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
Name the pointed structures
Blue arrow: Corpus cavernosa
Red arrow (shorter): Corpus spongiosum
Arrowhead: Epididymis
Curved arrow: Spermatic cord
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
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
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
Name the pointed structure
Arrow: Urethra
Lower intensity zone surrounding the urethra: Transitional zone
Arrowhead: Peripheral zone
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.
Bilateral calcification of this structure is almost universally associated with the presence of diabetes mellitus.
Vas deferens
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
