Uterine Tumours

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  • TEXTBOOK READING OF SUTTON

    Textbook of Radiology and Imaging 7th Edition, Volume 2, page 1095-1097

    CHAPTER 34:

    GYNECOLOGICAL IMAGING

    Presented by: Yessi Oktiari

    Consultant: dr. Yana Supriatna, Ph.D, Sp.Rad(K)RI

  • CHAPTER 34: GYNECOLOGICAL IMAGING

    Ultrasound

    Plain Film Radiology

    Contrast Studies

    Computed Tomography

    Interventional Radiology

    Magnetic Resonance Imaging

    Uterus, Cervix and Vagina

    Congenital Uterine Abnormalities

    Uterine Tumours

    Cervical Carcinoma

    Ovaries

  • UTERUS ANATOMY

    Source: Atlas of Human Anatomy 6th Ed

    Source: Diagnostic Imaging 7th Ed

  • LEIOMYOMA (UTERINE FIBROID)

    Most common solid uterine tumour

    Composed of smooth muscle, varying amount of fibrous tissue

    Single or multiple

    Estrogen dependent

    Location

    Submucosal

    Intramural

    Subserosal Source: mayoclinic.org

  • LEIOMYOMA

    MRI

    Accurate assesment of the site, number, size as small as 3 mm diameter

    IV gadolinium-chelate does not improve the detection

  • LEIOMYOMA

    Non degenerating

    T1: uniform signal intensity T2: low signal intensity

    Degenerating

    T1: intermediate-high signal intensity T2: high signal intensity

    Source: Diagnostic Imaging 7th Ed

    Sagittal T2-weighted MRI demonstrating several uterine fibroids (white arrows), which are of low signal intensity. The endometrial cavity is normal (black arrow). B, bladder; C, cervix

  • LEIOMYOMA

    USG

    Useful in demonstrating subserosal and submucosal lesion on pedicle

    Precludes the use of uterine artery ablation

    MRI

    Limited in the presence of retroverted displaced uterus

    Difficult in discriminating a uterine & adnexal mass

    False negative up to 20%

  • ADENOMYOSIS

    http://www.emedicinehealth.com/adenomyosis-health/article_em.htm

    The presence of endometrial glandular cells and cells of the

    chorion more than 2.5 mm from the endometrium-myometrium

    interface

    Risk factor: 1. Prior endouterine surgery 2. Multiparity 3. Women between 40-50

    tahun

    Signs and symptoms: 1. Menorrhagia 2. Dysmenorrhea 3. Recent onset of menstrual

    cramping that is gradually getting worse

    MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011

  • ADENOMYOSIS

    Cant be distinguished from leiomyomas on clinical findings or by ultrasound

    Similar pelvic pain & menorraghia with uterine enlargement

    Different treatment

    Adenomyosis vs leiomyoma on MRI

    MRI findings Adenomyoma Leiomyoma 1. Diffuse or focal thickening of junctional zone

    Yes No

    2. Ill-defined margin Yes No

    3. Signal intensity Low Low but often high

    4. Periphery large vessels No Yes

  • JUNCTIONAL ZONE

    MRI is the first imaging technique to reveal this structure

    Innermost layer of myometrium

    A distinct low signal on T2-weighted sequences separating the endometrium in high signal intensity from the outer myometrium in intermediate signal

    Looser extracellular matrix, lower water content

    The upper limit of normal for the junctional zone thickness: up to 58 mm (midsagital image through the long axis of uterus)

    MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011

  • JUNCTIONAL ZONE

    MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011

  • ADENOMYOSIS ON MRI

    Direct sign Indirect sign

    1. Microcysts 2. Adenomyoma

    Thickness of the junctional zone exceeding 12 mm Diagnostic accuracy 85% and spesificity of 96%

    Advantages Limitation

    Less interoperator variability More specific diagnosis

    Only 50% cases detecting mycrocysts From 20% to 30% of patients will not have

    a measurable junctional zone during their reproductive cycle, 50% in postmenopausal women

    MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis, Novellas et al., 2011

    Sensitivity: 70% to 86% and a specificity of 8693% These numbers are similar to ultrasound

  • ADENOMYOSIS

    Source: Diagnostic Imaging 7th Ed

  • RESUME

    Uterus anatomy

    Leiomyoma

    Pathology

    MRI

    Adenomyoma

    Definition

    Junctional Zone

    MRI

  • QUIZ

    What is the most likely diagnosis on the following MRI:

    a. Endometriomas

    b. Adenomyosis

    c. Leiomyosarcoma

    d. Uterine fibroids

    e. Cervical carcinoma

  • TERIMA KASIH MOHON ASUPAN