MDS 1b_Imaging in Obst & Gyn_Dr Gupta

8/2/2019 MDS 1b_Imaging in Obst & Gyn_Dr Gupta

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IMAGING

INOBSTETRICS &

GYNAECOLOGY

Dr. Renu Gupta

Associate Professor

Radiology Department

Kuwait University


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Plain Radiographs of Abdomen & Pelvis

1. Trauma2. Calculus

- Renal

- Ureteric

- Bladder

3. Calcification

- Uterine Fibroid

- Ovarian Dermoid- Ovarian carcinoma

- Tuberculous pyosalpinx

Plain X RayOvarian Dermoid


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Plain Radiographs of Abdomen &Pelvis

5. Abdominal or Pelvic

mass unsuspectedcalcified fibroid

Plain X RayCalcified Fibroid


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Plain Radiographs of Abdomen &Pelvis

4. IUCDs

(intrauterine

contraceptivedevices)

Plain X RayIUCD migrated to the region of the Liver


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Chest Radiographs

1. Pulmonary Tuberculosis

( evaluation of

infertility )2. Pulmonary metastasis

( ovarian or uterinecarcinoma )

3. Pleural effusion

( ovarian or uterinecarcinoma )


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HysterosalpingographyIndications:

1. Infertility: To demonstrate normal patency offallopian tubes & their communication withperitoneal cavity

2. Recurrent abortion: To demonstratecongenital anomalies of uterine cavity orincompetence of internal os of uterus

3. Occlusion of sterilization procedure

4. To monitor effects of tubal surgery5. To demonstrate patency after sterilization

reversal

6. Post operatively after restoring patencypathologically obstructed tube


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Hysterosalpingography (contd.)

Contraindications:

1. Acute pelvic sepsis

2. Sensitivity to contrast media

3. Pregnancy

4. Recent dilatation & curettage

5. The week prior to and week followingmensturation

6. Severe renal or cardiac disease


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HSG

Normal Salpingogram


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Important Congenital Anomalies of Uterus


10/33Bicornis unicollis Uterus

Contrast medium has spilled from the

left tube and outlines the adjacentovary


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HSG

Bicornis bicollis Uterus

Bicornuate Uterus

Arcuate Uterus


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Left Hydrosalphinx

Bilateral Hydrosalphinx


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Tuberculous Endometritis


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Urinary Tract In Gynecology

IVP:

1. Partial or completeureteric obstruction

2. Division of ureterExtravasation of contrast

3. Vesicovaginal fistula

IVPCa Cervix invading Bladder


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Barium Enema

Detection ofbowel

involvement by:1. Endometriosis

2. Ovarian Carcinoma

3. Rectovaginal fistulaBarium Enema showing compression of

Sigmoid Colon byOvarian Carcinoma


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CT of Female Pelvis

Staging of malignantGynaecological tumors

Primary diagnosis of pelvictumors in cases which

precludes ultrasound .1. Obesity2. Previous surgery3. Unstable bladder

To demonstrate pelvic lymph

nodes To assess retroperitoneum Liver metastasis Peritoneal seeding

Cervical CarcinomaCT showing Metastatic nodal deposits


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MRI ShowingTumor Infiltration of Pelvic side wall byCarcinoma Of the cervix


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Advantages & Role of MRI inGynaecology

1. High soft tissuecontrast

2. Multiplanarimagingcapability

3. PrimaryTechnique ofchoice instaging pelvicmalignancies MRI Showing

Normal Uterus


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Role of MRI in benign conditionsof Pelvis

1. Fibroids:- Size- Site- Number

2. Endometriosis:- Multiple multiloculated

cysts seen outside uterinecavity

3. Adenomyosis:- Diffuse or focal

thickness of junctionalzone MRI Showing

Large Uterine Leiomyomas


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Role of MRI in benign conditions ofPelvis

4. Dermoid cysts-contain lipidmaterial, septate,

sebaceous or adiposetissue

5. Benign ovarian cysts:

- Polycystic ovaries

6. Congenital uterineanomalies:

- Bicornuate/

unicornuate /

septate uterus

Multiloculated Benign Ovarian Cysts


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Role of MRI in malignant conditions ofPelvis

1. Staging for CaCervix

2. Staging forOvarian Ca

3. Staging forEndometrial Ca

4. Repeatedaccuracy ( 85-90 %) in staging

MRI ShowingBulky Exophytic Cervical Carcinoma


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Bulky Carcinoma of Cervixextending to Uterus and bladder

and Vagina


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Imaging Modalities for Breast

Mammography- Conventional

- Digital Ultrasound

- Diagnostic

- Guidance

MRI Image guided biopsy

- Stereotactic

- Needle localization/ Excision


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Conventional Mammography

Gold standard

Screening

Symptomatic

Except

Cyst Abscess

A very young patient


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Ultrasound Indications

Diagnosis of

Cyst

Fibroadenoma

Mammographically dense tissue

Confirm palpable CA

Guided FNAC


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ULTRASOUND SHOULDNEVER BE USED TO

EXCLUDE CARCINOMAWITHOUT MAMMOGRAPHY


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MRI Breast

Exclusion of Malignancy in Breast

Post operative breast

After Silicone Implants

Multicentricity/ Bilateral Cancers


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Breast Imaging

In the diagnosis of symptomatic breast,Mammography, Ultrasound / MRI are complimentaryto each other.

Ultrasound to be done first.Cysts, Fibroadenoma, Inflammatory < 35yrs

Mammography first in suspectedCarcinoma, Mass > 35 yrs.

MRI - Post operative, silicone implants, multicentriccancers.


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Triple Test for Breast Diagnosis

Mammogram

Ultrasound/ MRI FNAC/Biopsy


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Pituitary Gland

MRI is the investigation of choice Pre and past contrast scans are essential

to detect microadenomas(


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Pituitary gland

Common benign slow growing

tumor

Represents about 50%ofsellar/parasellar neoplasms inadults

Can be associated withendocrine abnormalities relatedto over secretion of hormones(Prolactinomas) more common

in females.

Rarely, extensive hemorrageinvolving the adenomaresulting in pituitary apoplexy

(sheehans syndrome)


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Bone mineral density

Postmenopausal women

Osteoporosis

WHO classification of BMD

1. Normal2. Osteopenia

3. Osteoporosis

MDS 1b_Imaging in Obst & Gyn_Dr Gupta

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