gynae imaging Flashcards
indications for using radiology
diagnosis of pelvic pan
assessment of pelvic masses
investigation of abnormal menstrual bleeding
assessment of patients with post-menopausal bleeding
investigation of infertility
interventional radiology
what is the most common imaging modality used in gynae
ultrasound
pros of USS
relatively cheap
safe (no ionising radiation)
good definition of different pelvic organs
can be used in the clinic as an adjunct to pelvic examination
two main types of USS
trans abdominal
transvaginal
why must patient have a full bladder for trans abdominal USS
a distended fluid-filled bladder acts as an ‘acoustic window’ and displaces gad-filled bowel loops out of the pelvis
bowel gas scatters the ultrasound beam and degrades image quality
disadvantages of TA USS
difficult to obtain good images in obese patients and in patients where there is gaseous distension of the bowel
operator dependent
difficult to produce the same images every time the patient attends (not often used for assessing response to cancer treatment)
full/empty bladder for transvaginal USS
empty
disadvantages of TV USS
more invasive
not suitable for individuals who have not been sexually active
may not depict full extent of pelvic masses
indications for CT
second line after USS for acute abdominal pain
assess post-surgical complications
staging of gynae malignancy (ovarian/endometrial cancers)
assessing response to treatment after chemo/radiotherapy
disadvantages of CT
high radiation dose (avoid in children and patients of reproductive age)
does not provide optimal depiction of different pelvic organs
advantages of MRI
excellent depiction of pelvic organs
no ionising radiation
can give some idea about the composition of soft tissue masses (fluid, fat, blood etc)
disadvantages of MRI
time-consuming
poor depiction of lung parenchyma
not tolerated in patients with claustrophobia
contraindicated in patients with pacemakers, many artificial heart valves, nerve stimulators, cochlear implants etc
indications for MRI
cancer staging
evaluation and characterisation of adnexal and uterine masses, where USS have not provided diagnosis
evaluation of patients with sub-fertility
MR of pituitary gland is performed in patients with suspected prolactinoma
how can endometriosis be diagnosed by MRI
endometriosis deposits contain altered blood and haemoglobin degradation products
these cause characteristic MR signal changes
what is hysterosalpingography
X-ray screening procedure for assessment of tubal latency in patients with infertility
