Download Free Medical IMAGING ANATOMY OF FEMALE REPRODUCTIVE SYSTEM PowerPoint Presentation

IMAGING ANATOMY OF FEMALE REPRODUCTIVE SYSTEM PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Radiology and Imaging, which is titled "IMAGING ANATOMY OF FEMALE REPRODUCTIVE SYSTEM", to know about the Imaging anatomy of female reproductive system.

Tags : Radiology, Imaging, Imaging anatomy, female reproductive system

Published on : Jul 28, 2021 | Views : 3419 | Downloads : 20

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

IMAGING ANATOMY OF FEMALE REPRODUCTIVE SYSTEM Dr Roshan Valentine Moderator : Dr Rakesh C A St Johns Medical College Bangalore
Slide 2-

EMBRYOLOGY
Slide 3-

ppt slide no 3 content not found
Slide 4-

UTERUS Thick walled fibromuscular organ Composed of myometrium and endometrium 2 divisions Body( Corpus Uteri) Fundus Isthmus Cornua Cervix Endometrium – mucosal lining Myometrium : smooth muscle + connective tissue and elastic fibers
Slide 5-

UTERUS PreMenarche : Cervix >Corpus Uterus : 2.5-3.5cm Menarche Nulliparous corpus = cervix (6-8cm in length) Parous non pregnant women : corpus is 2/3 of uterine mass(L- 9-10cm) Post Menopausal : Corpus atrophies to premenarche size
Slide 6-

UTERUS MENSTRUAL CYCLE Menstrual Phase Sloughing of functionalis layer of endometrium Proliferative Phase D1-D14 Estrogen dependent – proliferation of functionalis layer Correspond to FOLLICULAR phase of Ovary Secretory Phase D15 – Menstruation Progesterone dependent – endometrium secrete glycogen and mucus Correspond to LUTEAL phase of ovary Endometrial glands hypertrophy
Slide 7-

UTERUS SUPPORTING STRUCTURES Broad Ligament – Laterally to pelvic wall Round Ligament Transverse cervical ligaments(Cardinal Ligaments) Uterosacral ligaments Vesicouterine/vesicocervical ligaments – lateral margin of cervix and vagina to bladder
Slide 8-

FALLOPIAN TUBE Connects uterine cavity to peritoneal cavity Attached to mesosalpinx 8-14cm in length 4 segments : interstitial, isthmus, ampulla and infundibulum
Slide 9-

UTERUS VASCULAR SUPPLY ARTERIAL SUPPLY Uterine artery( Ant br int iliac artery) – gives off arcuate arteries – radial arteries – spiral arteries Ovarian arteries VENOUS SUPPLY Myometrial veins Drains into uterine or ovarian vein in broad ligament LYMPHATIC DRAINAGE Int iliac nodes
Slide 10-

UTERUS – LYMPHATIC DRAINAGE USA ME LIES U Upper-S superficial inguinal A aortic M middle- E external iliac L lower- I internal iliac, E external iliac, S sacral
Slide 11-

CERVICAL ANATOMY CERVIX UTERI Fibromuscular caudal segment of the uterus that communicates with vagina 2 segments Supravaginal segment – internal Os Vaginal segment - External Os Size 2.5-3 cm in non gravid <6cm in pregnancy
Slide 12-

CERVICAL ANATOMY -BLOOD SUPPLY ARTERIAL SUPPLY Descending cervical branch of uterine artery Superior branches of vaginal artery VENOUS DRAINAGE Parametrial venoud plexus – uterine vein – int iliac vein LYMPHATIC DRAINAGE External iliac nodes (via broad ligament) Internal iliac nodes Presacral nodes
Slide 13-

CERVICAL ANATOMY – Age related changes Increases in volume till 5th decade and then reduce Premenarche : Cervix = uterine body Puberty : Body > cervix Menopause : Cervix > body
Slide 14-

VAGINAL AND VULVAL ANATOMY Fibromuscular tube with mucosal lining Interposed between bladder/urethra and rectum Separated from bladder/urethra by connective tissue (vesicovaginal septum) Separated from rectum by rectovaginal septum Morphology classic "H" morphology on axial imaging Upper vagina folds around cervix to form recessed vaginal fornices
Slide 15-

VAGINAL AND VULVAL ANATOMY Vagina divided into thirds Upper 1/3: At level of vaginal fornices Middle 1/3: At level of bladder base Lower 1/3: Below bladder base, at level of urethra Size : 4-12 cm in length Anterior wall : 4-8cm( shorter in length) Posterior wall : 8-10cm(longer)
Slide 16-

VAGINAL AND VULVAL ANATOMY- BLOOD SUPPLY ARTERIAL ANATOMY Descending cervicovaginal artery (upper 1/3 of vagina) Inferior vesicular artery (middle 1/3 of vagina) Middle rectal/inferior pudendal arteries (lower 1/3 of vagina) VENOUS DRAINAGE Drain into internal iliac system by perivaginal venous plexus LYMPHATIC DRAINAGE Upper vagina: Internal and external iliac nodes (similar to cervical drainage pattern) Middle vagina: Internal iliac nodes Lower vagina: Superficial inguinal nodes (similar to vulvar drainage pattern)
Slide 17-

OVARIAN ANATOMY Paired intraperitoneal reproductive ova producing organs Size Premenarche : 3cc Pre menopausal : 4-16cc Multiple bilateral developing follicles Volume increase in follicular phase Peaks at ovulation Post menopausal : 6cc Follicles and cysts less common
Slide 18-

OVARIAN ANATOMY Position Neonates : Above pelvis Nulliparous : Ovarian fossa Anterior : oblit Umbilical artery Superior : Ext iliac A Post : Ureter and Int Iliac A Ligamentous Support Suspensory Ligament Utero-ovarian ligament
Slide 19-

ppt slide no 19 content not found
Slide 20-

OVARY – VASCULAR SUPPLY Arterial Supply Ovarian arteries Enter ovaries at renal hilum Minimal from Uterine artery Venous Supply Ovarian Veins ( rt to IVC and left to Renal vein) Lymphatic Drainage Aortocaval and para aortic nodes
Slide 21-

IMAGING ANATOMY
Slide 22-

HSG Reference radiologic method for assessing tubal patency Indications Infertility and recurrent miscarriages Congenital uterine anomalies Uterine tube pathologies Contraindications Metrorrhagia Acute and sub acute PID Contrast allergy Pregnancy ( UPT/Bhcg mandatory)
Slide 23-

HSG D8-D12 of menstrual cycle Lithotomy position Use of atraumatic catheter , uterine injector(<250-300mmhg) Non ionic contrast media( 10-20 ml) Sequence of images Scout Beginning of uterine filling Uterus completely distended Uterine tube opacification Peritoneal spill
Slide 24-

HSG COMPLICATIONS Pain Bleeding Infection Contrast media reactions
Slide 25-

HSG
Slide 26-

ULTRASOUND Trans- abdominal and trans-vaginal USG TAS Equipment : 3.5-5Mhz curved transducer Wide field of view Requires a filled bladder Displace bowel loops Acoustic window Straightens anteverted/anteflexed vertebra
Slide 27-

ULTRASOUND OVARIES LOCATION Ovarian fossa Medial to external iliac , levator ani Anterior to int iliac artery and ureter Left ovary – difficult to visualize FEATURES Central echogenic stroma with peripheral anechoic follicles( 3- 4mm) Surrounding hyperechoic Tunica Size : 3 x 2 x 1 cm
Slide 28-

ULTRASOUND CYCLICAL VARIATION D1-D5 ( Follicular Phase) Avg diameter of follicles 3-5mm(antral follicles) D6-D8 Increase in size ; 20mm(max) – dominant follicle Anechoic with central hyperechogenicity ( granulosa cells) Ovulation Dec in size Increased echogencity with wall thickening Luteal Body – Inc echogenicity due to prolifern of granulosa cells
Slide 29-

ULTRASOUND
Slide 30-

ULTRASOUND - OVARY POST- MENOPAUSAL Smaller in size – difficult to identify More hypoechoic Fewer/smaller cysts – atretic follicles Punctate peripheral hyperechoic foci of calcification ( dystrophic)
Slide 31-

ULTRASOUND FALLOPIAN TUBES Normally not seen Seen in hydrosalpinx/ascites Seen as continuation of uterine body
Slide 32-

ULTRASOUND UTERUS Size : 7 x 5 x 4cm Echogenicity Myometrium : Thin hypoechoic inner layer - subendometrial halo Thicker echogenic middle layer Thinner hypoechoic outer layer No change with menstrual cycle
Slide 33-

ULTRASOUND - UTERUS ECHOGENICITY Endometrium Menstrual Phase: Extremely thin with hyperechoic line Follicular Phase: TRILAMINAR appearance ET : 8-11mm Ovulatory Phase : hyperechoic endometrium(secretions)
Slide 34-

ULTRASOUND UTERUS Luteal phase ET: 14-16mm Inc echogenicity due to stromal edema and proliferation of glands Post menopausal period With HRT : more thickened w/o HRT : ET < 5mm Thin hyperechoic line /not visible Min fluid within – mucus secretion
Slide 35-

ppt slide no 35 content not found
Slide 36-

ULTRASOUND - CERVIX USG Fluid in endocervical canal: Anechoic linear stripe Echogenic foci of air occasionally can be seen in endocervical canal Endocervical mucosa: Hyperechoic inner band Contiguous with endometrial echocomplex Inner cervical stroma: Hypoechoic middle band Contiguous with junctional zone of uterine body Outer cervical stroma: Slightly echogenic outer band Contiguous with outer uterine body myometrium
Slide 37-

ULTRASOUND CERVIX Walls may have Nabothian cysts RECTOUTERINE POUCH Minimal fluid during menstruation and periovulatory phase
Slide 38-

ULTRASOUND VAGINA Normal Length : 7-10cm Trilaminar appearance Vaginal wall with TVS – hypoechoic and uniformly thin Coated vaginal mucosal layers – echogenic linear interface Lumen appreciable if menstrual blood + Posterior fornix crescent shaped anechoic area
Slide 39-

ppt slide no 39 content not found
Slide 40-

ULTRASOUND - DOPPLER Mid Follicular Mid Luteal Pregnancy + No pregnancy Vascularity ↑ Late luteal phase Vascularity ↓ Vascularity ↑ FLOW IN OVARY
Slide 41-

ULTRASOUND - DOPPLER OVARIAN AND UTERINE ARTERIES Luteal Phase : Inc volume flow compared to follicular phase Pre –pubertal phase : High impedance with absent diastolic flow Menarche :: Low impedance with diastolic flow
Slide 42-

COMPUTED TOMOGRAPHY Less often use due to dec soft tissue resolution Used to see calcification in various lesions ( ex : leiomyoma) and In lymph nodes TECHNIQUE Partially distended bladder required NECT CECT 100-120 ml of non ionic contrats at 2-3 ml/s Delayed scan( 3-5mins) – assess bladder and distal ureter involvement
Slide 43-

COMPUTED TOMOGRAPHY OVARY During acute pelvic pain Identified by following ovarian vessels Ovoid structures with decreased attenuation Ovarian ligaments in presence of free fluid Corpus luteum may shows prominent thickened enhancing wall
Slide 44-

ppt slide no 44 content not found
Slide 45-

ppt slide no 45 content not found
Slide 46-

COMPUTED TOMOGRAPHY UTERUS NECT Uterus : homogenous soft tissue density Endometrium : hypodense CECT Myometrium : variable CE , hypoenhancing in postmenopausal state Endometrium : hypodense central stripe
Slide 47-

ppt slide no 47 content not found
Slide 48-

POST CONTRAST
Slide 49-

COMPUTED TOMOGRAPHY CERVIX NECT: Cervix is of homogeneous soft tissue density CECT: Cervix may demonstrate targetoid enhancement Central secretions/fluid: Hypodense Inner cervical mucosa: Intense enhancement Inner stroma: Hypoenhancing Outer stroma: Intermediate enhancement Cervix often displays diffuse hypoenhancement compared to uterine body
Slide 50-

COMPUTED TOMOGRAPHY VAGINA Mucosa may show prominent smooth, early enhancement in premenopausal patients Hypoenhancing in postmenopausal women Muscular layer is hypoenhancing when compared to mucosa
Slide 51-

COMPUTED TOMOGRAPHY PARAMETRIUM Visible on CT are Round ligament( ribbon like appearance) Uterine ligaments( thickened post RT) Broad Ligament Cardinal ligament ( less often visualized)
Slide 52-

MAGNETIC RESONANCE IMAGING Indications Better soft tissue resolution Characterization of pelvic masses Staging of pelvic malignancies Evaluation of congenital (müllerian) anomalies Treatment follow-up Pelvic floor assessment (dynamic) Evaluation of pelvic lymphadenopathy Pelvimetry Evaluation of pelvic pain in pregnancy
Slide 53-

MAGNETIC RESONANCE IMAGING CONTRAINDICATIONS Metallic implants Claustrophobia GETTING STARTED Anxiolytics Anti-peristaltic agents ( small bowel motion artefacts)
Slide 54-

MAGNETIC RESONANCE IMAGING PATIENT PREPERATION Empty Bladder Reduce motion artefacts Fasting 4-5 hrs Anti-peristaltic agents Bacteriostatic vaginal surgical lubricant Intra luminal contrast Improved visualization of Cx and Vagina
Slide 55-

MAGNETIC RESONANCE IMAGING PROCEDURE Position Supine Equipment Preparation Surface array multi channel coil Abdominal/pelvic coil provides for larger field of view but decreased resolution/signal Phase-array coil increases resolution and decreases imaging time Endoluminal coils (endorectal and endovaginal coils)
Slide 56-

MAGNETIC RESONANCE IMAGING IMAGING PLANES Axial : pelvic anatomy and parametrial assessment Sagittal : Uterine zonal anatomy Coronal : complementary information in assessment of uterus, cervix, parametrium, vagina, and ovaries Oblique : evaluation of parametria in cervical Ca Characterisation of mullerian duct anomalies
Slide 57-

MRI PLANNING
Slide 58-

MAGNETIC RESONANC IMAGING
Slide 59-

MAGNETIC RESONANCE IMAGING SEQUENCES T2WI : Better uterine , ovarian and cervical anatomy w/o Fat suppression : pelvic fat acts as intrinsic contrast T1WI : pelvic soft tissues, lymph nodes, and bone marrow T1WI + FS : Differentiate fat and blood T1WI c+ FS : Characterising adnexal leisons Ovarian and cervical ca staging Assessing vascularity of leiomyoma prior to therapy
Slide 60-

MAGNETIC RESONANCE IMAGING DWI/ADC Water mobility/tissue cellularity/ integrity of cellular membranes Low ADC often associated with malignancy(overlap do exist) Low cellularity tumors and mucinous tumors – high ADC Peritoneal implants from ovarian Ca have low ADC
Slide 61-

MAGNETIC RESONANCE IMAGING -OVARY T2WI Outer cortex – slightly decreased SI Inner medulla – intermediate to slightly increased signal intensity Reduced in menstruation – decreased water content Pre menopausal : rounded hyperintense follicles within the cortex Post menopausal: homogenous low SI
Slide 62-

MAGNETIC RESONANCE IMAGING -OVARY T1WI Homogenous low to intermediate signal Cysts as hypointense foci Hemorrhagic cyst are hyperintense T1WI + C Ovarian parenchyma enhances to lesser degree than myometrium Myometrium enhancement = Ovary (Post menopausal) Functional cysts and corpus luteum show peripheral enhancement DWI Low signal in menstruation High signal in periovulatory period
Slide 63-

MAGNETIC RESONANCE IMAGING -OVARY Post menopausal – difficult to identify Decreased size Intermediate to low signal on T1WI Hypointense on T2WI Fewer/smaller cysts Iso to hypoenhancing to myometrium
Slide 64-

ppt slide no 64 content not found
Slide 65-

MAGNETIC RESONANCE IMAGING PARAMETRIUM Loose connective tissue between layers of broad ligament Contains blood vessels and lymphatics T1WI: low-intermediate T2WI : variable Other ligaments seen better in presence of ascites
Slide 66-

MAGNETIC RESONANCE IMAGING UTERUS T1WI : Uterus and cervix have uniform intermediate signal T2WI : Three zones – Endometrial cavity, Junctional zone,myometrium Endometrium Central hyperintense layer ( basal layer + secretions) ET 1-3mm( post menstruation/follicular phase) to 3-7mm(Luteal phase) During menstruation – Low SI areas within cavity Abnormal : >12mm
Slide 67-

MAGNETIC RESONANCE IMAGING UTERUS Junctional Zone Hypointense layer Deepest zone of myometrium Greater concentration of smooth muscle cells compared to periphery Myometrium No significant change in size during the cycle But SI changes occur Luteal phase : inc due to edema ( hence the junctional zone becomeless distinguishable) Arcuate vessels will be identifiable
Slide 68-

MRI UTERINE APPEARANCE Premenarche : body is small and zonal anatomy is indistinct Premenopausal(postmenarche) Endometrium thickens throughout proliferative and secretory phase Myometrial T2 signal increase in secretory phase - inc water content and vascular flow Menstruation : Thickness and T2 signal decrease Junctional zone shows no change Post menopausal : endometrial and myometrial atrophy , Decreased T2 signal
Slide 69-

ppt slide no 69 content not found
Slide 70-

ppt slide no 70 content not found
Slide 71-

MAGNETIC RESONANCE IMAGING UTERUS Post menopausal W/o HRT – zonal anatomy unclear , thin endometrium , myometrium shows dec SI W/ HRT Inc T1 and T2 SI Junctional zone – difficult to identify /absent In presence of GnRH replacement : dec estrogen – endometrial atrophy and hypointense myometrium Estrogen replacement therapy – Identifiable trilaminar appearance CE MRI Myometrium enhances Junctional Zone : Decreased enhancement
Slide 72-

ppt slide no 72 content not found
Slide 73-

ppt slide no 73 content not found
Slide 74-

MAGNETIC RESONANCE IMAGING CERVIX Three zones in T2WI Cortical Zone – Hyperintense zone(mucus secretions) Intermediate zones – Hypointense (deep part of fibro muscular stroma) Peripheral zone – iso/hypointense (smooth muscle cells prevail) CEMRI Inner cervical mucosa enhances to greater degree than cervical stroma
Slide 75-

ppt slide no 75 content not found
Slide 76-

ppt slide no 76 content not found
Slide 77-

ppt slide no 77 content not found
Slide 78-

MAGNETIC RESONANCE IMAGING PARAMETRIUM T1 – intermediate SI T2 – variably higher signal Suspensory ligaments – Dec T1 and T2
Slide 79-

MAGNETIC RESONANCE IMAGING VAGINA MR is preferred modality superior soft tissue differentiation Allows for delineation of vulvar anatomy Superior evaluation of vaginal wall and characterization of associated lesions CT is most useful in Staging of vaginal/vulvar malignancy Evaluation for nodal and metastatic disease
Slide 80-

MAGNETIC RESONANCE IMAGING VAGINA Endoluminal secretions T2WI hyperintense and T1WI hypointense Mucosal Layer T2WI hyperintense ( more in proliferative phase) T1WI hypointense Smooth enhancement on CE Submucosal and muscular layers Hypointense on T1WI and T2WI images
Slide 81-

MAGNETIC RESONANCE IMAGING VAGINA Pre-pubertal Central thin hyperstrip on T2 T2 hypointense wall Early follicular phase : T2 central hyper with peripheral hypointensity Luteal phase mucus component inc Vaginal wall SI inc , hence dec structural differentiation Post Menopausal w/ HRT – similar to follicular phase w/o HRT Thin central mucus layer Dec T2 SI of vagina CEMRI – enhanced vaginal wall and mucosal compartment
Slide 82-

ppt slide no 82 content not found
Slide 83-

ppt slide no 83 content not found
Slide 84-

ppt slide no 84 content not found
Slide 85-

ppt slide no 85 content not found
Slide 86-

MISC BOLD (BLOOD OXYGENATION LEVEL DEPENDENT) MR Measures differences in paramagnetic deoxyhemoglobin in blood as a marker of tumor hypoxia Tumors with higher levels of hypoxia may be more aggressive and resistant to therapy Identifies higher grade portions of tumor to help guide therapy
Slide 87-

DIFFUSION TENSOR IMAGING (DTI) Can help detect and quantify defects/asymmetries in pelvic floor musculature Provides 3D representation of pelvic floor skeletal muscle MR DEFECOGRAPHY Imaging performed after rectal administration of contrast (typically ultrasound gel) to evaluate pelvic floor Multiphase dynamic imaging performed (at rest, strain, defecation) typically with fast T2 imaging or bright-blood techniques
Slide 88-

3D/4D USG
Slide 89-

SONO HSG
Slide 90-

ELASTOGRAPHY
Slide 91-

PET CT PET imaging relies upon increased glucose uptake and metabolism by malignant cells FDG-18 is the most widely used tracer in clinical practice
Slide 92-

OTHERS MR LYMPHOGRAPHY Can detect metastases in normal size lymph nodes with very high sensitivity and specificity Requires intravenous injection of Ultra small Superparamagnetic Particles of Iron Oxide (USPIO) USPIO is taken up by normal lymph nodes, whereas metastatic lymph nodes show no uptake
Slide 93-

PELVIC MRA Vascular involvement in pelvic malignancy Prior to uterine artery embolization
Slide 94-

MR HSG MR imaging is performed after cannulation of cervix and injection of dilute gadolinium contrast into endometrial cavity Can evaluate for tubal patency as well as structural abnormalities
Slide 95-

DYNAMIC CONTRAST ENHANCED MRI (DCE-MRI) Evaluate the microcirculation of tumors Hypovascularity may suggest poor- oxygenation status and poor response to treatment Marked enhancement, which indicates high tumor perfusion or good blood supply, was associated with higher local control.
Slide 96-

ppt slide no 96 content not found