Term
| what is the sagittal view? axial? |
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Definition
| sagittal: from the side axial: from the inferior/superior perspective. |
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Term
| how do you remember what T1/T2 are? |
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Definition
| T2 - like H2O, enhances water (bright) |
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Term
| what characterizes plain film radiology? |
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Definition
| plain film radiology involves a limited dose of *ionizing radiation (0.1 mSv - small dose). the avg dose of radiation for a US resident is 3 mSv/yr. limited diagnostic yield for gyn path. |
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Term
| what characterizes fluoroscopy? |
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Definition
| this also involves ionizing radiation, but allows for a *dynamic evaluation of anatomy/physiology, such as for hysterosalpingograms/recanalizations. dose is pt dependent. interpretation may be fluoroscopist-dependent. |
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Term
| what characterizes ultrasound (US)? |
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Definition
| this is the primary exam for gym path and involves *no ionizing radiation. US can determine anatomy, pathology, vascular flow, and resistive index. |
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Term
| what characterizes computerized tomography (CT) scans? |
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Definition
| CT scans involve ionizing radiation, w/typical doses: ~ 3 mSv. (comparable to total avg yearly dose of radiation for a US resident). CT scans are non-operator dependent and can be used to exclude other pathology/disease. |
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Term
| what characterizes magnetic resonance imaging (MRI)? |
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Definition
| MRIs contain no ionizing radiation, but are expensive and slow (less available, claustrophobia, metallic implants, etc). they are non-operator dependent - but are *protocol dependent (requires good hx: detailed evaluation of uterus/adnexa w/multiplanar reconstruction). *can get a lot of gyn information from this modality. |
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Term
| what characterizes nuclear radiology? |
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Definition
| nuclear radiology constitutes various exams/isotopes, but essentially radiopharmaceuticals are injected which localize to various parts of the body in diseased/non diseased states. *PET-CTs are most used for gyn path, which determine CA uptake in staging conditions like endometrial CA (consists of a tracer is labeled w/glucose complexed w/fluoride). |
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Term
| what gyn path can be determined from a plain film? |
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Definition
| constipation, IUD presence, evidence of prior sx...not much else |
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Term
| what gyn path can be determined from fluoroscopy? how is this performed? |
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Definition
| the cervix is cannulated and contrast is injected which fills the uterus, fallopian tubes and spills into cavities - allowing evaluation of fallopian tube patency, adhesions and anomalies. |
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Term
| what gyn path can be determined from a US? |
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Definition
| the structures of uterus are visible, including the junctional zone, myometrium, and endometrial stripe (evaluate thickness). nabothian cysts (benign) are also visible. power doppler allows visualization of blood flow. 3D US can help visualize gestation better. |
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Term
| what gyn path can be determined from a CT? |
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Definition
| not much, "normal uterus" is a common evaluation, ovaries are hard to see etc. |
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Term
| what gyn path can be determined from an MRI? |
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Definition
| this offers multiplanar imaging, good for visualizing the uterus |
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Term
| what gyn path can be determined from a nuclear radiology? |
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Definition
| PET-CT allows staging of CA |
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Term
| how can an arcuate uterus be diagnosed? |
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Definition
| hysterosalpingogram (HSG, fluoroscopy) would show a mild convex contour of the fundus. (this is an "aunt minnie" - a distinctive always recognizable dx) |
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Term
| how can an septate uterus be diagnosed? what is a septate uterus? |
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Definition
| HSG (fluoroscopy) would show widely separated cornua. US/MRI is diagnostic for this (shows convex fundal contour and muscular septum). *a septate uterus is due to incomplete resorption of the fibromuscular septum and may result in 1st trimester miscarriages, due to implantation of the embryo onto hypovascular septum. tx: septoplasty. most common congenital gyn anomaly. |
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Term
| how can a unicornuate uterus be diagnosed? |
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Definition
| this would feature a characteristic R angle appearance - HSG only filling a single cornu. (another aunt minnie) |
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Term
| how can a bicornuate uterus be diagnosed? what characterizes this anomaly? |
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Definition
| HSG would show two separate endometrial cavities, but one common cervix. typically mom doesn’t have a 1st trimester miscarriage, but prone to premature labor b/c of less endometrial canal capacity (potential for IUGR as well). |
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Term
| how would uterine didelphys be diagnosed? |
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Definition
| HSG would show complete duplication of the endometrial cavity/cervix (uterus x2). this is due to complete failure of the mullerian ducts but pts w/this have normal fertility. (aunt minnie). |
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Term
| what is a DES uterus? how would this be diagnosed? |
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Definition
| HSG would show a small, T-shaped uterus w/normal tubes. this is due to in-utero DES (diethylstilbestrol) exposure and increases risk of vaginal clear cell CA. (aunt minnie) |
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Term
| what is an intrauterine filling defect? |
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Definition
| HSG would show a smooth oval filling defect in the fundus, which may be due to: air bubble, endometrial poly, submucosal leiomyoma, endometrial CA, blood clot/mucoid material or an early IUP. |
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Term
| what is asherman's syndrome? how would this appear in HSG? |
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Definition
| asherman's syndrome is characterized by multiple adhesions, tiny intrauterine volume, infertility and may include a hx of postpartum/post abortion curettage. the uterus would appear small/squeezed on HSG. (aunt minnie) |
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Term
| what is salpingitis isthmica nodosa? how would this appear in HSG? |
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Definition
| numerous small foci of adhesions/outpouchings in the fallopian tube - appears as small foci of contrast pooling along the proximal fallopian tube (irregular tube contour). this may cause infertility and can be due to infection etc. |
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Term
| how would diffuse adenomyosis appear on US? (*exam question*) |
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Definition
| *myometrial cysts* in the junctional zone of the uterus (cysts/fluid appear black on US). the pt may present w/bleeding, pain, similar presentation to fibroids - but diffuse adenomyosis will show more of a *thickened junctional zone (> 12 mm)* and fibroids would have more of an effect on the endometrial stripe. tx: embolization or hysterectomy. focal adenomyosis may also occur which would would appear as a lump of endometrial tissue in the muscle (emphasis on associated thickness of involved junctional zone). |
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Term
| how would fibroids appear on CT/MRI? |
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Definition
| MRI: dark (T1, T2), sharply defined, homogeneously enhancing. CT: w/gadolinium contrast lights up these leiomyomas. |
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Term
| how would degenerating fibroids appear on CT? |
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Definition
| focal areas of decreased attenuation, w/T2 bright areas (liquid). pts w/this present w/sharp pain - due to fibroids outgrowing their blood supply. |
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Term
| what is uterine artery embolization (UAE)? |
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Definition
| going into each uterine artery and injecting small beads; beads go to the fibroids b/c they’re very vascular, inject them to block off uterine flow completely. anastomoses are present to supply the uterus, but fibroids strictly love the uterine artery, so you inject pellets to “asphyxiate” the fibroids. (performed by interventional radiologists). |
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Term
| what characterizes endometrial CA? |
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Definition
| this is due to excessive estrogen stimulation and often these pts are postmenopausal - but bleeding (hx = important). |
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Term
| how is endometrial CA diagnosed? |
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Definition
| evaluation of increased blood vessel formation/endometrial thickness which may be the sign of an enhancing tumor either by bright areas on doppler or MRI (r/o pregnancy or secretory phase). lymphadenopathy may also co-present. MRI has a limited role for this, *bx/US is better, b/c MRI cannot differentiate between endometrial polyp/hyperplasia very well. |
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Term
| when would CT/MRI imaging be used to dx cervical CA? |
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Definition
| if the imaging was done for something else on a pt who had not had a recent pap smear or for staging. *US should be the primary gyn imaging tool* |
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Term
| how would cervical gestation be dxed via US? |
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Definition
| no visualized IUP, may see pseudogestational sac, a widened cervical canal, and a cervical gestational sac below a closed internal cervical os. |
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Term
| how would heterotopic pregnancy (one in, one out) be dxed via US? |
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Definition
| IU gestational sac; adnexal mass/gestational sac; echogenic material in a cul de sac. |
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Term
| how would an abdominal pregnancy appear on US? |
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Definition
| no IUP, possible pseudogestational sac, extrauterine placenta, oligohydramnios, fetal parts adjacent to maternal wall, abnormal lie, and maternal bowel gas blocking visualization |
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Term
| what risk factors are ectopic pregnancies associated with? causes? |
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Definition
| risks: PID, ART, blockage in tubes (scarring due to infection, surgery or prior ectopics, endometriosis, IUD use). caused by: prior D&C, asherman's |
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Term
| how would pelvic congestion syndrome appear on CT? what is this? tx? |
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Definition
| dilated veins around the uterus (like varicocele in males - L gonadal vein empties vertically into the L renal vein while the R gonadal into IVC inferior to R renal vein). pts w/this present with feelings of "heaviness". tx: embolization/sclerosing of veins. |
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Term
| how is embolization for pelvic congestion syndrome carried out? |
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Definition
| fluoroscopy is used to stuff metal coils into the gonadal vein which have fibers that lead to clotting and shriveling of veins (may cause fever). |
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Term
| how is fallopian tube recanalization carried out? indications? contraindications? |
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Definition
| fluoroscopy allows guidance of a wire through the tubes. indications: proximal unilateral/bilateral fallopian tube occlusion, confirmed by HSG; selective salpingography or laparoscopy; + eval by infertility specialists & gynecologists; reocclusion post surgical reversal of tubal ligation. contraindications: active PID, severe conditions, distal occlusions, and allergy to contrast. |
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Term
| how would adnexal torsion appear on US? |
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Definition
| fluid collection, increased echogenicity, no flow in ovary, multiple follicles |
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Term
| how would a pedunculated fibroid appear on US? |
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Definition
| a round echogenic area; coming off the uterus w/endometrial striping |
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Term
| if a pt is febrile and US shows a large mass in the pelvis, what might it likely be? |
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Definition
| an abscess - esp if fat is visible w/out hair or teeth (like teratoma) |
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Term
| how would a ruptured corpus luteum w/hemoperitoneum appear? |
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Definition
| all hemorrhage around & below cyst |
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Term
| how would hydrosalpinx appear on CT? |
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Definition
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Term
| how would peritoneal inclusion cysts appear on MRI w/contrast? |
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Definition
| spots of brightness (fluid pockets) spread out through the bowel. ddx: seroma, lymphocele, etc |
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Term
| what procedures can the interventional radiologist do? |
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Definition
| uterine fibroid embolization, non fibroid uterine artery embolization, prepartum uterine artery embolization, pelvic congestion syndrome, fallopian tube recanalization, and endovenous ablation of varicose veins. |
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