Imaging in Gynecology CH 36

Question 1

xrays for imaging uterus and cervix

Answer 1

rarely imaging of choice, used to detect calcified leiomyomas (fibroids) and IUDs

Question 2

Pelvis US types for uterus and cervix

Answer 2

most common modality for scanning uterus and cervix. can be: transvaginal, transabdominal, and saline infusion sonohysterosalpingogram. d

Question 3

Pelvic US diagnostic uses for uterus and cervix

Answer 3

diagnosis for uterine leiomyomas and polyps and monitoring follicular development in assisted reproduction. Initial test for mullerian anomalies and adenomyosis (may also need MRI for these 2)

Question 4

MRI diagnostic uses for uterus and cervix

Answer 4

used for eval of congenital abnormalties of uterus, leiomyomas, adenomyosis, gestational trophoblastic dz, and endometrial CA with staging. accurately measures size. used to discern between septate and bicornate uterus and complicated mullerian fusion defects

Question 5

Colposcopy biopsy uses for uterus and cervix

Answer 5

needed for diagnosis of cervical CA and its precursor lesions. expensive and long waiting period for results.

Question 6

Other non invasive techniques for cervical CA screening

Answer 6

optical coherence tomography (OCT) noninvasive imaging that uses coherent light to make images of subsurface tissue. used to eval normal and abnormal cervical tissue

Question 7

Pelvic US for endometrium

Answer 7

used to eval uterine cavity and endometrium thickness. Obtain maximal thickness dimension and subtract fluid area.

Question 8

Normal endometrium size

Answer 8

4-8 mm during follicular phase and 7-14 mm during luteal phase

Question 9

Menopausal endometrium changes

Answer 9

may have endometrial stripe <4 mm. if receiving hormone replacement therapy, may have thickness exceeding 8 mm and a small amount of fluid

Question 10

abnormal bleeding caused by?

Answer 10

1/5 of pts with abnormal uterine bleeding have submucous myomas or polyps

Question 11

polyps detected by saline infusion sonohysterography..what do they look like?

Answer 11

appear as smoothly marginated focal lesion that protrudes into endometrium.

Question 12

standard of care for evaluation of endometrium

Answer 12

transvaginal ultrasound fro screening, then endometrial biopsy or hysteroscopy for diagnosis

Question 13

when is transvaginal assessment of ovary used?

Answer 13

for management and prediction of success in assisted reproduction cycles. antral follicles can be seen and used to predict ovarian response and timing for hCG injection and oocyte retrival. also used to eval blood flood and diagnose ovarian torsion

Question 14

Ovarian CA criteria (cyst findings)

Answer 14

cysts larger than 4 cm, solid and cystic components, septa, and papillary nodules

Question 15

CT use for ovarian CA

Answer 15

useful for biopsy and drainage in pts with benign appearing adnexal masses

Question 16

Contraindications to needle biopsy and drainage

Answer 16

lack of safe unobstructed path for needle, bleeding disorders, lack of motivated patients

Question 17

CT and US used in conjunction for diagnose what diseases

Answer 17

pelvic inflammatory disease, adnexal torsion, ovarian vein thrombosis (MRI used for this one too), and hemorrhagic ovarian cysts

Question 18

evaluation of fallopian tubes

Answer 18

endoscopic techniques best for direct evaluation of patency and architecture. HSG gives best indirect evaluation of tubal function (tubal patency and visualization of tubal rugations while avoiding laproscopic sx)

Question 19

disadvantages of Hysterosalpingogram (HSG)

Answer 19

pelvic infection, dye allergies, failure to detect adnexal adhesions, false positive results for tubal occlusion.

Question 20

honeycombing of contrast material in tubes during HSG suggests?

Answer 20

salpingitis isthmica nodosa

Question 21

hypoechoic “sausaging” of the tube during HSG suggests?

Answer 21

hydrosalpinges

Question 22

imaging in ectopic pregnancy

Answer 22

adnexal US, if there is a true getational sac there will be a double ring sign resulting from the decidua parietalis abutting decidua capsularis.

Question 23

transvaginal US dectection of pregnancy

Answer 23

intrauterine pregnancy can be detected when hCG level is 1000-2000 mIU/mL. look for double ring and yolk sac to ensure pregnancy is uterine. if intrauterine pregnancy is not visualized, suspicious for ectopic pregnancy

Question 24

test of choice for diagnosis of pelvic malignancy

Answer 24

CT

Question 25

test of choice for diagnosis for deep and surface pelvic endometriosis

Answer 25

MRI

Question 26

gold standard for diagnosis of peritoneal pathology

Answer 26

laprascopy

Question 27

patients with hyperprolactinemia may present with??

Answer 27

infertility, galactorrhea, decreased libido, and oligomenorrhea. image pituitary if prolactin over 100 ng/mL

Question 28

imaging for pituitary gland

Answer 28

MRI used for greater sensitivity of micoadenomas. will show as areas of low intensity T1 signaling.