INTRAUTERINE DEVICE = IUD

INTRAUTERINE DEVICE = IUD

CONGENITAL

DISORDERS

Pyometra = pyometrea is a uterine infection, it is

accumulation of purulent material in the uterine cavity.

Ultrasound is usually the initial form of imaging. CT and MRI scanning

may be required for the diagnosis and assessment of perforated pyometra.

Doppler scanning is helpful in detecting blood flow changes when pyometra

complicates endometrial cancer. Pneumoperitoneum on plain X-ray (sub-

diaphragm free gas) or CT scan shows evidence of spontaneous perforation.

= is a bacterial infection that results in collections

of pus in the body.

Pelvic actinomycosis

involving the adnexa and uterus in a

68-year-old woman.

(a) Axial contrast-enhanced

CT image shows a mixed solid and

cystic mass (arrows) in the right

adnexa. U = uterus.

(b) Axial contrast-enhanced CT

image obtained at a lower level

than (a) shows diffuse enlargement of

the uterus (U) with small abscesses

(white arrows). Note the perirectal

soft-tissue infiltrations (black arrows)

and the intrauterine device

(arrowhead).

ENDOMETRIOSIS=is defined as the presence of functional endometrial glands and stroma outside

the uterine cavity.

Transvaginal ultrasonography (US) is the first imaging technique used

to diagnose endometriosis and remains the most accessible technique. Transvaginal

US is used in identifying deep endometriosis, especially in detecting lesions of the

rectal wall and retrocervical space. However, the accuracy of transvaginal US in

the detection of some deep endometriotic lesions may vary depending on the

location of the lesions and the experience of the operator.

MRI imaging is a noninvasive imaging method with high spatial

resolution that allows multiplanar evaluation and good tissue characterization, but

without the use of ionizing radiation or iodinated contrast agents. It is highly

accurate in the diagnosis of infiltrating extraperitoneal endometriosis and allows

the identification of lesions that are hidden by adhesions and the evaluation of

subperitoneal lesion extension. MR imaging also possesses a huge advantage over

other imaging modalities in that it allows a complete survey of the anterior and

posterior compartments of the pelvis to be made with a single study.

Normal anatomy of the anterior

compartment. Sagittal T2-weighted MR image

shows the bladder (*), prevesical space

(outlined in white), vesicouterine pouch

(outlined in red), and vesicovaginal septum

(outlined in yellow)

Endometriotic involvement of the

posterior pelvic compartment in a 29-year-old

woman with hypermenorrhea and

dysmenorrhea. Sagittal T2-weighted MR

images show an irregular hypointense mass

(arrowhead) that extends from the posterior

cervix inferiorly to the vaginal fornix. Note the

presence of a subserous leiomyoma in the

anterior uterine wall (black arrow )

LEIOMYOMA=is a benign smooth muscle tumor that very rarely

becomes cancer

Multiple intramural leiomyomas in a 50-year-old

woman. Axial (a) and sagittal (b) T2-weighted images

show multiple intramural (IM) and

submucosal (SM) leiomyomas with decreased signal

intensity.

•is the third most common gynecologic malignancy, with an average patient age at

onset of 45 years.

•The International Federation of Gynecology and Obstetrics (FIGO) staging system

is used for standardization of treatment results.

•Magnetic resonance (MR) imaging is accepted as optimal for evaluation of the

main prognostic factors and selection of treatment strategy.

•MR imaging examination obviates the use of invasive procedures such as

cystoscopy and proctoscopy

Cervical carcinoma

TABLE 1. Correlation between FIGO Staging, MR Imaging Staging,and Treatment of Cervical Carcinoma

Cervical carcinoma. Sagittal T2-weighted

MR image reveals a small, posterior

cervical carcinoma (arrow)Exophytic cervical carcinoma. Sagittal T2-

weighted MR image demonstrates a large,

exophytic cervical mass protruding into the

posterior vaginal fornix (arrow)

Hydrosalpinx

occurs when a distally blocked fallopian tube fills with fluid.

The blocked tube may be substantially distended

Serous fluid, hemorrhage, or pus may accumulate within the

tube, depending on the cause of the obstruction

A fallopian tube that is filled and distended with blood is

referred to as hematosalpinx, and a tube filled with pus is referred

to as pyosalpinx.

NOTE: On MR images, both hydrosalpinx and pyosalpinx appear as

dilated, fluid-filled, tubular structures. With pyosalpinx, the wall of a dilated fallopian

tube may be thickened, and it has variable signal intensity on T1-weighted images

and heterogeneous signal intensity on T2-weighted images. However, pyosalpinx

often cannot be reliably differentiated from hydrosalpinx on MR images

Radiography shows dilatation of the ampullary portion of the left

fallopian tube, a finding that is consistent with a hydrosalpinx.

The right fallopian tube is abruptly cut off, a finding that is consistent

with previous tubal ligation.

Endometrial carcinoma infiltrating whole

thickness of myometrium (stage

IC). Sagittal image shows hyperintense

endometrial neoplasm (arrows)

infiltrating adjacent myometrium to more

than 50% of its thickness

Normal uterine zonal anatomy. Sagittal

image shows the normal uterine zonal

anatomy. The endometrium is surrounded

by the homogeneous low-signal-intensity

junctional zone (arrow), which is

continuous with the fibrous cervical stroma.

The myometrium (arrowhead) has

intermediate signal intensity

The diagnosis of teratoma or dermoid at CT and MR imaging is fairly

straightforward because these modalities are more sensitive for fat