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 (subdiaphragm 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.

Cervical carcinoma 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

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