Imaging in Gynecology CH 36 Flashcards
xrays for imaging uterus and cervix
rarely imaging of choice, used to detect calcified leiomyomas (fibroids) and IUDs
Pelvis US types for uterus and cervix
most common modality for scanning uterus and cervix. can be: transvaginal, transabdominal, and saline infusion sonohysterosalpingogram. d
Pelvic US diagnostic uses for uterus and cervix
diagnosis for uterine leiomyomas and polyps and monitoring follicular development in assisted reproduction. Initial test for mullerian anomalies and adenomyosis (may also need MRI for these 2)
MRI diagnostic uses for uterus and cervix
used for eval of congenital abnormalties of uterus, leiomyomas, adenomyosis, gestational trophoblastic dz, and endometrial CA with staging. accurately measures size. used to discern between septate and bicornate uterus and complicated mullerian fusion defects
Colposcopy biopsy uses for uterus and cervix
needed for diagnosis of cervical CA and its precursor lesions. expensive and long waiting period for results.
Other non invasive techniques for cervical CA screening
optical coherence tomography (OCT) noninvasive imaging that uses coherent light to make images of subsurface tissue. used to eval normal and abnormal cervical tissue
Pelvic US for endometrium
used to eval uterine cavity and endometrium thickness. Obtain maximal thickness dimension and subtract fluid area.
Normal endometrium size
4-8 mm during follicular phase and 7-14 mm during luteal phase
Menopausal endometrium changes
may have endometrial stripe <4 mm. if receiving hormone replacement therapy, may have thickness exceeding 8 mm and a small amount of fluid
abnormal bleeding caused by?
1/5 of pts with abnormal uterine bleeding have submucous myomas or polyps
polyps detected by saline infusion sonohysterography..what do they look like?
appear as smoothly marginated focal lesion that protrudes into endometrium.
standard of care for evaluation of endometrium
transvaginal ultrasound fro screening, then endometrial biopsy or hysteroscopy for diagnosis
when is transvaginal assessment of ovary used?
for management and prediction of success in assisted reproduction cycles. antral follicles can be seen and used to predict ovarian response and timing for hCG injection and oocyte retrival. also used to eval blood flood and diagnose ovarian torsion
Ovarian CA criteria (cyst findings)
cysts larger than 4 cm, solid and cystic components, septa, and papillary nodules
CT use for ovarian CA
useful for biopsy and drainage in pts with benign appearing adnexal masses
Contraindications to needle biopsy and drainage
lack of safe unobstructed path for needle, bleeding disorders, lack of motivated patients
CT and US used in conjunction for diagnose what diseases
pelvic inflammatory disease, adnexal torsion, ovarian vein thrombosis (MRI used for this one too), and hemorrhagic ovarian cysts
evaluation of fallopian tubes
endoscopic techniques best for direct evaluation of patency and architecture. HSG gives best indirect evaluation of tubal function (tubal patency and visualization of tubal rugations while avoiding laproscopic sx)
disadvantages of Hysterosalpingogram (HSG)
pelvic infection, dye allergies, failure to detect adnexal adhesions, false positive results for tubal occlusion.
honeycombing of contrast material in tubes during HSG suggests?
salpingitis isthmica nodosa
hypoechoic “sausaging” of the tube during HSG suggests?
hydrosalpinges
imaging in ectopic pregnancy
adnexal US, if there is a true getational sac there will be a double ring sign resulting from the decidua parietalis abutting decidua capsularis.
transvaginal US dectection of pregnancy
intrauterine pregnancy can be detected when hCG level is 1000-2000 mIU/mL. look for double ring and yolk sac to ensure pregnancy is uterine. if intrauterine pregnancy is not visualized, suspicious for ectopic pregnancy
test of choice for diagnosis of pelvic malignancy
CT
