Radiology - Common Pathologies of Female GU

Question 1

Describe the use of MRI in female GU pathologies

Answer 1

T2 MRI is good for soft tissue detail. The endometrial cavity appears bright and the junctional zone is dark.

Question 2

What size of ovarian follicle is concerning?

Answer 2

Premenopausal women - bigger than 5cm
Menopausal women - bigger than 3cm

Question 3

What is a haemorrhagic cyst and some of its features?

Answer 3

When a haemorrhage occurs in a dominant follicle. It can be detected on doppler ultrasound, it will have speckling within it. It can be asymptomatic but can present with pain. Requires follow up in 6 weeks as most will resolve.

Question 4

What is an endometrioma

Answer 4

• A cyst full of endometrial tissue (haemorrhagic debris)
• These will not go away after 6 weeks
• If unsure then do MRI

Question 5

If a menopausal women has an ovarian follicle bigger than 3cm, what marker is investigated?

Answer 5

CA125 tumour marker. This is the tumour marker for ovarian cancer

Question 6

What would make you consider a dermoid cyst?

Answer 6

If there is fat and calcification on imaging. Ultrasound is not enough for diagnosis. Must have CT or MRI as well

Question 7

Describe the appearence of PCOS on ultrasound

Answer 7

• Lots of little follicles. However diagnosis should be made on the basis of hormone levels

Question 8

Describe features of ovarian torsion

Answer 8

Occurs when ovary twists on its vascular pedicle. It presents in young women with abdominal/pelvic pain, nausea and vomiting.
- Often associated with ovarian mass such as a dermoid cyst

Question 9

Describe the appearence of ovarian torsion on ultrasound

Answer 9

• Enlarged ovary
• Free fluid in the pelvis,
• Ovary may show absent vascularity

Question 10

What are the signs and symptoms of ovarian cancer?

Answer 10

• Abdominal distention,
• Pelvic/abdominal pain
• Feeling full and loss of appetite,
• Increased urinary urgency/frequency
• Irritable bowel disease

Question 11

Describe features of malignancy on ultrasound

Answer 11

• Irregular solid or multi-loculated cystic mass,
• Solid compounent on cyst wall
• Bilateral ovarian lesion
• Ascites, peritoneal nodules or evidence of metastasis.

Question 12

What is the RMI?

Answer 12

Risk of malignancy index, calculated by ultrasound score x menopausal score x CA 125

Question 13

What are the two main classes of ovarian carcinomas?

Answer 13

• Epithelial (90%)
• Non epithelial (10%)

Question 14

Name the different types of epithelial tumours

Answer 14

• Serous (most common)
• Mucinous,
• Clear cell,
• Endometrial,
• Brenners,
• Squamous
  Can be benign, malignant or intermediate

Question 15

What are the different non epithelial tumours?

Answer 15

• Germ cell,
• Sex cord

Question 16

Describe features of serous tumours

Answer 16

• Most are benign.
• Malignant features are thick septations and solid components. Ascites, peritoneal metastasis, lymphadenopathy and distant metastases.

Question 17

What are the potential causes of bilateral ovarian masses

Answer 17

• Metastasis from other primary ovarian malignancy
• Metastasis from other sources eg, Krukenberg

Question 18

Describe features of uterine fibroids and how they appear on imaging

Answer 18

• May cause pain, infertility or menorrhagia or asymptomatic.
• Hypoechoic mass on ultrasound,
• Bulky, lobulated uterus on CT

Question 19

Describe features of adenomyosis and how they might present on imaging

Answer 19

• May be asymptomatic, dysmenorrhoea, menorrhagia, dyspareunia, chronic pelvic pain.
• On imaging thee uterus will have a thick junctional zone. Best imaging is US or MRI.

Question 20

What is parametrial invasion?

Answer 20

Occurs in stage 2b cervical cancer and above. Invasion of the parametrium which is a fibrous band which separates the cervix from the bladder. Contraindication for surgery.