Imaging in gynaecology - US Flashcards
What are the different imaging methods used in gynaecology ?
- US
- CT
- MRI
- X-ray screening fluroscopy - e.g. hysterosaplinogram (HSG)
- Functional imagine - PET-CT
Describe X-ray screening fluroscopy and the example of HSG
Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object.
Hysterosalpingography (HSG), also known as uterosalpingography, is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It entails the injection of a radio-opaque material into the cervical canal and usually fluoroscopy with image intensification.
What are the indications for using imaging in gynaecology ?
- Diagnosis of pelvic pain – to figure out the cause
- Assessment of pelvic masses
- Investigation of abnormal menstrual bleeding
- Assessment of patients with post-menopausal bleeding
- Investigation of infertility (these patients may also undergo MR scanning of the pituitary)
- Interventional radiology – fallopian tube recanalisation, uterine artery embolisation etc (these topics will not be discussed further in this lecture)
What is the most commonly used imaging modality in gynaecology and ante-natal practice ?
US
Why is US such a good imaging modality to use ?
- Its cheap
- No ionising radiation
- Can be used in clinic alongside doing pelvic exammination
- Provides very good definition of different pelvic organs
What are the 2 main US techniques used ?
Transabdominal and Transvaginal
What is the appearnace of fluid and tissue on US?
If you remember that FLUID is always BLACK and TISSUE is GRAY. The denser the tissue, is the brighter white it will appear in ultrasound the brightest
Describe the key points to remember to do to ensure a good transabdominal US is taken
The pelvic organs are scanned through the anterior abdominal wall
It is good practice to perform a brief assessment of the 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
The patinet must have a full bladder
Why when taking a transabdominal US must the patinet have a full bladder ?
Because a distended bladder displaces gas-filled bowel loops out of the pelvis (bowel gas scatters the ultrasound beam and degrades image quality)
What are the advantages and disadvantages of transabdominal US ?
ADVANTAGES
- Safe
- Readily available
- No ionising radiation ==> ideal for children and women of reproductive age
DISADVANTAGES
- It is difficult to obtain good images in obese patients and in patients where there is gaseous distension of the bowel
- Operator dependent i.e. quality of image depends on whose taking it
- 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
Describe the 3 main different planes images can be taken in
Remind yourself of the lower abdominal/pelvic anatomy
Go over the strctures seen in the sagittal transabdominal US
Key points to remember to help interpreting:
- Its a sagittal view
- Patinet is lying down
What structure is being shown in this US pic ?
What vascular strcture can the ovaries be shown to be closely related to ?
The R and L external iliac vessels
Go over the strctures shown in this transvaginal US
What structure is being shown here? (obtained via TVS)
Ovary
What pathological finding is shown here ?
Abnormal mass in the left adenexa - this is a transabdo scan
What pathological sign is shown in this pic ?
Ascities in the hepatorenal recess due to an inflam reaction in the peritoneum
What type of mass is shown
Cyst becaue there is mainly fluid in it - i.e. black filled
