BRANT: Chapter 49: Genital Tract - CT, MR and Radiographic Imaging

Question 1

The primary modality for imaging of the female genital tract is

Answer 1

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.

Question 2

It is combined with US, CT, and MR to diagnose congenital anomalies of the female genital tract and mechanical causes of infertility.

Answer 2

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.

Question 3

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 ____

Answer 3

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.

Question 4

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.

Answer 4

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.

Question 5

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 ____

Answer 5

Müllerian ducts, urogenital sinus

Question 6

It refers to the connective tissue adjacent to the uterus between the folds of the broad ligament and adjacent to the vagina.

Answer 6

Parametrium

Uterine vessels and lymphatics pass through the parametrium.

Question 7

The cervix is cylindrical in shape and ____ in length.

Answer 7

3 to 4 cm

Question 8

T/F: The ureters pass 2 cm lateral to the supravaginal portion of the cervix

Answer 8

True

Question 9

The adult ovary is oval with maximal dimensions of ____

Answer 9

5 × 3 × 2 cm

Question 10

Abnormalities of size are best determined by calculating ovarian volume using the formula

Answer 10

length × width × thickness × 0.52

Question 11

Maximum ovarian volume is ____ before menarche, ____ in menstruating women, and ____ in postmenopausal women.

Answer 11

9 cc, 22 cc, 6 cc

Question 12

T/F: The typical location of the ovaries is lateral, superior, or posterior to the uterine fundus, or in the cul-de-sac.

Answer 12

True

Question 13

T/F: The ovaries are anterior to the ureters, so an ovarian mass will displace the ureter posteriorly or posterolaterally.

Answer 13

True

Question 14

The internal anatomy of the uterus is depicted best on what MR sequence?

Answer 14

T2WI

Question 15

Name the pointed structures

Answer 15

Skinny arrow: Endometrium surrounded by low signal intensity junctional zone
Short red arrow: Vagina
Short white arrow: Urethra

Question 16

Name the pointed structures

Answer 16

Curved arrows: Broad ligaments
Arrowhead: Right ovary

Question 17

The endometrium may normally be up to ____ in thickness in women of menstrual age.

Answer 17

14 mm

Question 18

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.

Answer 18

True

Question 19

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.

Answer 19

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.

Question 20

Signal intensity of the myometrium is highest during ____ and ____ and is lowest during ____and _____

Answer 20

HIGHEST: Late proliferative and early secretory phase
LOWEST: Menstruation and early proliferative phase

Question 21

T/F: Normal fallopian tubes are usually evident on CT.

Answer 21

False

Normal fallopian tubes are usually not evident on CT.

Question 22

Name the structure pointed by the curved arrow

Answer 22

Left fallopian tube

Question 23

In cases of leiomyomas, this imaging modality provides the best characterization of size, number, and location.

Answer 23

MR

Question 23

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.

Answer 23

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.

Question 24

T/F: In imaging leiomyomas, contrast enhancement does not improve leiomyoma detection or characterization.

Answer 24

True ## Footnote Coarse calcifications within the mass are common and characteristic

Question 25

Diffuse disease of adenomyosis is indicated by regular or irregular thickening of the junctional zone myometrium measuring

Answer 25

>12 mm

Question 26

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 ____

Answer 26

Cul-de-sac

Question 27

The term “Krukenberg tumor” is properly applied only to mucinous tumors metastatic to the ____ from a mucinous ____ carcinoma.

Answer 27

Ovary, gastric

Question 28

a. Carcinoma of the ____ is the most common gynecologic malignancy b. Carcinoma of the ____ is now the most common invasive gynecologic malignancy

Answer 28

a. Cervix b. Endometrium

Question 29

Initial imaging method of choice to evaluate the testes and scrotal contents

Answer 29

US with color doppler

Question 30

It is the imaging method of choice for the staging of testicular neoplasms and in locating undescended testes that are not found by US.

Answer 30

CT

Question 31

It is the choice for additional characterization of scrotal lesions when US findings are insufficient to determine for treatment.

Answer 31

MR

Question 32

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.

Answer 32

1 mm

Question 33

Name the pointed structures

Answer 33

Blue arrow: Corpus cavernosa Red arrow (shorter): Corpus spongiosum Arrowhead: Epididymis Curved arrow: Spermatic cord

Question 34

The testis, if present, will be seen between the lower pole of the kidney and the ____

Answer 34

Internal inguinal ring

Question 35

T/F: CT has no current role in the detection of prostate cancer as CT findings of benign and malignant disease overlap extensively.

Answer 35

True

Question 36

It contains approximately 70% of prostate tissue and is draped around the remainder of the gland like a catcher’s glove holding a baseball.

Answer 36

Peripheral zone

Question 37

Most prostate cancers (70%) arise in this prostate zone

Answer 37

Peripheral zone ## Footnote Prostate cancer or Peripheral zone All P

Question 38

This zone consists of two small areas of periurethral glandular tissue

Answer 38

Transitional zone ## Footnote 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

Question 39

Site of benign prostatic hypertrophy and may enlarge greatly in the older man.

Answer 39

Transitional zone ## Footnote Benign prostatic hyperTRophy = TRansitional zone

Question 40

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.

Answer 40

Central zone

Question 41

The anterior portion of the prostate is occupied by nonglandular tissue called the ____

Answer 41

Anterior fibromuscular stroma

Question 42

The ____ of the prostate is that portion adjacent to the base of the bladder and the seminal vesicles (base to base).

Answer 42

Base

Question 43

The apex of the prostate rests on the ____

Answer 43

Urogenital diaphragm.

Question 44

On ____, the internal structure (zonal anatomy) of the prostate is demonstrated

Answer 44

T2WI

Question 45

Name the pointed structure

Answer 45

Arrow: Urethra Lower intensity zone surrounding the urethra: Transitional zone Arrowhead: Peripheral zone

Question 46

This zone has the highest water content and looser acinar structure, and hence appear bright on T2WI

Answer 46

Peripheral zone

Question 47

Maximum diameter of prostate gland

Answer 47

4 cm

Question 48

MR sequences most helpful in detecting prostate carcinoma

Answer 48

1. DWI/ADC 2. MRSI

Question 49

MRSI shows cancers have lower levels of ____ and higher levels of ____ than benign prostate tissue.

Answer 49

Citrate, choline

Question 50

MR sequence best for assessing invasion of periprostatic fat and for detecting enlarged lymph nodes

Answer 50

T1WI

Question 51

They produce 60% to 80% of the fluids passed during ejaculation.

Answer 51

Seminal vesicles ## Footnote The seminal vesicles are paired elongated sac-like glands located in the posterior groove between the bladder base and the prostate.

Question 52

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 ____.

Answer 52

Ampulla Ejaculatory duct Verumontanum

Question 53

Normal seminal vesicles are ____ in length and ____ in diameter The wall of the glands is ____ thick

Answer 53

3 cm, 8 mm, 1 to 2 mm

Question 54

The vas deferens is ____ in diameter.

Answer 54

3 to 5 mm

Question 55

Serves as a landmark for the lowest extent of the peritoneal cavity and for the location of the ureteral junctions with the bladder.

Answer 55

Seminal vesicles

Question 56

Bilateral calcification of this structure is almost universally associated with the presence of diabetes mellitus.

Answer 56

Vas deferens

Question 57

Two imaging modalities of choice for abnormalities of the penis.

Answer 57

US and MR

Question 58

Name the pointed structures

Answer 58

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 ## Footnote 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)

Question 59

The paired corpus cavernosa and the single corpus spongiosum containing the urethra are enveloped by the tough fibrous covering of the ____

Answer 59

Tunica albuginea

Question 60

____ encases the corpora and deep vessels of the penis and fuses proximally with the deep urogenital fascia.

Answer 60

Buck fascia

Question 61

T/F: A loose outer dartos facial layer is continuous with Colles fascia in the perineum.

Answer 61

True

Question 62

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

Answer 62

Buck fascia ## Footnote 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.

Question 63

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.

Answer 63

Tunica albuginea