![• Endometrial
carcinoma in a 58-
year-old patient. (a)
Sagittal fast SE T2-
weighted (4,000/119
[effective]) MR image
shows nodular,
discretely irregular
foci of low signal
intensity (arrowheads)
in the endometrial
cavity.](https://image.slidesharecdn.com/gynaecologicalimaging5-160613023211/85/Gynaecological-imaging-116-320.jpg)
![• Ovarian fibromas are composed of
spindle cells that form collagen and
usually display low signal intensity
on both T1- and T2-weighted MRI.
High signal intensity on T2-
weighted images corresponded to
regions of hyalinization and
myxomatous changes [5].
Intratumoral edema is also
common in larger fibromas.](https://image.slidesharecdn.com/gynaecologicalimaging5-160613023211/85/Gynaecological-imaging-171-320.jpg)
Gynaecological imaging
- 2. NORMAL RADIOLOGICAL ANATOMY • UTERUS • It is pear shaped structure • varies in size • Before puberty cervix large and body of uterus small. • After puberty uterus size increases to 7 to 8 cm. • After menopause involute to 5 to 6 cm
- 4. • May be retrovertes or anteverted • Retroflexed or anteflexed • There is difficulty in seeing the fundus if retroverted retroflexed
- 5. On MRI T2W images endometrium is of High signal intensity
- 6. Normal pediatric endometrium. Sagittal US image of the uterus in a 2-year-old girl demonstrates a thin endometrium
- 7. Sagittal US image of the uterus obtained during menstruation shows a thin endometrial lining
- 8. Sagittal US image of the uterus obtained during the late proliferative phase of the menstrual cycle demonstrates the endometrium with a multilayered appearance
- 9. Sagittal US image of the uterus obtained during the secretory phase of the menstrual cycle shows a thickened, echogenic endometrium
- 10. • ENDOMETRIUM IS CONSIDERED ABMORMAL IF IT MEASURES MORE THAN 1.4cm IN PREMENOPAUAL AND MORE THAN 4mm IN POST MENOPAUSAL.
- 11. • On USG endometrium is of high echogenecity . • At the start of follicular phase of menstrual cycle it is thin echogenic line. • From day 8 to 10 of menstrual cycle endometrium thickens and become five layered at midcycle. • In the luteal phase endometrium loses its five layered appearance and becomes progressively more echogenic with normal thickness of 1.2 to 1.4cm.
- 12. • MYOMETRIUM IS HYPOECHOIC ON USG • ON MRI T2W The layer of myometrium just below endometrium is of low signal intensity and the remaining myometrium is of intermediate signal intensity.
- 13. The zonal anatomy, with differentiation between the high- intensity endometrium (E), low-intensity junctional zone (arrow), and intermediate-intensity outer myometrium, is well seen.
- 14. T2-weighted MR image shows the normal endometrium (straight arrow) and junctional zone (curved arrow).
- 15. • Parametrium is hypoechoic on USG • and on MRI T1W intermediate signals and increase in signals on T2W.
- 16. CERVIX • Cervix is cylinderical shape structure 2 to 4cm. • connecting with body of uterus at internal os.
- 17. Normal Uterus–Transabdominal. Longitudinal scan through the urine-filled bladder (B) demonstrates a normal adult uterus with smooth contours, pear shape, and well-defined bright endometrial echo (open arrow). The cervix (arrow) is recognized at the junction of imaginary lines drawn through the long axis of the uterus and the long axis of the vagina (between arrowheads). This uterus is anteverted.
- 18. Transvaginal sonogram in early pregnancy showing a normal cervix. Arrows point to the internal and external os.
- 19. Transabdominal sonogram showing a normal cervix.
- 20. • On MRI • On T2W images,there is hyperintense central zone representing cervical mucus and epithelium • Outer zone of low signals due to fibrostromal wall similar to junctional jone of myometrium • Further peripheral layerof intermediate signal intensity continuous with myometrium.
- 21. VAGINA RADIOLOGICAL ANATOMY • On USG Vagina is visualizes as two linear hypoechoic muscular walls around and echogenic mucosa. • On MRI T2W images vagina has a high signal central zone of mucus and epithelium surrounded by low signal muscular wall.
- 23. Normal vagina seen in the axial plane. T2-weighted shows the vagina as an intermediate-intensity tube (arrow) between the bladder base (B) anteriorly and the rectum (R) posteriorly.
- 24. OVARY • These are oval structures lying in relation with internal iliac vessels on the pelvic side walls. • They are less echogenic than the uterus. • may contain variable number of follicles/cysts.
- 26. • IN MENSTRUATING WOMEN its VOLUME SHOULD BE NORMALLY LESS THAN 7.5ml • AND IN POSTMENOPAUSLA WOMEN NOT MORE THAN 3ml.
- 27. OVULATORY CYCLE • At start of FOLLICULAR PHASE few number of follicles start to develop • From day 8 to 10 one follicle become dominant nad continues to grow at a rate of 2 to 3 mm/day. • About midcycle it measures 18 to 25mm. • after ovulation corpus luteum can be seen seen as irregular cystcontaining internal echoes due to blood or a hypoechoic area.
- 28. Doppler studies • During menstruation and early follicular phase high impedance flow RI appro 0.7 • Following neovascularization and corpus luteum development ,diastolic flow increases leading to low impedance flow and RI less than 0.6 • Doppler indices in postmenopausal are of high resistive index.
- 29. Color Doppler US scan shows abundant flow in the wall of the corpus luteum.
- 30. • Ovaries are best seen in transverse or coronal planes. • They measure about 1.5 to 3 cm in diameter. • Ovary show low to intermediate signal intensity similar to muscle on T1W and low signals on T2W.
- 32. Axial T2-weighted magnetic resonance image of the pelvis. This image reveals multiple subcapsular follicles in both ovaries
- 33. • Follicles are seen which are of Low to intermediate signals on T1W and high signals on T2W • On T1W images difficulty arise in differentiating ovaries from bowel and uterus.After IV gadolinium normal ovaries enhance
- 34. CONGENITAL UTERINE ANOMALIES • The upper two third of vagina uterus and fallopian tube develop from fusion and descent of paired mullerian ducts. • The lower third of vagina is derived from urogenital sinus. • Partial or complete failure of the ducts to fuse result in spectrum of complex abnormalities.
- 36. UNICORNUATE UTERUS • Unicornuate uterus results from complete or incomplete arrest of development of one müllerian duct
- 37. Axial T2-weighted FSE image (2,000/120) shows a laterally deviated banana-shaped uterus (arrow). No rudimentary horn could be detected.
- 39. BICORNUATE UTERUS • Bicornuate uterus results from partial nonfusion of the müllerian ducts . Double uterine bodies and a single cervix are present. An arcuate uterus is considered a milder form of bicornuate uterus; it has a convex or flat external fundal contour and mild impression on the endometrial cavity. Bicornuate bicollis is a variant of bicornuate uterus in which the anomaly is combined with a muscular uterine septum that extends to the external os
- 42. SEPTATE UTERUS • In it uterine septum fails to resorb resulting in failure of correct placental implantation and subsequent miscarriage. Septate uterus results from complete fusion of the müllerian ducts with failure of resorption of the central septum
- 43. Septate uterus: incomplete septum
- 44. the outer fundal contour (superior border) is flat or slightly concave, which is sufficient to make the diagnosis of septate uterus
- 46. UTERUS DIDELPHYS • .Didelphic uterus results from complete nonfusion of both müllerian ducts Two uterine bodies and two cervices are present
- 47. Didelphys uterus. Complete separation and full development of both müllerian ducts is noted. (a) Two vaginas and 2 cervices; (b) 2 distinct cervices; (c) 2 uterine horns are widely splayed; (d) cross section of uterine bodies and cervices.
- 48. Bicornuate uterus. The midline uterine external fundal cleft (superior border) has a depression greater than 1 cm, excluding septate uterus from the differential diagnosis. This image is of bicornuate bicollis, since 2 cervices are present
- 50. Normal uterus. Note a single uterine cavity and flat or convex outer fundal contour.
- 51. Septate uterus. Midline septum can be of variable length and can be muscular or fibrous. In the diagram, the septum is shown as an extension of the uterine myometrium.
- 52. Bicornuate uterus. Note the partial fusion of the lower uterine segment and persistently separated upper uterine segments. Of key importance is the prominent fundal cleft (>1 cm), which distinguishes the anomaly from septate uterus.
- 53. Unicornuate uterus. Note the failure of the development of one half of the uterus.
- 54. Didelphys uterus. Note the complete separation but full development of each müllerian duct.
- 55. Arcuate uterus. Mild thickening of the midline fundal myometrium resulting in fundal cavity indentation but normal outer fundal contour.
- 56. Diethylstilbestrol-exposed uterus. Myometrial hypertrophy results in a T-shaped uterine cavity and cavity irregularity, which is pathognomonic for the anomaly. Typically, the uteri are hypoplastic.
- 57. HEMATOMETRIUM AND HEMATOCOLPOS • Primary amenorrhea • cyclical abdominal pain • pelvic pain • severe dysmenorrhea • USG reveals a thick walled cystic mass either due to obstructed vagina or obstructed uterus with low level internal echoes due to blood.
- 58. Transverse vaginal septum (class 2). Sagittal T2-weighted shows a transverse septum in the middle of the vagina (arrow), causing dilatation of the proximal vagina (V) and uterus (U) (hematocolpos and hetmatometria).
- 59. Obstructed hymen (class 2). Sagittal T1-weighted spin-echo image (500/8) shows a dilated hematometrocolpos. The obstruction is at the level of perineum
- 60. Hematometrocolpos in a 12-year-old girl with abdominal pain. Sagittal US image demonstrates a markedly distended vagina (straight arrow) and uterine cavity (curved arrow)
- 62. MR image shows a blood-filled vagina and a normal uterus
- 63. High incidence of associated single kidney
- 64. kidneys shows congenitally absent left kidney.
- 65. • MRI IS THE TECHNIQUE OF CHOICE IN ASSESSMENT AND EVALUATION OF CONGENITAL LESIONS
- 67. UTERINE FIBROIDS • SUBMUCOUS arise within cavity and distort it • MURAL may or maynot distort cavity depends on precise location • SUBSEROSAL cause bulge on surface of uterus •
- 70. • On USG most fibroids are • ROUND WELL DEFINED • HYPOECHOIC MASSES WITH CHARACTERISTIC INTERNAL ARCHITECTURE SHOWING RECURRENT SHADOWING
- 71. • Nondegenerating fibroids • have a uniform signal intensity indistinguishable from myometrium on T1W images and with lower signals on T2W images.
- 72. • Degenerating fibroids show variable and nonspecific signal appearanceswith an intermediate to high signals on T1W and high signals on T2W images. • Malignant transformation cant be differentiated from degenerating fibroids
- 73. Arrowheads point to enlarged uterus with multiple fibroids
- 74. Axial MRI shows the cross section of a fibroid in the lower uterus. Note the mass effect on the bladder, which is located anteriorly
- 75. Calcified fibroid. Arrrowheads point to the contour of the uterus
- 76. Calcified fibroid. Rectum has contrast from a previous procedure.
- 77. Coronal T2-weighted MRI shows an enlarged uterus with multiple fibroids.
- 79. CT scan shows a subserosal, 2.3- to 2.5- cm, right anterior fundal uterine fibroid.
- 82. MR Coronal image. Fibroid.
- 83. MR Sagittal image Calcified fibroid.
- 84. Sagittal T2-weighted MRI shows a large heterogeneous fundal uterine fibroid.
- 85. Submucosal fibroids. T2-weighted MR image shows a hypointense submucosal fibroid splaying the endometrium (
- 86. Transabdominal sagittal sonogram shows a heterogeneous but predominately hypoechoic posterior uterine fibroid
- 87. young adult female patient with a relatively large submucous fibroid bulging into the uterine cavity
- 88. • Pedunculated fibroids on pedicle usually from serosal surface
- 90. • They can be hyperechoic and may be calcified particularly in postmenopausal women.
- 91. • Degeneration within fibroid appear as • area of increase echogenecity or • irregular cystic areas.
- 92. Fibroids can undergo various degenerative changes, especially when large. This fibroid of the uterus measures 11.2 cms. and shows multiple hypoechoic and hyperechoic patchy areas
- 93. Doppler USG • Fibroids can be very vascular so may show very low impedance flow.
- 94. ADENOMYOSIS
- 95. • It is the presence of endometrial glands within myometrium associated with adjacent myometrial hyperplasia.
- 96. • It is usually a diffuse process but may form a localazised mass or adenomyoma. • Clinical findings are dysmenorrhea and menorrhagia with a tender bulky uterus.
- 97. USG features • On USG poorly defined areas of decreased echogenecity and heterogeneity in myometriumassociated with small 2to 5mm cystic spaces in myometrium in 50% cases. • Focal adenomyoma cause focal bulge in myometrium and may be hypo or hyperechoic but less well defined than fibroids.
- 98. Normal uterus. Sagittal endovaginal US scan shows a normal myometrium (M), which is moderately echogenic and has a homogeneous echotexture. The subendometrial halo, which represents the innermost layer of the myometrium, is visualized subjacent to the endometrium (E) as a thin hypoechoic band (arrows). The endometrium is uniformly echogenic in this patient, who was in the secretory phase of the menstrual cycle.
- 99. • sagittal oblique endovaginal US scan shows that the myometrium is thickened ventrally and has a heterogeneous echotexture (straight arrows). The echogenicity of the ventral myometrium is decreased relative to that of the dorsal myometrium. Additional features of adenomyosis seen in this image include poor definition of the endomyometrial junction and a myometrial cyst (curved arrow).
- 100. adenomyosisSagittal transabdominal sonogram of an enlarged uterus with a thickened posterior myometrium (arrows).
- 101. MRI features • Maximum thickness of junctional zone is 12mm • And in adenomyosis there is diffuse or focal thickening of junctional zone,with or without focal areas of high signal on T2W. • On T2W images focal adenomyosis appear as poorly marginated low signal mass within the myometrium.
- 102. • sagittal T2-weighted MR image shows marked thickening of the junctional zone. The result is a poorly defined low-signal- intensity mass that replaces the ventral myometrium (arrows). The numerous bright foci, some of which have a rounded appearance whereas others have a linear or fingerlike appearance, represent the heterotopic endometrium. Bl = bladder.
- 103. • Focal thickening of the junctional zone. Sagittal T2- weighted MR image shows focal thickening of the junctional zone at the level of the fundus (arrows). Although the maximal thickness of the junctional zone was more than 12 mm in this patient, any focal thickening of the junctional zone should raise the possibility of adenomyosis. Bl = bladder, E = endometrium.
- 104. ENDOMETRIAL HYPERPLASIA • If premenopausal more than 1.4cm • and postmenopausal women more than 4mm.
- 106. Endometrial hyperplasia. US image shows an endometrium with diffuse thickening (maximum thickness, 1.74 cm) due to hyperplasia
- 107. ENDOMETRIAL CARCINOMA • Occurs mainly in postmenopausal women • Most common presenting symptom abnormal uterine bleeding
- 108. Ultrasound features • vary from endometrial thickening to an irregular hypoechoic intracavitatory mass to an enlarged diffusely infiltrated uterus.
- 109. Endometrial adenocarcinoma. (a) US image reveals a heterogeneous endometrial mass (arrows) that is difficult to distinguish from the myometrium. Cursors indicate the entire transverse width of the uterus.
- 110. CT features • Hypodense irregular mass expanding the uterine cavity sometimes associated with blood,fluid or pus within cavity. • CT is good at determining the extent of extrauterine disease but cant easily differnentiate stage1 from stage 2 disease.
- 111. 63-year-old woman with moderately differentiated endometrial adenocarcinoma
- 112. A 57-year-old woman with stage IVB poorly differentiated endometrial carcinoma. CT image through the uterus. The cervix is markedly enlarged and replaced by tumor.
- 113. CT scan also reveals a heterogeneous tumor (arrowheads).
- 114. endometrial adenocarcinoma. CT image through the uterus shows fluid-filled cavity marginated by tumor involving most of the endometrial andcervical regionenlarged lymph node right pelvic
- 115. T2-weighted MR image shows a large, heterogeneous tumor distending the endometrial canal (arrows).
- 116. • Endometrial carcinoma in a 58- year-old patient. (a) Sagittal fast SE T2- weighted (4,000/119 [effective]) MR image shows nodular, discretely irregular foci of low signal intensity (arrowheads) in the endometrial cavity.
- 118. • THE MOST RELIABLE CRITERIA FOR THE DIAGNOSIS OF MYOMETRIAL INVASION IS DISRUPTION OF JUNCTIONAL ZONE.
- 119. • FOLLOWING IV CONTRAST ENDOMETRIAL CARCINOMA ENHANCES .
- 120. FIGO STAGING FOR UTERINE CORPUS
- 121. •OVARIAN PATHOLOGIES
- 122. POLYCYSTIC OVARY • LARGE OVARIES VOLUME >7.5ml • MORE THAN 2to 5mm follicles MAINLY PERIPHERAL DISTRIBUTION INCREASED STROMA LARGE /NORMAL UTERUS THICK ENDOMETRIUM
- 123. • numerous peripheral follicles and hyperechoic stroma. Note that none of the follicles is larger than 1.2 cm.
- 127. MULTIFOLLICULAR OVARY • Size of uterus and ovary normal. • several follicles of 5 to 10mm. • no increase stroma
- 128. Primary ovarian failure • Size of uterus and ovary small • no follicle seen • no increase stroma
- 129. SIMPLE ADNEXAL CYST • Most commonly functional in origin • D/D • Paraovarian cysts • Endometrioma • Hydrosalpinx • Neoplastic cysts • Peritoneal cysts.
- 130. • 3.5-cm simple ovarian cyst (calipers). Normal-appearing ovarian tissue (arrows) with a few follicles around the periphery confirms the ovarian origin of the cyst.
- 132. • corpus luteum within the ovary. It has a slightly thick, crenulated wall (arrows) and a small cystic center
- 134. Anechoic lesion with posterior acoustic enhancement.thin smooth walls.no solid part.unilocular.simple follicular cysts.no septa.normal vessels
- 135. HEMORRHAGIC CYST • a retracting clot (asterisk) with concave margins along the wall of a hemorrhagic cyst
- 136. • hemarragic cyst complex cystic mass within the periphery of the ovary. The seemingly solid area within the cystic mass has concave margins and no demonstrable flow, both typical features of a clot.
- 137. • hemorrhagic cyst complex ovarian cyst with a seemingly solid area due to a clot (C). This could be mistaken for the solid area of a neoplasm. No flow was evident
- 138. • hemorrhagic cyst complex ovarian cyst with internal echoes. There is a reticular or fishnet pattern to the internal echoes due to fibrin strands (arrows). Note how the fibrin strands are thin
- 140. RUPTURED CYST • right adnexa shows a thick-walled ovarian cyst (corpus luteum) with surrounding anechoic free fluid, a finding indicative of rupture
- 141. TORSION OF CYST • Twisted vascular pedicle showing the circular string-of- beads appearance of dilated veins (arrows). BL-indicates urinary bladder; and CYST, ovarian cyst.
- 142. Whirlpool Sign in Ovarian Torsion
- 143. Whirlpool Sign
- 144. A, Snail shell appearance of the twisted pedicle (arrows). BL indicates urinary bladder; and CYST, ovarian cyst. B, Color Doppler study of the twisted artery and vein.
- 145. • A, Twisted pedicle appearing as a large echogenic mass (arrows). B, Color Doppler study of the pedicle showing absent flow.
- 146. ENDOMETRIOMA
- 148. • endometrioma complex ovarian cyst with homogeneous internal echoes. It contains a small solid- appearing area (arrow). Color Doppler US (not shown) did not demonstrate flow in the solid area.
- 149. • endometrioma complex ovarian cyst (between arrows) with homogeneous internal echoes.
- 150. DERMOID CYST
- 151. • Mature cystic teratomacomplex ovarian cyst (long arrows) with low-level internal echoes and a markedly hyperechoic solid-appearing area (with faint distal acoustic shadowing (S).
- 153. 'tip-oftheiceberg sign acoustic shadowing from the hyperechoic part of the dermoid cyst
- 154. mature cystic teratoma.suppresed on stir.contain fat
- 155. TUBO OVARIAN ABSCESS
- 156. Endovaginal sonogram. This image shows anechoic tubular structures in the adnexal area; the finding is compatible with a hydrosalpinx.
- 157. Endovaginal ultrasound scan. This image shows anechoic tubular structures in the adnexa; the finding is compatible with a hydrosalpinx.
- 158. Endovaginal ultrasound scan. This image reveals a tubular structure with debris in the left adnexa; the finding is compatible with a pyosalpinx.
- 159. hydrosalpinx tubular-shaped cystic mass with a septum. Small nodules (arrows) in the mass are due to thickened endosalpingeal folds
- 160. Endovaginal ultrasound scan. This image shows a relatively enlarged right ovary, increased flow, and a small amount of adjacent free fluid. These findings are compatible with oophoritis.
- 162. Endovaginal ultrasound scan. This image shows a healthy left ovary.
- 163. This sonogram shows a markedly heterogeneous and thickened endometrium, a finding that is compatible with endometritis.
- 164. This sonogram demonstrates a markedly heterogeneous and thickened endometrium. On closer evaluation, a fluid-fluid level in the endometrial cavity is revealed. In the appropriate clinical setting, this finding is compatible with pyometrium, as it was in this case.
- 165. This sonogram reveals bilateral complex masses in a patient who had pyometrium. The finding is compatible with tubo-ovarian abscesses.
- 166. This sonogram reveals bilateral complex masses in a patient who had pyometrium, a finding that is compatible with tubo-ovarian abscess.
- 167. Power Doppler sonogram. This image shows increased flow to the wall of a tubo-ovarian abscess. The inner hypoechoic regions are due to the presence of purulent material
- 168. Endometritis with air in the endometrial cavity and bilateral tubo-ovarian abscesses are shown.
- 169. Paraovarian cyst.
- 170. Ovarian fibroma • Ovarian fibroma in a 24-year-old woman. Sagittal transvaginal US scan reveals a slightly hypoechoic solid mass (M) within and replacing most of the ovary (calipers). No distal acoustic shadowing is present
- 171. • Ovarian fibromas are composed of spindle cells that form collagen and usually display low signal intensity on both T1- and T2-weighted MRI. High signal intensity on T2- weighted images corresponded to regions of hyalinization and myxomatous changes [5]. Intratumoral edema is also common in larger fibromas.
- 172. 52-year-old woman with ovarian fibroma with prominent cystic change. Axial T2-weighted
- 173. axial T1-weighted
- 176. EPITHELIAL OVARIAN TUMORS • serous cystadenocarcinoma complex ovarian cyst (calipers) with several thick septa (arrows) and solid areas.
- 177. • Benign serous cystadenoma in a 49- year-old woman. Contrast material- enhanced CT scan shows a unilocular cystic mass in the right lower quadrant (arrows). The wall of the mass is not delineated, and there is no evidence of any excrescence within it.
- 181. • 21-year-old woman with ovarian serous cystadenoma. Sonogram shows echogenic mural nodule (arrow) in cystic mass.
- 182. • 21-year-old woman with ovarian serous cystadenoma. CT scan shows enhancing papillary projection
- 183. • Bilateral serous cystadenocarcinomas in a 50-year-old woman. Contrast- enhanced CT scan shows bilateral ovoid tumors (T) with some septa and mural nodules.
- 184. • 21-year-old woman with ovarian serous cystadenoma. Sagittal contrast-enhanced T1-weighted MR image shows papillary projection (arrows) in cystic mass.
- 185. • 38-year-old woman with ovarian mucinous cystadenofibroma. CT scan shows large cystic mass with enhancing solid portion
- 186. • Benign mucinous cystadenoma in a 26- year-old woman. Contrast-enhanced CT scan shows a large, multilocular cystic mass (arrows) with a smooth contour, honeycomb appearance, and heterogeneous attenuation in the locules.
- 187. • . Serous cystadenocarcinoma of the ovary with peritoneal carcinomatosis in a 60-year-old woman. Contrast-enhanced CT scans obtained at the level of the liver
- 188. Brenner tumour • They are mainly hypoechoic solid masses. Calcifications have been reported in 50% of Brenner tumours on ultrasound. • CT • calcifications have been reported in ~ 83% of Brenner tumours on CT. • solid component may show mild to moderate enhancement post contrast. • Pelvic MRI • due to its predominantly fibrous content content they appear hypointense on T2 weighted sequences
- 189. Axial contrast-enhanced CT shows a solid mass (arrows) with 8 cm diameter arising from the right ovary. Extensive amorphous calcification within the mass is seen
- 190. Axial T1-weighted image showing a large hypointense adnexal mass (arrows) arising from the right ovary.
- 191. Sagittal T2-weighted image demonstrating large right adnexal mass to be uniformly hypointense (asterisk). Also seen is anteverted and anteflexed uterus (arrow).
- 194. DIFFERENTIATION OF BENIGN AND MALIGNANT OVARY TUMORS
- 195. • Color Doppler ultrasonogram shows very low impedance flow within the wall, which indicates an ovarian tumor.
- 196. OVARIAN HYPERSTIMULATION SYNDROME • ovarian hyperstimulationmark edly enlarged left ovary (arrows) with multiple adjacent simple cysts in a patient undergoing in vitro fertilization
- 197. HYSTEROCONTRAST SONOGRAPHY • Hysterosalpingo-contrast-sonography (usually shortened to HyCoSy) is a simple and well-tolerated outpatient ultrasound procedure used to assess the patency of the fallopian tubes, as well as detect abnormalities of the uterus and endometrium.
- 199. • The test uses “Levovist”, a non-iodine contrast agent. Levovist is a microparticle suspension consisting of 99.9% galactose and 0.1% palmitic acid. • The HyCoSy procedure is a safe and reliable alternative to the conventional hysterosalpingogram (HSG) which uses X- rays. No radiation or iodinated contrast material is used for a HyCoSy test.
- 202. • —Endometrial polyp in 33-year-old woman. • A, Sonohysterogram in transverse plane shows solitary, smooth, well-defined, uniformly echogenic intracavitary lesion. Angle of lesion with underlying endometrium (arrows) is acute.
- 203. • Endometrial polyp in 33-year-old woman. • B, Color Doppler image shows single feeding vessel at base of polyp (arrow).
- 204. • Endometrial cancer in 57-year- old woman. Sonohysterogram in sagittal plane with color Doppler reveals that diffuse, irregular frondlike thickening of posterior endometrium shows internal vascularity. Endometrial-myometrial interface has been lost, which suggests invasion into myometrium.
- 205. • Submucosal fibroid in 42-year-old woman at sonohysterography. • B, Transverse image with application of color Doppler sonography shows typical arborizing vascular pattern of fibroid lesion.
- 206. THANKyOU