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22 Cards in this Set
- Front
- Back
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normal uterine anatomy key features
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endometrium t2 bright
junctional zone (inner myometrium)-dark, <12mm outer myometrium-bright/intermediate may see zonal anatomy in neonate due to maternal estrogens premenarchal-indistinct zonal anatomy, minimal endometrium postmenopausal-indistinct zonal anatomy, endometrium < 3mm |
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normal cervical anatomy key features
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cervical stroma-elastic fibrous tissue, low T2
outer smooth muscle layer-high T2 endocervical canal-glands and secretions, high T2 |
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normal ovary key features
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size 3 x 2 x 2
low-intermediate T1 signal stroma intermediate T2 signal with high signal follicles fat suppression useful for identifying ovaries |
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benign cysts
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ovarian-unilocular
<4 cm premenopausal <3 cm postmenopausal cervix-nabothian cysts 1-3 mm superficial gartners duct cyst-anterolateral upper 2/3 vagina wolffian duct remant->look for renal anomalies 1-2% women bright T2 bartholins gland cyst-posterolateral lower 1/3 vagina or labia bright T2, may hemorrhage or infected ddx urethral diverticulum-midline, clawsign |
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mullerian duct anomalies
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2-3%
67% have reproductive dysfunction 20-40% have renal anomalies, no association with ovary anomalies arcuate-class VI, mild focal thickening of fundal myometrium with a fused external uterine contour, cleft < 1cm septate-class V, midline septum with fusion of fundal myometrium, NO cleft, high incidence of miscarriage bicornuate unicollis-class IV, fundal cleft > 1 cm separating divergent uterine horns, communication between horns, single cervix bicornuate bicollis-class IV, fundal cleft > 1 cm separating divergent uterine horns, communication between horns, duplicated cervix uterus didelphys-class III, complete duplication of uterine horns and cervix, no communication between endometrium or cerix, 75% have longitidunial vaginal septum (duplicated upper vagina), commonly seen with renal agenesis unicornuate uterus-single uterine horn, banana shaped uterus, +/- rudimentary contralateral horn which maybecome distended, assoc with endometriosis |
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leiomyomas
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90% uterine, 5% cevix, rarely broad ligament or adnexa
well cirumcscribed, round low T2 signal pseudocapsule, halo of high T2 signal brisk enhancement, similar to background myometrium, unless degen present |
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leiomyomas common MRI indications
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assess location and size prior to therapy
differentiation from adenomyosis atypical ultrasound features |
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localizing leiomyomas
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center of lesion determines location
try not to emboilze subserosal or exophytic lesions with a thin stalk |
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degenerating leiomyomas
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types
hyaline mixoid red/hemorrhagic nonenhancing nodule with blood products mostly seen after UAE pregnant women with pain cystic-t2 hyperintensity fatty-fat signal/denstiy mri can't distnguish types heterogenous T1,T2 signal with T2 bright halo less often to be tx successfully by embolization |
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distinguishing leiomyomas from leiomyosarcomas
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look for metastatic disease and invasion of adjacent structures
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adenomyosis
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basilis layer of endometrium within myometrium with smooth muscle proliferation
associated with leiomyomas, and endometriosis diffuse low T2, indistinct margins generalized thickened junctional zone >12mm high T2 punctate foci focal adenomyosis ovoid foci of low T2 indistinct margins foci of high T2 foci of high T2 |
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endometriosis
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hemorrhagic cyst vs endometriosis (can't distinguish on MRI->f/u US)
CT limited utility T1 +/- fat sat key to dx cancer and endometriosis rarely associated endometriomas, peritoneal implants, adhesions ovary>ut ligaments>peritoneum |
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endometriosis mri findings
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high signal intensity T1 fat sat
T2 shading of blood products hemosiderin ring fibrous enhancing wall and septation look for solid nodules to det cancer-clear cell or endometroid ca ddx dermoid- can have fluid fluid level, fat sats out, nodules |
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ovarian ca
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90% adenoca
10% germ cell, sex-cord stroma, other risk factors infertility, low parity family hx spread direct peritoneal seeding lymphatic hematogenous (late) MRI wall/septal thickness> 3mm nodules/vegetations large solid component necrosis ascites invasion omental caking/peritoneal disease staging 1-grossly confined to ovaries 2-grossly confined to true pelvis 3-nodal or extrapelvic peritoneal spread 4-distant spread staging, treatment-surgery stage 1 and 2-full stage laparotomy, infracolic omentectomy, sampling multiple peritoneal sites, and pelvic and para-aortic LAD stage 3 and 4-primary optimal cytoreduction and adjuvant chemo or interval cytoreduction after neoadjuvant chemo (nonoperative disease) suboptimal cytoreduction if deposits>1-2 cm |
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nonoperative disease sites of ovarian ca
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intersegmental fissure
porta hepatis lesser sac subphrenic space gastrosplenic ligament gastrohepatic ligament suprarenal retroperitoneum mesenteric root |
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endometrial ca
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most common female genital tract malignancy
50-60 yo 90% adenoca 10% squamous, clear cell, papillary, etc 10% genetic predisposition 50-70% as part of HNPCC (AD) HNPCC familiar early onset (<50yrs) common: colon, endometrium, stomach, ovary spread direct extension lymphatic peritoneal seeding hematogenous-lungs |
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endometrial ca MRI
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mass in endometrium
T1 is to hypointense T2 slightly hyperintense heterogenous enhancement |
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endometrial ca staging
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stage 1-confined to uterine body
1a-endoemtrium only 1b-<50% myometrium 1c->50% myometrium 1b and 1c increased likelihood of nodal mets stage 2-confined to uterus, but cervical invasion stage 3-early locoregional spread to pelvis or pelvic nodes stage 4-invasion of bladder or recturm or distant mets |
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cervical cancer
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4th decade-intermenstrual/postcoital bleeding
risk factors-multiple sexual partners, HPV, smoking poor correlation of clinical staging with surgery/pathology (40-70%) 85-90% squamous cell 10-15% adenoca spread direct invasion parametrial lymphatics rare hematogenous (liver, lungs) |
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cervical cancer MRI features
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t2-intmdt/high signal mass
disruption of dark cervical stroma enhances |
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cervical cancer staging
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stage 1
1a maybe invisible interuption of stromal ring uterine body involvement exophytic endocervical stage 2 2a increased T2 signal of vaginal wall increased vaginal wall thickness 2b parametrial invasion stromal ring disruption irregular interface with adjacent pelvic fat asymmetric paracerivcal mass stage 3 pelvic side wall dz 3a lower vaginal invasion 3b hydronephrosis loss of fat planes with iliac blood vessels + sidewall muscles increased T2 of muscles stage 4 4a rectal or bladder invasion 4b distant mets determine if there is parametrial extension or pelvic sidewall invasion |
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adenoma malignum
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1-3% of cervical adenoca
mimicks nabothian cysts, no enhancement on MRI well-differentiated early dissemination, poor response to therapy, poor px dx if cystic cervical lesion on MRI with dx of cervical adenoca |
