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Reproduction > Imaging in Gynaecology > Flashcards

Imaging in Gynaecology Flashcards

1
Q

what are the gynae indications for radiology

A

diagnosis of pelvic pain
assessment of pelvic masses
investigations of abnormal menstrual bleeding
assessment of patients with post menopausal bleeding (assess endometrial thickness)
investigating infertility (may also have MRI of pituitary and blood test for endocrinology)
interventional radiology (fallopian tube recanalisation, uterine artery embolisation)

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2
Q

where might USS be performed

A

radiology, Obs and Gynae and GP practises

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3
Q

what are the devices used to do transabdominal and transvaginal USS

A

TA- standard general abdo transducer (provides wide view of pelvis)
TV- endocavity high frequency transducer (more focused view)

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4
Q

what should you do before TAUSS

A

brief assessment of upper abdomen:
To ensure that there is no hydronephrosis
To detect early ascites
To ensure that the pelvic abnormality is not secondary to upper abdominal pathology

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5
Q

what must the patient do for a TAUSS

A

must have full bladder:

  • urine distended bladder acts as an acoustic window
  • a distended bladder displaces gas filled bowel loops out of the pelvis (gas scatters US beam)
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6
Q

what are the disadvantages of TAUSS

A

It is difficult to obtain good images in obese patients and in patients where there is gaseous distension of the bowel
Operator dependent
It is difficult to produce exactly the same images every time the patient attends and this means ultrasound is not often used for assessing the response to cancer treatment

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7
Q

what vessels are the ovaries very close to- can be seen on USS

A

external iliac arteries and veins

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8
Q

why is a transvaginal USS higher frequency

A

higher frequency has shorter wavelength and better spacial resolution but these are more likely to be scattered in body so transducer needs to be closer to target organs

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9
Q

is the bladder full or empty in a TVUSS

A

empty- full can be uncomfortable

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10
Q

what USS provides better depiction of the pelvic organs

A

TVUSS

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11
Q

what are the disadvantages of TVUSS

A

More invasive procedure
Not suitable for individuals who have not been sexually active
Can sometimes just demonstrate “the tip of the iceberg” and may not depict the full extent of large pelvic masses (ideally transvaginal scan should follow a transabdominal scan which allows better overview)

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12
Q

what does the endometrium look like on USS

A

in middle of uterus, is echogenic- brighter

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13
Q

what happens to ovarian volume in PCOS

A

is increased

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14
Q

what happens to ovarian volume in ovarian failure

A

is decreased

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15
Q

what might be seen on USS in a ruptures ovarian cysts

A

ascites in hepatorenal recess

small haematoma next to ovary

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16
Q

when is CT used in gynae

A

2nd line after ISS in acute abdo pain
to asses post surgical complications - small bowel obstruction due to adhesions, post op collections/ abscesses
staging of gynae malignancy- esp ovarian and endometrial cancers
assessing response to treatment in patients after chemo +/- radio

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17
Q

what are the disadvantaged of CT in gynae

A

High radiation dose (equivalent to about 160 chest x-rays) with a significant dose delivered to the ovaries
Therefore used sparingly in children and patients of reproductive age
Does not provide optimal depiction of different pelvic organs (MR is better at providing good tissue resolution)

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18
Q

what is diagnostic of a dermoid cyst

A

if it contains fat

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19
Q

what is bright on T1 MRIs

A

fat, protein, blood

20
Q

what is bright on T2 MRIs

A

water

21
Q

what are the advantages of MRI

A

excellent depiction of pelvic organs
No ionising radiation and is therefore suitable for children and women of reproductive age
Can give some idea about the composition of soft tissue masses – e.g. do they contain fluid, fat, blood etc ?

22
Q

is MRI safe in pregnancy

A

yes except in first trimester

23
Q

what does MRI provide poor depiction of

A

lung parenchyma – a CT scan should be performed if there is query about pulmonary metastases

24
Q

when is MRI used in gynae

A

Cancer staging – especially cervical cancer
Further evaluation and characterisation of adnexal and uterine masses, where pelvic ultrasound or other imaging have not provided a diagnosis
Evaluation of patients with sub-fertility – are there are contributory anatomical variations?
MR of the pituitary gland is performed in patients with suspected prolactinoma

25
Q

what is the junctional zone

A

area between myo and endometrium

26
Q

what is a hydrosalpinx usually caused by

A

previous chlamydia infection

27
Q

what Ix can be used to diagnose endometriosis

A

laparoscopy

MRI

28
Q

what can b suppressed on T1 weight MRIs

A

fat

29
Q

what does endometriosis look like on MRI

A

Endometriosis deposits contain altered blood and haemoglobin degradation products
Altered blood returns high-signal on T1 sequences (i.e. it looks white on the scan) whereas it returns lower signal on T2 sequences (looks grey)

30
Q

what are dermoid cysts

A

ovarian teratomas

31
Q

what do dermoid cysts contain

A

tissue derived from ectoderm, mesoderm and endoderm. They can therefore contain an admixture of many types of tissue, but most contain a large amount of fat.

32
Q

what Ix is best to see fat

A

Fat, when admixed with other tissues, can be difficult to perceive on ultrasound, but has predictable MR signal characteristics (T1, T1 fat suppression) and can also be diagnosed on CT

33
Q

what happens to fat on T1 fat suppression scan

A

goes dark

34
Q

what is hysterosalpingography

A

x ray with contrast

  • Cervix is cannulated and radiopaque contrast instilled to fill the uterine cavity
  • Just before instillation of contrast, a scout ‘control’ film is obtained
  • Once contrast instilled, a series of images are captured as the contrast fills uterine cavity, then into fallopian tubes and spills into peritoneal cavity
  • completed in 3-5 mins
35
Q

what is HSG used to assess

A

tubal patency in infertility

outline of uterine cavity

36
Q

why are pre cancer treatment scans important

A

serves as a “baseline” study so that subsequent scans can be used to assess response to treatment (chemotherapy, radiotherapy etc)

37
Q

how are gynae cancers staged

A

TNM

38
Q

how does ovarian cancer disseminate

A

peritoneal spread

39
Q

where does ovarian cancer commonly spread

A

Sub-diaphragmatic deposits
omental and peritoneal nodules

Lymph node metastases, lung metastases and hepatic metastases are less common and tend to be seen in patients in whom the disease behaviour has been modulated by chemotherapy or in cancers with the BRCA1 mutation

40
Q

how can ovarian cancer present

A

Ascites

Malignant pleural effusions can result from spread of disease via pleuro-peritoneal communications

41
Q

what Ix for ovarian cancer

A

Initial diagnosis is often made by ultrasound (ovarian masses)
CT scanning for radiological staging

42
Q

what is important in the staging of cervical cancer

A

determining whether there is;
Spread into the parametrium (tissue adjacent to cervix on either side)
Extension into the vagina
Infiltration of adjacent organs: rectum, ureters, urinary bladder
Metastases to regional lymph nodes (internal iliac and obturator)

43
Q

what scan for staging of cervical cancer

A

MR (especially T2-weighted sequences) is far better than CT at depicting local disease, but CT is often used to determine whether or not there are distant metastases – e.g. lung, para-aortic and mediastinal lymphadenopathy

44
Q

what is the best method of establishing abnormally thickened endometrium in a post-menopausal patient with PMB

A

TVUSS

45
Q

what Ix for endometrial cancer staging

A

CT to look for distal node and pulmonary mets

MRI can assess myometrial invasion

46
Q

what is the problems with patients who have endometrial cancer

A

many are very obese, too large for MR scanners

Reproduction (51 decks)

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