BRANT: Chapter 49: Genital Tract - CT, MR and Radiographic Imaging Flashcards
The primary modality for imaging of the female genital tract is
US
Transabdominal, transvaginal, and Doppler techniques
MR and CT are used to stage and follow-up pelvic malignancies and to supplement US by providing additional characterization of lesions.
It is combined with US, CT, and MR to diagnose congenital anomalies of the female genital tract and mechanical causes of infertility.
HSG
Hysterosalpingography
The HSG is performed by cannulating the cervix and injecting a contrast agent into the cavity of the uterus and fallopian tubes. Free communication of these lumina with the peritoneal cavity is evidenced by free spill of the contrast agent into the peritoneal cavity outlining loops of bowel.
The uterus is a pear-shaped muscular organ located between the bladder and rectum. The anterior and posterior surfaces of the uterus are covered by peritoneum, the folds of which extend laterally to the pelvic sidewalls forming the ____
Broad ligament
The broad ligament covers the fallopian tubes hanging over them like a sheet folded on a clothesline enveloping the vessels of the parametrium.
T/F: A “bare area” of extraperitoneal space is present between the mid-uterus and bladder. This is an important area for direct spread of tumor from one organ to the other.
False
A “bare area” of extraperitoneal space is present between the LOWER uterus and bladder. This is an important area for direct spread of tumor from one organ to the other.
The uterus, cervix, and upper one-third of the vagina are derived from the ____, while the lower two-thirds of the vagina arise from the ____
Müllerian ducts, urogenital sinus
It refers to the connective tissue adjacent to the uterus between the folds of the broad ligament and adjacent to the vagina.
Parametrium
Uterine vessels and lymphatics pass through the parametrium.
The cervix is cylindrical in shape and ____ in length.
3 to 4 cm
T/F: The ureters pass 2 cm lateral to the supravaginal portion of the cervix
True
The adult ovary is oval with maximal dimensions of ____
5 × 3 × 2 cm
Abnormalities of size are best determined by calculating ovarian volume using the formula
length × width × thickness × 0.52
Maximum ovarian volume is ____ before menarche, ____ in menstruating women, and ____ in postmenopausal women.
9 cc, 22 cc, 6 cc
T/F: The typical location of the ovaries is lateral, superior, or posterior to the uterine fundus, or in the cul-de-sac.
True
T/F: The ovaries are anterior to the ureters, so an ovarian mass will displace the ureter posteriorly or posterolaterally.
True
The internal anatomy of the uterus is depicted best on what MR sequence?
T2WI
Name the pointed structures
Skinny arrow: Endometrium surrounded by low signal intensity junctional zone
Short red arrow: Vagina
Short white arrow: Urethra
Name the pointed structures
Curved arrows: Broad ligaments
Arrowhead: Right ovary
The endometrium may normally be up to ____ in thickness in women of menstrual age.
14 mm
T/F: The bulk of the myometrium is intermediate signal intensity. The low signal intensity of inner junctional zone of the myometrium on T2WI is due to lower water content.
True
T/F: The cervix is largely composed of collagenous tissues that are high in signal intensity on both T1WI and T2WI, providing a dark background for visualization of hypointense cervical carcinomas.
False
The cervix is largely composed of collagenous tissues that are LOW in signal intensity on both T1WI and T2WI, providing a dark background for visualization of hyperintense cervical carcinomas.
Signal intensity of the myometrium is highest during ____ and ____ and is lowest during ____and _____
HIGHEST: Late proliferative and early secretory phase
LOWEST: Menstruation and early proliferative phase
T/F: Normal fallopian tubes are usually evident on CT.
False
Normal fallopian tubes are usually not evident on CT.
Name the structure pointed by the curved arrow
Left fallopian tube
In cases of leiomyomas, this imaging modality provides the best characterization of size, number, and location.
MR
The following statements are true, except:
a. The uterine cavity is sharply defined and triangular in shape with normal mild convexity in the fundal region.
b. The size of the cavity varies with parity. The endocervical canal is cylindrical in shape, 3 to 4 cm in length, and 1 to 3 cm in width.
c. The normal fallopian tubes are 10 to 12 cm in length extending from the cornua of the uterus.
d. The fallopian tube lumen is thread-like (1 to 2 mm) until it reaches the ampulla where it expands to 5 to 10 mm and rugal folds become visible.
a. The uterine cavity is sharply defined and triangular in shape with normal mild convexity in the fundal region.
The uterine cavity is sharply defined and triangular in shape with normal mild CONCAVITY in the fundal region.
T/F: In imaging leiomyomas, contrast enhancement does not improve leiomyoma detection or characterization.
True
Coarse calcifications within the mass are common and characteristic
Diffuse disease of adenomyosis is indicated by regular or irregular thickening of the junctional zone myometrium measuring
> 12 mm
Endometriomas (“chocolate cysts”) contain blood products of various ages reflecting recurrent episodes of bleeding corresponding to the menstrual cycle. They are characteristically multiple, bilateral, and located in the ____
Cul-de-sac
The term “Krukenberg tumor” is properly applied only to mucinous tumors metastatic to the ____ from a mucinous ____ carcinoma.
Ovary, gastric
a. Carcinoma of the ____ is the most common gynecologic malignancy
b. Carcinoma of the ____ is now the most common invasive gynecologic malignancy
a. Cervix
b. Endometrium
Initial imaging method of choice to evaluate the testes and scrotal contents
US with color doppler
It is the imaging method of choice for the staging of testicular neoplasms and in locating undescended testes that are not found by US.
CT
It is the choice for additional characterization of scrotal lesions when US findings are insufficient to determine for treatment.
MR
Because of high fluid content, the testes are of uniform low to intermediate signal on T1WI and uniform high signal on T2WI. The tunica albuginea forms a well-defined ____ thick rim low in signal on T1WI and T2WI.
1 mm
Name the pointed structures
Blue arrow: Corpus cavernosa
Red arrow (shorter): Corpus spongiosum
Arrowhead: Epididymis
Curved arrow: Spermatic cord
The testis, if present, will be seen between the lower pole of the kidney and the ____
Internal inguinal ring
T/F: CT has no current role in the detection of prostate cancer as CT findings of benign and malignant disease overlap extensively.
True
It contains approximately 70% of prostate tissue and is draped around the remainder of the gland like a catcher’s glove holding a baseball.
Peripheral zone
Most prostate cancers (70%) arise in this prostate zone
Peripheral zone
Prostate cancer or Peripheral zone
All P
This zone consists of two small areas of periurethral glandular tissue
Transitional zone
Although it contains only 5% of prostatic tissue in the normal young man, it is the site of benign prostatic hypertrophy and may enlarge greatly in the old man
Site of benign prostatic hypertrophy and may enlarge greatly in the older man.
Transitional zone
Benign prostatic hyperTRophy = TRansitional zone
It consists of the glandular tissue at the base of the prostate through which course the ducts of the vas deferens and seminal vesicles and the ejaculatory ducts.
Central zone
The anterior portion of the prostate is occupied by nonglandular tissue called the ____
Anterior fibromuscular stroma
The ____ of the prostate is that portion adjacent to the base of the bladder and the seminal vesicles (base to base).
Base
The apex of the prostate rests on the ____
Urogenital diaphragm.
On ____, the internal structure (zonal anatomy) of the prostate is demonstrated
T2WI
Name the pointed structure
Arrow: Urethra
Lower intensity zone surrounding the urethra: Transitional zone
Arrowhead: Peripheral zone
This zone has the highest water content and looser acinar structure, and hence appear bright on T2WI
Peripheral zone
Maximum diameter of prostate gland
4 cm
MR sequences most helpful in detecting prostate carcinoma
- DWI/ADC
- MRSI
MRSI shows cancers have lower levels of ____ and higher levels of ____ than benign prostate tissue.
Citrate, choline
MR sequence best for assessing invasion of periprostatic fat and for detecting enlarged lymph nodes
T1WI
They produce 60% to 80% of the fluids passed during ejaculation.
Seminal vesicles
The seminal vesicles are paired elongated sac-like glands located in the posterior groove between the bladder base and the prostate.
The dilated ____ portion of the vas deferens courses just superior to the seminal vesicles. The vas deferens joins the ducts of the seminal vesicles to form the ____, which courses through the prostate gland to empty into the urethra at the level of the ____.
Ampulla
Ejaculatory duct
Verumontanum
Normal seminal vesicles are ____ in length and ____ in diameter
The wall of the glands is ____ thick
3 cm, 8 mm, 1 to 2 mm
The vas deferens is ____ in diameter.
3 to 5 mm
Serves as a landmark for the lowest extent of the peritoneal cavity and for the location of the ureteral junctions with the bladder.
Seminal vesicles
Bilateral calcification of this structure is almost universally associated with the presence of diabetes mellitus.
Vas deferens
Two imaging modalities of choice for abnormalities of the penis.
US and MR
Name the pointed structures
Yellow arrow: Subepithelial tissue
Yellow arrowhead: Corpus spongiosum
White arrow: Urethral walls
GP: Glans penis
Asterisk: Corpora cavernosa
White arrowhead: Tunica albuginea-Buck’s fascia complex
Normal MRI anatomy of penis without intracavernosal injection. a. Axial T2-weighted MR image and b. axial post-contrast T1-weighted fat-saturated image showing cross-sectional anatomy of penile shaft. c. Sagittal T2-weighted MR image and d. sagittal post-contrast T1-weighted fat-saturated image showing longitudinal anatomy of penile shaft. Subepithelial tissue (yellow arrow) is predominantly fatty, hence hyperintense in T2-weighted image and non-enhancing in post-contrast images. Corpus spongiosum (yellow arrowhead) is seen as mildly hyperintense unpaired ventral tubular structure, containing the urethra. Urethral walls (white arrow) are hypointense to surrounding structures and collapsed. “GP” (glans penis) is the expanded distal end of corpus spongiosum at the tip of which urethra opens. The paired corpora cavernosa (left corpus cavernosum marked as *) are seen as paired tubular dorsal structures surrounded by thick hypointense layer of tunica albuginea–Buck’s fascia complex (white arrowhead)
The paired corpus cavernosa and the single corpus spongiosum containing the urethra are enveloped by the tough fibrous covering of the ____
Tunica albuginea
____ encases the corpora and deep vessels of the penis and fuses proximally with the deep urogenital fascia.
Buck fascia
T/F: A loose outer dartos facial layer is continuous with Colles fascia in the perineum.
True
This fascia determines whether or not hematomas or fluid collections remain confined to the penis or may extend to the scrotum and anterior abdominal wall
Buck fascia
Hematomas or fluid collections within Buck fascia remain confined to the penis, while those external to Buck fascia may extend to the scrotum or anterior abdominal wall.
Painful penile induration, focal or generalized priapism, is most often caused by Peyronie disease, a connective tissue disorder, which produces plaques in the ____ resulting in penile curvature and deformity.
Tunica albuginea
