Radiology VT: Female GU

Question 1

What are the disadvantages of using ultrasound for gynae imaging?

Answer 1

Resolution depends on body habitus as US waves struggle to penetrate through fat

Question 2

What patient preparation is required for US gynae imaging?

Answer 2

• patient must have a full bladder
• US waves can easily traverse through fluid and it forms an acoustic window to the uterus and ovaries

Question 3

What colour is the uterus on US?

Answer 3

• myometrium = hypoechoic (dark)
• endometrium = hyperechoic (lighter)

Question 4

Which imaging modality is best for checking for metastatic disease?

Answer 4

CT

Question 5

How can a haemorrhagic cyst be separated from a different fluid filled cyst?

Answer 5

Use Doppler flow on US which shows blood flow

Question 6

What does imaging show in an endometrioma?

Answer 6

• US = cyst with haemorrhagic debris
• MRI = haemorrhage

Question 7

What does imaging show in a dermis cyst?

Answer 7

• X-ray = calcification
• US = complex appearance with some solid mass
• CT = fat + calcification (marker of dermis cyst)

Question 8

What are the 3 criteria for PCOS?

Answer 8

• chronic anovulation syndrome associated with androgen excess
• clinical/biochemical hyperandrogenism
• Polycystic morphology on US

Question 9

Describe aspects of ovarian torsion

Answer 9

• twisting of the ovary on its vascular pedicle
• presents with abdo pain, nausea/vomiting (similar to appendicitis)
• US shows enlarged ovary, free fluid in pelvis, possible absent vascularity of ovary

Question 10

What are the symptoms of ovarian cancer?

Answer 10

• non-specific and variable
• abdominal distension
• pelvic/abdominal pain
• feeling full/loss os appetite
• increased urinary urgency/frequency
• IBS

Question 11

Describe how you would calculate the risk of malignancy index

Answer 11

RMI = ultrasound score x menopausal score x CA125

• menopausal score = pre-1, post-3
• ultrasound score = one abnormality-1, 2 or more - 3
• RMI >200 = concern of malignancy

Question 12

What are some features of malignancy on imaging?

Answer 12

• irregular solid/multi-lobulated cystic mass
• solid components on cyst wall
• bilateral ovarian lesions
• ascites, peritoneal nodules, something that suggests metastases

Question 13

What are malignant features of epithelial serous cancer of the ovary?

Answer 13

• thick septations, solid components
• ascites, peritoneal and distal metastases, lymphadenopathy
• imaging shows large cystic mass

Question 14

What do bilateral ovarian masses signify?

Answer 14

Possible metastases from other sources

Question 15

Describe features of fibroids and what you would see on imaging

Answer 15

• solid benign lesion
• pain, infertility, menorrhagia
• US - hyper-echoic mass
• CT - bulky lobulated uterus

Question 16

Describe features of Adenomyosis and what you would see on imaging

Answer 16

• endometrial tissue that has migrated to the myometrium
• asymptomatic, dysmenorrhea, menorrhagia, dyspareunia, chronic pelvic pain
• imaging shows thickening of junctional zone

Question 17

What is the common presentation of endometrial cancer and US findings?

Answer 17

• Post-menopausal bleeding
• US shows thickening of the endometrium

Question 18

What imaging is used to stage cervical cancer?

Answer 18

MRI

Question 19

What is the treatment of cervical cancer?

Answer 19

Stage 2B+ = parametrial invasion (area between cervix and bladder)

• if invasion = chemo/radiation
• if not invaded = surgery

Question 20

Describe features of vaginal cancer

Answer 20

• often associated with cervical cancer metastases
• bleeding, lump, itch that wont go away
• can be associated with HPV