Imaging of the pelvis – CT, MRI Imaging, Ultrasound, and Angiography Flashcards
What is commonly the imaging modality used initially in gynaecology examinations?
- ultrasound
Why is X-ray often a poor choice for investigating pathology in the pelvis?
- X-ray is poor for soft tissue examination
If a female has infertility issues with no known cause, clinicians can use hysterosalpingography. What is hysterosalpingography?
- hystero = womb, salpinx = tube and graphy = imaging
- contrast dye is inserted under pressure into the uterus
- dye moves throughout fallopian tubes and uterus
- good for checking blockages and normal structure
The image below shows a hysterosalpingography, which is where a contrast dye is inserted under pressure into the uterus and the dye will move throughout uterus, fallopian tubes and uterus. What is the abnormality in the image below?
- partially blocked fallopian tubes
A CT scan can be used to assess the pelvis, if there is a mass. However, generally it is not used, why is this?
- poor soft tissue resolution
- ultrasound and MRI are preferred
What is a cystic lesion, also called a functional cyst?
- closed capsule or sac like structure
- typically filled with liquid or gas, similar to a blister
- these can be unruptured graafian follicles that increase in size, generally resolve spontaneously
Label the image showing an ultrasound of the uterus using the labels below:
fundus of uterus bladder cervix endometrium myometrium
1 - bladder 2 - fundus of uterus 3 - endometrium 4 - myometrium 5 - cervix
What is an obstetric ultrasound?
- ultrasound performed to assess foetal growth and health during pregnancy
When assessing for abnormalities on an obstetric ultrasound, what 3 things are generally measured?
1 - crown rump length (head to feet)
2 - head circumference
3 - femur length
What is a defaecating proctogram?
- barium with mash potatoes (fluroscopy) or ultrasound gel (MRI) is inserted into the rectum
- images are then taken with MRI or fluroscopy
- images taken during resting, squeezing and straining your pelvic floor muscles
Defaecating proctogram is where barium or dye based paste is inserted into the rectum and images are then taken with MRI or fluroscopy. Images will be taken during resting, squeezing and straining your pelvic floor muscles. What does this test assess?
- assess dynamic function of pelvic floor
- patients with difficulty defaecating, urgency or faecal incontinence
What is a micturating cystourethrogram (MCU)?
- a scan to assess the functioning of the bladder
- provides information about if ureters are restricted
- if there is backflow of urine into the kidneys
A micturating cystourethrogram (MCU) is a scan that can be used to assess the functioning of the bladder. What is the process for this scan?
- catheter is placed into the penis and fed into the bladder
- contrast dye is injected through the catheter into the bladder
- child then asked to micturate
To assess the vascular anatomy of the pelvis there are 4 key approaches that can be used:
MRI / MRA
Doppler ultrasound
CT angiogram
Angiography (direct catheter angiography)
What is the most commonly used method?
- direct catheter angiography
To assess the vascular anatomy of the pelvis there are 4 key approaches that can be used:
MRI / MRA
Doppler ultrasound
CT angiogram
Angiography (direct catheter angiography)
The direct catheter angiography is the most commonly used approach. What is the procedure for this?
- catheter is inserted into a blood vessel into the groin
- contrast dye is inserted through the catheter
- X-rays are taken to detect the contrast dye
What imaging modality and pathology can be see in the image below:
1 - X-ray with fibroids
2 - CT scan with renal stones
3 - MRI with calcifications
4 - X-ray with calcifications
- 1 - X-ray with fibroids
- generally an incidental finding
What type of imaging can be seen below”
1 - CT fluroscopy
2 - X-ray
3 - ultrasound
4 - hysterosalpingography
4 - Hysterosalpingography
The image below shows a hysterosalpingography. What infertility abnormality can be identified in this image:
1 - blocked right fallopian tube
2 - bilateral blockage of the fallopian tubes
3 - congenital deformity of the uterus
4 - hysterectomy (removal of the womb)
1 - blocked right fallopian tube
- likely to have been caused by an inflammatory pelvic disease
A patient enters A&E following an accident and you suspect a pelvic injury. What imaging modality would be indicated?
1 - X-ray
2 - ultrasound
3 - CT scan
4 - MRI
- 3 - CT scan
- can assess internal organ damage and bones following trauma
You are assessing a patient with a palpable mass in their pelvic region. The patient has a BMI of 45. What would the next examination be?
1 - CT
2 - MRI
3 - Surgery
4 - Rectal examination
- 1 - CT scan
- can be used to assess palpable masses with high BMI
When evaluation a complex mass and staging gynae malignancy, what imaging modality should be used?
1 - MRI
2 - Hysterosalpingography
3 - CT
4 - X-Ray
- 1 - MRI
- even without contrast MRI can stage masses
Identify labels 1-3 in the image:
1 - femoral neck, bladder, uterus
2 - femoral neck, bladder, prostate
3 - ischium, bladder, uterus
4 - ischium, prostate, bladder
2 - femoral neck, bladder, prostate
State the pathology seen in this image:
1 - prostate carcinoma
2 - ovarian carcinoma
3 - uterus carcinoma
4 - bladder carcinoma
1 - prostate carcinoma
What are labels 1 and 2 in the image below:
1 - cervix and uterus
2 - prostate and bladder
3 - uterus and vagina
4 - uterus and cervix
4 - uterus and cervix
What pathology can be seen in the image below:
1 - left ovarian cyst
2 - right ovarian cyst
3 - left ovarian fibroid
4 - right ovarian fibroid
1 - left ovarian cyst
Which of the following is required for an optimal transabdominal ultrasound:
1 - full bladder
2 - high BMI
3 - empty bladder
4 - low BMI
1 - full bladder
Transvaginal ultrasound is best visualised with what:
1 - high BMI
2 - low BMI
3 - empty bladder
4 - full bladder
- 3 - empty bladder
- only required if a retroverted uterus is suspected
What type of imaging is used to assess placenta placement:
1 - obstetric ultrasound
2 - obstetric MRI
3 - obstetric CT
4 - obstetric X-ray
1 - obstetric ultrasound
What type of imaging and abnormality can be seen in the image below:
1 - Defaecating Proctogram with anterior rectocele
2 - Defaecating Proctogram with colon carcinoma
3 - CT with rectal carcinoma
4 - Fluroscopy Defaecating Proctogram with anterior rectocele
- 4 - Defaecating Proctogram with anterior rectocele
You have a patient and suspect urinary reflux through the ureter and into the kidney in a 2 year old patient. What imaging modality would be most appropriate:
1 - Micturating Cystourethrography (MCU)
2 - Defaecating Proctogram
3 - ultrasound
4 - catheter angiogram
- 1 - Micturating Cystourethrography (MCU)
What pathophysiology is evident in the angiography below:
1 - normal
2 - stenosis of right common iliac artery
3 - atherosclerosis plaque of right common iliac artery
4 - calcification of left common iliac artery
- 2 - stenosis of right common iliac artery
If a patient presents with intermittent claudication during exercise, what imaging modality is most suitable:
1 - angiography
2 - MRI
3 - CT
4 - Doppler ultrasound
- 1 - angiography
An 82 year old female patient, who has recently undergone a kidney transplant needs to have the kidney imaged. What is the most appropriate imaging modality:
1 - CT of kidney
2 - regular pelvic ultrasound
3 - MRI of kidney
4 - pelvic doppler ultrasound
- 4 - pelvic doppler ultrasound
What emergency presentation is shown in the images below:
1 - diabetic neuropathy
2 - testicular torsion
3 - idiopathic testicular pain
4 - epididymitis (testicle inflammation)
- 2 - testicular torsion
- blood supply cut off to testes, assessed using ultrasound doppler
