[08.39] Imaging of the Female Reproductive Tract V2.pdf

Smoothly contoured and pear shaped

What is the normal anatomical appearance of the uterus?

Ultrasound

What is the first choice of imaging modality for examining uterine lesions?

MRI

What is the second choice of imaging or the problem solver for uterine lesions?

CT

Which imaging modality is not the first choice for examining uterine lesions?

9 cm x 6 cm x 4 cm

What are the normal dimensions of an adult uterus?

Cigar shaped

How is the uterus described in the prepubertal stage?

Small

How does the uterus appear in post menopausal women?

Myometrium

Which uterine layer is described as having mid level echogenicity on ultrasound?

Endometrium

Which uterine layer is more echogenic than the myometrium on ultrasound?

Anechoic

How do structures usually appear on ultrasound if they contain fluid or are cysts?

Anteverted

What is the uterine position when it is tilted forward?

Retroverted

What is the uterine position when it is tilted posteriorly toward the sacrum?

Mid position

What is the uterine position when no tilting is present?

Anteflexed

What is the term for a uterus that is folded anteriorly?

Retroflexed

What is the term for a uterus that is folded posteriorly?

Zonal anatomy

What does T2 weighted MRI clearly show in the uterus of women of reproductive age?

Mullerian Duct Anomalies

What common congenital finding is encountered via imaging of the female reproductive tract?

Mullerian Duct

What is the primordial structure that differentiates to form the fallopian tube, uterus, and cervix?

Superior portion of the vagina

What part of the vagina is formed from the Mullerian ducts?

Seven

How many classes are in the American Fertility Society classification of Mullerian duct anomalies?

Class I

Which AFS class refers to hypoplasia or agenesis?

Class II

Which AFS class refers to a unicornuate uterus?

Class III

Which AFS class refers to a didelphys uterus?

Class IV

Which AFS class refers to a bicornuate uterus?

Class V

Which AFS class refers to a septate uterus?

Class VI

Which AFS class refers to an arcuate uterus?

Class VII

Which AFS class refers to diethylstilbestrol related anomalies?

Vaginal agenesis

What condition is commonly associated with AFS Class I hypoplasia?

Mayer Rokitansky Kuster Hauser Syndrome

What syndrome is characterized by the complete absence of the cervix and uterus?

Blind pouch

In MRKH syndrome, how does the abnormally truncated vagina end?

Normal ovaries

What pelvic structures are typically present and normal in cases of MRKH syndrome?

Unicornuate uterus

Which anomaly results from the failure of one Mullerian duct to elongate?

Pear shaped

What is the shape of a unicornuate uterus?

Halved

How does the uterus appear on imaging in a Class II unicornuate anomaly?

One adnexum

In a unicornuate uterus, the one developed half is associated with how many fallopian tubes?

Didelphys uterus

Which anomaly is characterized by two separate uteri and two separate cervixes?

Midline fusion

In Uterus Didelphys, what process of the Mullerian ducts is arrested?

Bicornuate uterus

Which anomaly results from incomplete fusion of Mullerian ducts at the level of the uterine fundus?

Indentation in the endometrium

What feature is used to distinguish a bicornuate uterus from other types?

Septate uterus

What is the most common structural abnormality among the Mullerian duct anomalies?

Incomplete resorption of the septum

What is the cause of a septate uterus?

Midline fundal region

Where is the septum located in a septate uterus?

Amenorrhea, dyspareunia, and infertility

What are three common clinical presentations of a septate uterus?

Subseptate uterus

What is shown in Figure 10 when there is splitting of the endometrium only in the fundus?

Arcuate uterus

Which anomaly results from the near complete resorption of the uterovaginal septum?

Slight indentation less than 1 cm

What characterizes the top of the uterine cavity in an arcuate uterus?

Uterosalpingogram

What is the most common imaging method used to diagnose an arcuate uterus?

Normal anatomical variation

How is an arcuate uterus often classified?

Diethylstilbestrol

What estrogen analog was given in the 1940s to prevent miscarriages?

T shaped endometrium

What is the classic endometrial shape in Class VII DES related anomalies?

Clear cell adenocarcinoma

What type of cancer risk is higher in the daughters of women exposed to DES?

Miscarriage or premature delivery

What obstetric complications are more common in DES daughters?

Uterine Myoma

What are the benign smooth muscle tumors of the uterus commonly known as?

Pregnancy

When do uterine myomas typically grow?

Menopause

When do uterine myomas typically involute?

Malignant degeneration

What rare transformation can happen to a uterine myoma?

Menorrhagia or vaginal bleeding

What are the primary clinical presentations of uterine myoma?

Location

On what basis are uterine myomas classified?

Submucous

Which myoma type abuts and impinges on the endometrium?

Intramural

Which myoma type is located within the myometrium and does not touch the endometrium?

Subserous

Which myoma type appears exophytic and creates a hump on ultrasound?

Calcifications

Uterine myomas are usually difficult to see on CT unless what is present?

MRI

What imaging modality is used to clearly see myoma nodules when ultrasound is equivocal?

Hypointense

How do myoma nodules typically appear on T2 MRI?

Hyperintense

How does the endometrium typically appear on T2 MRI?

Bladder

What structure serves as a fluid filled landmark on T2 MRI?

L5 and S1

Which spinal levels can be appreciated on a sagittal MRI of the uterus?

Adenomyosis

What is the focal invasion of the myometrium by benign endometrium?

Multiparous women over age 30

What patient group is typically affected by adenomyosis?

Dysmenorrhea

What is the common clinical presentation of adenomyosis?

Uterine myoma

What is the closest differential for adenomyosis?

Globular

What is the characteristic uterine configuration in adenomyosis?

Heterogeneous echotexture

How is the echotexture of the myometrium described in adenomyosis?

Subendothelial echogenic nodules

What specific nodules are seen in the myometrium in adenomyosis?

Subendometrial myometrial cysts

What type of cysts are seen in adenomyosis?

Subendometrial hypoechoic linear striations

What linear patterns are seen on ultrasound in adenomyosis?

Absence of nodular lesions or margins

How can you differentiate adenomyosis from myoma on ultrasound?

MRI

What is the best imaging modality for detecting adenomyosis?

Small high T2 signal regions

What MRI finding represents areas of cystic change in adenomyosis?

CT

Which modality may show uterine enlargement but is insensitive to adenomyosis?

Inner layer

What is the endometrium in relation to the layers of the uterus?

Phase of menstruation

On what does the appearance of the endometrium greatly depend?

Proliferative phase

In which phase is the endometrium thin and less than 8 mm?

Days 5 to 14

What days of the cycle constitute the proliferative phase?

Secretory phase

In which phase is the endometrium thick and between 8 to 14 mm?

After ovulation

When does the secretory phase occurs?

Postmenopause

In what stage is the endometrium expected to be thin and less than 5 mm?

Hormonal replacement therapy

What can cause the postmenopausal endometrium to thicken by 1 to 2 mm?

Flow phase

What phase occurs during days 1 to 5 of the cycle?

Junctional Zone

In Figure 22, what layer is indicated by the short white arrow?

Endometrial Hyperplasia

What condition is caused by unopposed or prolonged estrogen stimulation?

Thickened endometrium with small cysts

How does endometrial hyperplasia appear on ultrasound?

Hydrometrocolpos

What is the accumulation of vaginal and uterine secretions in the uterus?

Hematometrocolpos

What is the term for retained menstrual blood in the uterus?

Anechoic

How does fluid in the endometrium appear on ultrasound?

Endometrial Polyp

What is a focal hyperplasia of the endometrium that does not float?

Ages 30 to 60

In what age group are endometrial polyps common?

One to four percent

What is the rate of malignant transformation for endometrial polyps?

Saline infused salpingogram

What procedure helps view endometrial polyps by distinguishing them from floating clots?

Endometrial Carcinoma

What is the peak incidence of this cancer in the 6th decade of life?