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repro > Imaging the repro tract > Flashcards

Imaging the repro tract Flashcards

1
Q

Most common imaging for the reproductive tract

A

Ultrasound

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2
Q

Other imaging for repro tract

A

MRI - very good for soft tissues
Fluoroscopy
CT - least used, but used for acute cases or cancer staging

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3
Q

Why is CT not used first line for repro tract?

A

It doesn’t give great definition of inside of the organs, ultrasound and MRI are better for internal organ structure

Reproductive system is VERY sensitive to radiation due to lots of cell division - can cause malignancy if repeatedly exposed

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4
Q

Problem with MRI vs Ultrasound

A

MRI takes longer - 30 mins+ report
US is user dependent though
No radiation in either
Claustrophobia in MRI

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5
Q

What is the risk of cancer after 1 CT on Chest, abdo and pelvis?

A

1 in 263

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6
Q

2 options of US imaging of repro tract

A

Trans-abdominal - need to have full bladder
Trans-vaginal - slightly better definition

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7
Q

Why do you need to have full bladder with transabdominal US?

A

If you inflate the bladder it gives a better window to the uterus

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8
Q

When do we use MRI for female anatomy?

A

Ovarian cnacer
Endometriosis
Placenta anatomy - accreta, praevia
View anatomy of uterus - orientation, bicornuate uterus (two parts) etc

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9
Q

What are the smudges sometimes seen on MRI?

A

Arterfact caused by patient moving slightly when breathing

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10
Q

What is didelphys?

A

When you have two uteruses

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11
Q

When do we use a hysterosalpingogram?

A

Assess subfertility by assessing tubal patency - X-ray contrast is injected into uterus via external os, goes to fallopian tubes and then peritoneal cavity

Can check course of contrast and see if there is blockage preventing egg from being fertilised and travelling to uterus

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12
Q

What can cause non-patent tubes seen in a hysterosalpingogram?

A

PID - causes scarring and fibrosis

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13
Q

Reasons for male MRI

A

Image prostate, penis (for penile cancer)
WE DO NOT USE FOR TESTES - do USS of pelvis for this

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14
Q

What can you see on US of testes?

A

Varcioceles, tumours, inflammation/infection

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15
Q

Different types of ovarian cysts

A

Simple
Haemorrhagic
Endometrioma
Cystic teratoma
Any other - could be malignant

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16
Q

How many oocytes mature at each mesntrual cycle?

A

10 Graafian follicles - but only one becomes dominant Graafian follicle

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17
Q

Normal size of domiannt follicle

A

18-20mm by mid cycle - then ruptures and releases oocyte

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18
Q

What happens to the follicle after the release of the oocyte?

A

Dominant follicle collapses
Granulosa cells of inner lining proliferate and swell to form corpus luteum
Then degenerates and forms corpus albicans

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19
Q

Why is the ovarian cycle important for imaging?

A

You can see the changes of menstrual cycle on imaging, it is important to be aware of what is normal

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20
Q

What are the two types of functional cysts?

A

Follicular cyst
Corpus luteum cysts

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21
Q

What causes a follicular cyst?

A

Graafian follicle sometimes fails to ovulate and does not shrink/degenerate to normal size

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22
Q

What is the size a graafian follicle needs to be to be called a follicular cyst?

A

Larger than 3cm

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23
Q

Usual size of follicular cyst

A

3-8cm - can be larger

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24
Q

Appearance of follicular cyst on ultrasound

A

Simple, unilocular (one cavity), anechoic (no echo) cysts, with thin smooth wall

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25
Q

What is treatment for follicular cyst?

A

Nothing - usually spontaneously resolve on follow up appt

26
Q

What is a corpus luteum cyst?

A

Corpus luteum can seal and fill wiht fluid/blood forming a corpus luteum cyst

27
Q

Appearance of corpus luteum cyst on doppler

A

Ring of fire - around cyst

28
Q

Who will not get corpus luteum cysts?

A

Women on birth control that prevents ovulation

29
Q

What increases the chance of corpus luteum cyst?

A

Fertility drugs that induce ovulation

30
Q

Haemorrhagic cyst appearance on US

A

Cyst filled with grey debris

31
Q

Haemorrhagic cyst on MRI

A

On T1 - cyst is brighter (as fat, blood appear bright)
OnT1 fatsat, cyst will still be bright (fat is made black here)
Therefore, we know cyst is filled with blood

32
Q

What is PCOS also known as?

A

Hyperandrogenic anovulation

33
Q

What is PCOS?

A

Chronic anovulation associated with androgen excess
- ovulatory dysfunction, clinical/biochemical hyperandrogenism, PCOS on USS

34
Q

What do you see on PCOS MRI?

A

Small cysts within enlarged ovaries
Should be at least 20 cysts for PCOS to be considered

35
Q

What is a mature cystic ovarian teratoma?

A

Encapsulated tumours with mature tissue/organ components
Composed of well differentiated tissues from at least 2 of the three germ cell layers - ectoderm, endoderm, mesoderm
Can contain hair, sebum, blood, teeth, eyes, sweat glands

36
Q

What is ovarian hyperstimulation?

A

Rare condition caused by hormonal overstimulation by hCG, so usually bilateral
Causing lots of cysts within ovary

37
Q

Causes of ovarian hyperstimulation

A

Gestational trophoblastic disease (abnormal trophoblast cells grow inside the uterus after conception)
PCOS
Patients receiving hormonal therapy eg fertility treatment

38
Q

What is PID?

A

Acute clinical syndrome associated with spread of micro-organisms usually ascending from vagina/cervix/endometrium
Unrelated to pregnancy or surgery

39
Q

Where does the infection ascend from in PID?

A

Ascends from vagina/cervix/endometrium
Then to fallopian tubes
Then to other structures eg peritoneal cavity, can cause tubo-ovarian abscess

40
Q

What can PID cause in the liver?

A

Fitz-Hugh-Curtis syndrome
Peri-hepatitis - can see this as enlarged liver on MRI

41
Q

How are malignant ovarian lesions assessed?

A

US and MRI
and CA125 - tumour marker for ovarian cancer
- work out if lesion is likely to be malignant or not

Then cancer staging using contrast enhanced CT - check if metastasis etc

42
Q

What is it called when a GI malignancy spreads to ovary?

A

Krukenberg tumour - appears as black splodge on ovary on MRI

43
Q

Low risk vs high risk for ovarian tumours

A

Low risk - premenopausal and no risk factors

High risk - postmenopausal or risk factors eg: familial history of breast or ovarian cancer, BRCA1 or 2 carriers, Ashkenazi descent

44
Q

What is endometriosis?

A

Presence of endometrial tissue outside the uterine cavity - mainly in abdominal cavity and most common on surface of ovaries

45
Q

How common is endometriosis?

A

1/10

46
Q

Most common symptoms of endometriosis

A

Dysmenorrhoea
Dyspareunia
Pelvic pain
Infertility
Can be asymptomatic

47
Q

What does endometriosis cause?

A

Endometrioma - into ovary and can haemorrhage into ovary

48
Q

What is superficial endometrosis?

A

Pin-point plaques on peritoneum
Often need laparoscopy to diagnose as struggle to do radiographically (MRI will only pick up 50%)

49
Q

What is deep infiltative endometriosis?

A

Endometrial tissue implants or extends to other organs eg bowel, liagments, bladder or even diaphragm
Can see radiographically

50
Q

How to test for deep infiltrative endometriosis?

A

Bimanual exam - transvaginal ultrasound, and try and palpate uterus with hand on abdomen
See if adhesions viewed on ultrasound move

51
Q

Where can endometrosis occur?

A

Rectum or in rectouterine pouch
Bladder
C-sectional or any other abdominal scar
Ligaments at back of uterus (torus uterinus)

52
Q

What is the kissing ovary sign?

A

Seen in endometrosis
Caused by endometrial tissue pulling ovaries together

53
Q

When do we image testes?

A

Presentation of lump
NOT in testicular torsion as this is acute emergency and needs urgent surgery

54
Q

Seminoma on US

A

Tumour in middle of testes

55
Q

Non seminoma on US

A

Complex calcification, necrosis and less well defined than seminoma

56
Q

Varicocele on US

A

Bag of worms, reverse flow of blood when pt coughs

57
Q

What imaging is reccomended prostate cancer suspicion?

A

MRI - reduce biopsies, previously these were done US guided but not now

58
Q

When is an MRI used for suspected prostate cancer?

A

Raised PSA using PSA density calculation - takes into account PSA value and size of prostate

59
Q

Problem with just PSA value and not PSA density

A

PSA value does not take into account if you have a large prostate, could normally have high PSA anyway

60
Q

What is fusion biopsy?

A

US and MRI together

repro (22 decks)

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