Female genital tract

• Imaging techniques are US , CT & MRI.• US is usually the principle examination.• Conventional radiology plays always no major part , the

major exception of HSG .• US either T- Abdominal or T- Vaginal .• See the uterus size, shape, direction, endometerium &

the ovaries .• The normal US findings , the vagina appear as a tubular

structure with centeral echogenic line , the body of the uterus lie behind the urinery bladder .

• The ovaries are suspended by broad ligament . • fallopian tubes are too small to be visualized by US .

Female genital tract

• During child birth years the ovaries measure 2,5 cm – 5 cm in greatest diameter , but in menopause it often atrophy . The endocrine changes occorring during the menistrual cycle have a great effect on the appearance of the ovaries .

• At time of ovulation the follicles rapture give rise to corpus luteum it degenerate if there is no intervening pregnancy .

CT & MRI• The quality of pelvic CT has improved with faster , spiral or

multislice CT . The diagnostic quality of pelvic scans is also improoved with ues of oral & IV contrast ..

• The fallopian tubes & broad ligaments are not visible , the ovaries cannot be usually identified .

• Oral contrast media is used in pelvic examination to differentiate between the bowel and adjacent structures , & IV contrast media used for blood vessels, mass & lymph nodes .

• MRI is excellent soft tissue contrast afforded & images usually taken in sagital, coronal,& axial.

• The ovaries & the broad ligament can also visualized .• The cervix show a low signals on T2 waited , the myometerium

show intemediate signals , the endometerium show high signals, the ovaries show intermediate signals with mullitple follicles of high signala seen in it .

Female genital tract

• Pelvic masses• Imaging techniques US , CT & MRI.• But US sometimes it is difficult to determine from which

organ the mass arises .• Ovarian masses • Cyst : a – follicular cyst are mostly asymptomatic &

regress spontaneously b - corpus luteum cysts are most often seen in first trimester of pregnancy, they usually resolve, but may rapture or twisted .

• Hemorrhagic cyst give characteristic appearance in MRI

Female genital tract • Ovarian tumours • The commonest is cystadenoma & cystadenocarcinima.• They are cystic , solid or mixed , the cyst may be multilocular .• Diagnosis by US, CT & MRI , but this cannot differentiate between

benign & malignant unless there is local invasion & distal spread ,• A malignant nature is suggested if the septa are thick or a solid

nodules are visible within or adjacent to the cyst .• US, CT& MRI may show • Hydronephrosis from ureteric obstruction .• Enlarges lymph nodes .• Liver metastasis .• Ascitis. • Omental & peritoneal metastases are difficult to be visible because of

there small size .• Treatment is surgical removal but staging should be carried out befor

surg.• The main role of post operative imaging is for follow up

Female genital tract

• Dermoid cyst • Are some time confidently diagnosed because of

the fat within it & it contain various calcified components of which teeth are the commonest. The findings can be recognized on US, CT & MRI & some time on plain radiography , other wise only a very large tumours are recognizable on plain film as soft tissue mass occasionaly containing calcium arising from pelvis .

Female genital tract

• Uterine tumours • Fibroid ( leiomyoma ) are common in women over 30

years .• Are usually asymptomatic .• May cause menorrhagia or presented as palpable mass • If it is large may seen on plain film as soft tissue may

contain multiple irregular but well defined calcification.• US & CT show spherical or lobular mass• US show either hypoechoic or echogenic or mixed .• CT give same density as myometerium .• MRI give different signal characteristic from normal uterus.• Very rarely leiomyoma under go malignant changes to

leiomyosarcoma it is less than 1,0 % it is of about 0,2 %

Female genital tract

• Ca of the cervix & body of the uterus diagnosed by physical examination , biopsy & cytology .

• Ca of the endometerium is suspected on US when there is widening of the end-stripe, but confirmation done by cytology & biopsy .

• MRI is useful to assess Ca of the cervix & for staging because it dermined whether surgery , radiotherapy or combined of two .

• CT is less accurate than MRI for local extend• CT & MRI enable detection of enlarged lymph

nodes & dilatation of the ureters in ureteric obst.

Pelvic inflammatory diseases

May be due to the venereal infection, commonly gonorrhea, which in the acute stages give rise to tubo-ovarian abscess .

Pelvic inflamation & abscess formation may also occur following pelvic surgery ,child birth, or abortion or may be seen in association with IUCD ,appendicitis or diverticular disease.

The usual imaging technique is US which show a hypoechoic or complex mass in the adnexa or in the pouch of douglas ( cul-de-sac). Blokage of fallopian tube may cause a hydrosalpinx appear as hypoechoic adnexal mass which is often tubular in shape .

DD from endoeteriosis & ectopic pregnancy .

Female genital tract • Endometeriosis present of endometerial tissue out side

the uterus in the pelvis .• Causes .• US show a cystic or hypoechoeic mass in the adnexal

region or in pouch of douglas .• It is chocolate cyst found in pathology .• Age incidence 25 – 35 ys.• Complications .• MRI give characteristic appearance because of recurrent

bleeding , if the endometeriosis has bled in peritoneal cavity as it commonly does at the time of the menstruation, fluid may be detected in the pouch of douglas .

• Detection of IUCD . US & Plain X-Ray .

Hysterosalpingography ( HSG )

Contrast study of uterus , fallopian tubes .Indications 1- Infertility .2- recurrent abortion .3- monitor the effect of

tubal surgery .Contraindication 1- acute pelvic infection . 2- sever renal or cardiac disease . 3- sensitivity to contrast . 4- recent dilatation or curettage .5- pregnancy .Week prior & week following menstrual cycle .

HSG• Complications : • 1- pain .• 2- Intravasation .• 3- exacerbation of infection .• Normal HSG .• Congenital anomalies :• 1- uterus didelphys .• 2- uterus bicornis bicollis .• 3- uterus bicornuate unicolies .• 4- septate uterus ( arcuate uterus ) & complete septation ..• 5- infantile uterus .• 6- Unicornis unicollis uterus .• Fibroid can be detected by HSG .• Abnormalities in the fallopian tubes 1- hydrosalpinx 2- TB.