills prevent ovulation
- Use of fertility drugs that induce ovulation, increases the chance of developing CL cysts
Haemorrhagic cysts
Occur when you get bleeding into follicular of CL cysts
Hyperandrogenic anovulation
Polycystic ovarian syndrome
polycstic ovarian syndrome is a
- Chronic anovulation (no ovulation) syndrome associated with androgen excess
- Ovulatory dysfunction
- Clinical or biochemical hyperandrogenism
- Polycystic ovarian morphology on US
Mature cystic ovarian teratoma
- Encapsulated tumours with mature tissue or organ components
- They are composed of well differentiated derivations from at least two of the three germ cell layers (ectoderm, mesoderm and endoderm)
- Contain developmentally mature skin complete with hair follicles and sweat glands
- Sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat (93%), bone, nails, teeth, eyes, cartilage, and thyroid tissue
Ovarian hyperstimulation
- Relatively rare
- It is caused by hormonal overstimulation by hCG and is therefore usually bilateral
- Hormonal overstimulation can occur in gestational trophoblastic disease, PCOS or in pts receiving hormonal therapy
Pelvic inflammatory disease
- PID is defined as an acute clinical syndrome associated with ascending spread of microorganisms, unrelated to pregnancy or surgery
- Infections generally ascend from the vagina or cervix to the endometrium causing endometritis
- Then to the fallopian tubes- salpingitis
- Then to and/or contiguous structures – tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome caused by PID
- PID can causes perihepatitis
- Causes swelling of the tissue around the liver
lesion assessemnt of malignant ovarian lesions use
US and MRI
plus CA125
cancer staging of malignant ovarian lesions use
contrast enhanced CT
women at low risk of of malignant ovarian lesions
premenopausal
no other risk factors
women at high risk of of malignant ovarian lesions
- postmenopausal
- personal or familial history of breast or ovariancer cancer
- BRCA1-2 carriers
*
- Metastatic spread from the rectum to the ovarian called a
(Krukenberg tumour)
endometriosis is the
presence of endometrial tissue otuside the uterine cavity- mainly found int he abdominal cavity, but mostly on the surface of the ovaires
- oestrogen dependent disease
symptoms of endometriosis
dymenorrhea, dysparaeunia (recurring pain in the genital area or within the pelvis during sexual intercourse) , pelvic pain, and infertility- although may be asymptomatic
- may haemorrhage into the ovary
- Superficial endometriosis hard to spot on
imaging
other structures which can be inolved in endometriosis
The intestines.
The rectum.
The bladder.
The vagina.
The cervix.
The vulva.
Abdominal surgery scars.
when are main reproductive system imaged
- testes
- chronic pain (not acute- if testicular torsion suspected- should go straight to surgery)
- tumour
- varicocele
- high PSA value
testicular tumour
varicocele
PSA density
PSA value/ Prostate volume
prostate volume= length x width x heigh x 0.52
