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Radiology Clerkship > Mammography and GYN imaging > Flashcards

Mammography and GYN imaging Flashcards

1
Q

Dense breat tissue categories

A
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2
Q

Mammogram anatomy

A
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3
Q

Mammogram views

A
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4
Q

Breast cancer screening recommendations

A
  • They vary for general population:
    • Most conservative: Start at age 40, image anually
    • USPSTF: Start at age 50, image every two years
  • For patients at high risk:
    • Start imaging at age 30 with mammogram and breast MRI
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5
Q

BIRADS

A
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6
Q

When is BIRADS 0 appropriate?

A

When a screening mammogram (not diagnostic) finds something of uncertain signfiicance

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7
Q

Diagnostic vs screening mammograms

A

Screening mammograms show only two views of each breast (CC and MLO)

Diagnostic mammograms have multiple views from different angles and better magnification, enabling much better characterization of a lesion. An ultrasound is often additionally indicated following a diagnostic mammogram, and is performed at the same appointment.

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8
Q

Indications for a diagnostic mammogram

A
  • Callback from a screening mammogram (BIRADS 0)
  • Palpable mass on exam
  • Patients with short interval followup for abnormal mammograms (BIRADS 3)
  • Patients with known breast cancer who require further pretreatment or preoperative workup (BIRADS 6)
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9
Q

Utility of dopplar ultrasound in workup of a breast mass

A

Can tell you if it is cystic (no flow) or solid (bloodflow)

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10
Q

For biopsy-confirmed breast cancer with clinically suspected stage 1 disease . . .

A

. . . no further imaging is required before surgery (at least for staging purposes)

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11
Q

Indicatons for breast MRI

A
  • High risk screening
  • Intermediate risk screening
  • New diagnosis of breast cancer – to evaluate for contralateral malignancy not detected on mammography (note, requires contrast)
  • Evaluating for breast implant rupture (does not require contrast)
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12
Q

Does MRI ever replace mammography for screening?

A

NO

It only ever is used in conjunction with mammography

Some low-grade conditions, like DCIS, are more easily identifiable on mammography than MRI

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13
Q

Handling of axillary lymph nodes

A

The sentinel lymph node will typically be biopsied for breast cancer surgery.

If positive, the patient will return for an axillary lymph node dissection.

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14
Q

When should a patient with a history of thoracic radiation begin mammography screening?

A

10 years following radiation

Often contrast MRIs are also indicated for these cases

The classic example is radiotherapy for childhood or young adulthood Hodgkin’s lymphoma

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15
Q

When should a patient with family history of breast cancer begin mammography screening?

A

If their family member was diagnosed before age 50, 10 years prior to their age of diagnosis

Otherwise, standard screening schedule

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16
Q

What is the only situation in which you don’t use contrast on a breast MRI?

A

If you are evaluating for ruptured breast implants

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17
Q

BRCA1 and BRCA2

A
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18
Q

Current recommendations regarding screening for ovarian cancer

A

Nothing has been shown to be effective! This includes clinical exam, transvaginal ultrasound, and CA-125.

There is no good evidence, even for high-risk groups like Lynch syndrome patients, however sometimes these patients are screened anyway.

19
Q

What is the normal endometrial thickness in a postmenopausal patient?

A

< 5 mm if not on hormone therapy

< 8 mm if on hormone therapy

20
Q

You detect endometrial thickening suspicious for endometrial cancer on ultrasound. What are the next steps?

A

Either straight to biopsy, or sonohysterogram first if you want to be confident there is no polyp or other structure you may miss with a biopsy alone.

21
Q

Endometrial hyperplasia on sonohysterogram

A
22
Q

Retained products of conception on ultrasound

A

There will be vascular flow

This is a key finding

23
Q

Once you have your diagnosis from biopsying endometrial cancer, what is the next step?

A

Pelvic MRI with and without contrast to stage the cancer

Also, CXR to look for pulmonary metastases.

This will determine whether the patients gets TLH-BSO, or chemo/rad.

24
Q

1 and #2 most common breast masses in a woman under age 30

A

1: Fibroadenoma

25
Q

Initial imaging in the workup of infertility

A
  • Pelvic ultrasound
  • Hysterosalpingogram (to evaluate uterine and fallopian tube patency)
26
Q

Limitation of sonohysterogram in comparison to hysterosalpingogram

A

Sonohysterogram cannot visualize the fallopian tubes well, while hysterosalpingogram can

Shown is a normal HSG with “fill and spill”

27
Q

Three main treatment options for fallopian tube obstruction

A
  1. IVF
  2. Laporoscopic lysis of adhesions (if present) in attempt to increase fertility
  3. Interventional radiology (attempt to achieve patency through tubal catheterization)
28
Q

Routine workup of new pregnancy

A
  1. Transvaginal ultrasound at 6 weeks post-LMP (note, NOT transabdominal)
  2. Serial beta hCG
29
Q

At what level of beta hCG should you be able to see an intrauterine pregnancy if it is present?

A

>1000 mIU/mL

30
Q

Major limitation of transabdominal ultrasound to visualize GYN anatomy

A

It often requires the bladder to be full, which cannot be done in the acute setting

31
Q

Management of a patient with suspected ectopic pregnancy but negative imaging findings apart from no visible intrauterine pregnancy (with beta hCG < 1500)

A
  • Given the beta hCG, this may yet be an intrauterine pregnancy that is still too small to visualize
  • In this situation, there should be serial beta hCG and clinical monitoring
  • If date of LMP is in question, US should be repeated in 7-10 days
32
Q

Management of a patient with suspected ectopic pregnancy but negative imaging findings apart from no visible intrauterine pregnancy (with beta hCG > 1500)

A
  • D&C followed by progression to laporoscopy or methotrexate if not present
  • Straight to methotrexate
  • Straight to laporoscopy (preferred if pain is severe or there are signs of blood loss)
33
Q

Time by OB ultrasound findings

A
34
Q

What is going on in this pregnant woman’s transvaginal ultrasound?

A

There is a gestational sac with an associated yolk sac and fetal pole

This gestation is 6 weeks along and should also have an observable heartbeat. By the time it is 5 mm long, its heartbeat should be > 100 bpm.

35
Q

Criteria for methotrexate in suspected ectopic pregnancy

A

Additionally, no evidence of ruptured ectopic

36
Q

What gives you the most accurate EDD for a pregnancy?

A

The first trimester ultrasound crown-rump length

37
Q

How does a normal fetal Down syndrome screening ultrasound result change the risk of Down syndrome?

A

It reduces it by half

So by no means does it exclude Down syndrome

38
Q

Three major markers of Down’s syndrome on fetal ultrasound

A
  1. Increased nuchal fold thickness (> 6 mm)
  2. Major structural abnormality (heart abnormality, omphalocele, etc)
  3. Shortened or absent nasal bone
39
Q

There are lots of indications for repeat fetal ultrasound in the 2nd or 3rd trimesters

What are some inappropriate ones?

A

Parental desire to see

Fetal determination of sex unless medically necessary for some reason

40
Q

Even in high risk pregnancies, fetal weight should not be checked more frequently than. . .

A

. . . every 2-3 weeks

41
Q

What is the best way to estimate fetal weight in the 2nd and 3rd trimesters?

A

Abdominal circumference

This reflects fetal glycogen stores and is a sensitive marker for placental insufficiency

42
Q

Diagnosing appendicitis in pregnancy

A

1st line: Ultrasound

If negative: non-contrast MRI (Gadollinium should not be used in pregnant patients)

43
Q

While MRI is fine in pregnancy, you should NOT. . .

A

. . . do a contrast MRI

Gadollinium contrast may be fetotoxic

Radiology Clerkship (24 decks)

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