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Imaging in Gynaecology Flashcards

1
Q

What imaging modalities are used in gynaecology?

A

US, CT, MRI, fluoroscopy (HSG), PET-CT

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2
Q

What are the indications for using radiology?

A 
Diagnosis of pelvic pain
Assessment of pelvic pain 
Investigation of abnormal menstrual bleeding
Assessment of postmenopausal bleeding
Investigation of infertility
Interventional radiology
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3
Q

Where can US be performed?

A

Radiology department, gynaecology clinic and some GP practices

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4
Q

What are the two types of US used?

A

Transabdominal and transvaginal

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5
Q

How are pelvic organs scanned during a transabdominal US?

A

Through the anterior pelvic wall

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6
Q

Should the upper abdomen be looked at during a transabdominal US?

A

Yes = look for hydronephrosis, ascites or primary abdominal pathology

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7
Q

What preparation is needed for a transabdominal US?

A

Need a full bladder = urine-distended bladder acts as acoustic window

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8
Q

What are the advantages of transabdominal US?

A

Safe, readily available, no ionising radiation

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9
Q

What are the disadvantages of transabdominal US?

A

Difficult to image obese patients and if there is gaseous bowel
Difficult to produce exactly the same image every time

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10
Q

What are some features of transvaginal US?

A

Higher frequency so shorter wavelength and better spatial resolution but needs to be close to target as more likely to scatter

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11
Q

How should the bladder be prepared for a transvaginal US?

A

Requires empty bladder = uncomfortable if the bladder is full

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12
Q

What are the advantages of a transvaginal US?

A

Excellent depiction of pelvic organs

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13
Q

What are the disadvantages of a transvaginal US?

A

Invasive, not suitable for those who haven’t had sex, may not depict full extent of large pelvic masses

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14
Q

What are CT scans used for as a second line investigation?

A

Often used as second line investigation after US in patients with acute abdominal pain

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15
Q

What are some uses of CT in gynaecology?

A

Can be used to assess post-surgical complications
Useful for staging malignancy (endometrial, ovarian)
Can assess response to treatment after chemotherapy +/- radiotherapy

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16
Q

What are the advantages of CT?

A

Quick, entire chest/abdomen/pelvis can be assessed in one image, can manipulate images to give many different views

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17
Q

What are the disadvantages of CT?

A

High radiation dose, doesn’t provide optimal depiction of different pelvic organs

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18
Q

How does MRI create images?

A

Uses radiofrequency energy rather than ionising radiation = different protocols can be used to define tissue composition in the area being scanned

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19
Q

What are the advantages of MRI?

A

Provides excellent depiction of pelvic organs, no ionising radiation, can give some idea about composition of soft tissue masses

20
Q

What are the disadvantages of MRI?

A

Time consuming, poor depiction of lung parenchyma, not suitable if claustrophobic

21
Q

What are the contraindications of MRI?

A

Pacemaker, artificial metal heart valves, nerve stimulators, cochlear implants

22
Q

What are the gynaecological uses of MRI?

A

Cancer staging = especially cervical
Evaluation of adnexal and uterine masses
Evaluation of patients with subfertility
MRI of pituitary for suspected prolactinoma

23
Q

How is endometriosis diagnosed?

A

Difficult to diagnose = patients may need diagnostic laparoscopy

24
Q

How is endometriosis recognised on MRI?

A

Deposits contain altered blood and haemoglobin degradation products = cause characteristic MRI changes

25
Q

How does the altered blood in endometriosis appear on MRI?

A

Returns high signal on T1 sequences = looks white

Returns low signal on T2 sequences = looks grey

26
Q

How does fat appear on MRI?

A

Looks white on T1 sequences but appears dark on special fat-suppression sequences

27
Q

What do dermoid cysts contain?

A

Tissue derived from ectoderm, mesoderm and endoderm = mostly contain fat v=but can contain many types of tissue

28
Q

How is fat imaged?

A

Has predictable MRI signal characteristics and can also use CT, but difficult to perceive on US

29
Q

What is a hysterosalpingography (HSG)?

A

X-ray screening procedure = real-time imaging, usually takes 3-5mins

30
Q

What is an HSG used for?

A

Assessment of tubal patency in suspected infertility and assessment of uterine cavity

31
Q

How is an HSG carried out?

A

Cervix cannulated and radiopaque contrast instilled to fill uterine cavity

32
Q

What is done before contrast is instilled during an HSG?

A

A scout “control” film is obtained just before

33
Q

When are images captured during an HSG?

A

Once contrast is instilled = series of images captured as contrast fills uterine cavity, then into fallopian tubes and spills into peritoneal cavity

34
Q

How is cancer staged?

A

Using TMN system

35
Q

What is the purpose of the pre-treatment scan for cancer?

A

Serves as baseline so subsequent scans can be used to assess treatment response

36
Q

How does ovarian cancer spread?

A

Disseminates by peritoneal spread

37
Q

What extra-ovarian features are common in ovarian cancer?

A

Ascites, omental and peritoneal nodules are common

38
Q

How do malignant pleural effusions occur in ovarian cancer?

A

Result from spread of disease via pleuro-peritoneal communications

39
Q

Are lymph node, lung and liver metastases common in ovarian cancer?

A

No = tend to be seen in patients in whom disease behaviour has been modulated by chemo or in cancers with BRCA1 mutation

40
Q

How is the initial diagnosis of ovarian cancer made?

A

Using US

41
Q

How is ovarian cancer staged?

A

CT usually used for radiological staging

42
Q

What must be determined when when staging cervical cancer?

A

Presence of = spread into parametrium, extensions into vagina, infiltration of adjacent organs, metastases to regional lymph nodes

43
Q

What is used for imaging cervical cancer?

A

MRI (esp T2) is better than CT for local disease

CT used for determining presence of distant metastases

44
Q

What modality is best for diagnosing endometrial cancer?

A

Transvaginal US = best for establishing abnormally thickened endometrium

45
Q

What are MRI scans used for in endometrial cancer?

A

Assessing degree of myometrial invasion

46
Q

Why is there difficulty using MRI to image endometrial cancer?

A

Many patients obese so are too large for narrow MRI bore

47
Q

What are CT scans used for in endometrial cancer?

A

Used to find distant metastases and pulmonary metastases

Reproduction (62 decks)

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