Lecture 20: Imaging of the reproductive tract Flashcards
What imaging do we use mostly in the reproductive tract?
USS (really good at looking at uterus/female pelvis)
MRI
Fluroscopy
(CT not used much: gives good resolution but not much definition within the organs, testis and ovaries are highly sensitive to radiation as there is active cell division: increase chances of malignancies)
How do we ultrasound the female pelvis?
Transabdominal US- through the tummy (longitudinal in mid-sagittal axis to see uterus, transverse to see the ovaries)
Transvaginal US- probe up vagina up to cervix
What imaging do females who are being assessed for subfertility have?
HSG (hysterosalpingogram): see patency of tubes
- x-ray dye (contrast) into uterus, which will pass out through fallopian tube into peritoneal cavity
- ultrasound contrast
What imaging do we mainly use for the male reproductive anatomy?
MRI (prostate/penis)
-you see seminal vesicles and then as you go down you see the prostate
(sometimes do USS of prostate so we do biopsy-transrectal, but MRI is taking over)
What do we look for on USS of the ovaries?
-simple cyst
-haemorrhagic cyst
-endometrioma
-mature cystic teratoma
-any other cyst
(we can see the cycle of ovulation on the ovary)
What are functional cysts in the ovary?
- follicular cyst: dominant graafian follicle sometimes fails to ovulate, 3-8cm, resolve on their own
- corpus luteum cyst: corpus luteum may fill with fluid or blood, use of fertility drugs which induce ovulation increases the chances of these developing and women on birth control don’t form a corpus luteum (characterised by ‘ring of fire’: circular doppler appearance, vascular ring around cyst)
Why do haemorrhagic cysts arise?
Bleeding into corpus luteus cysts or follicular cysts
What is bright on T1 weighted MRI?
Fat, blood
-you can then do a T1W fatsat MRI where fat appears black, so if the cyst is still white it is filled with blood)
Can you see PCOS on USS?
Yes
-cysts/follicles within the ovaries (>20)
What is a mature cystic ovarian teratoma?
- encapsulated tumours with mature tissue/organ components
- composed of well differentiated derivations from at least 2 of the 3 germ cell layers
- contain developmentally mature skin with hair follicles and sweat glands
- sometime clumps of long hair and pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, thyroid tissue (can see teeth in ovaries on imaging)
What is ovarian hyperstimulation syndrome?
Caused by hormonal overstimulation by hCG and is usually bilateral
-can occur in gestational throphoblastic disease, PCOS, patients receiving hormonal replacement therapy
=see large ovaries with lots of cysts
What could you see on imaging if the patient had PID?
- abcess
- gas within fallopian tube and endometrium
How do we image for suspected malignant ovarian lesions?
- USS and MRI
- plus CA125 test (measure amount of cancer antigen 125 in blood)
Cancer stagig after identifying it as cancer: contrast enhanced CT, and look for metastases
What are the risk factors for ovarian cancer?
Low risk: premenopausal
High risk: postmenopausal, FHx of breast/ovarian cancer, BRCA1/2 carriers
Wha do you see on imaging in endometriosis?
- endometriomas (in ovary)
- struggle to detect superficial endometriosis
- deep infiltrative endometriosis can be seen on imaging (USS user dependant, MRI see more clearly and can send it to other people so isn’t user dependant)
(if patient has endometriosis in bladder, you will see blood in urine during menses)
