Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis—part II: uterine emergencies and pelvic inflammatory disease

Abstract

Due to the growing use of cross-sectional imaging in emergency departments, acute gynaecologic disorders are increasingly diagnosed on urgent multidetector computed tomography (CT) studies, often requested under alternative presumptive diagnoses in reproductive-age women. If clinical conditions and state-of-the-art scanner availability permit, magnetic resonance imaging (MRI) is superior to CT due to its more in-depth characterisationof abnormal or inconclusive gynaecological findings, owing to excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation.This pictorial review aims to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their CT and MRI appearances, in order to provide a timely and correct imaging diagnosis. Specifically, this second instalment reviews with examples and emphasis on differential diagnosis the main non-pregnancy-related uterine emergencies (including endometrial polyps, degenerated leiomyomas and uterine inversion) and the spectrum of pelvic inflammatory disease.

Computer Tomography in the Diagnosis of Ovarian Cysts: The Role of Fluid Attenuation Values

“…The contents of an ovarian cyst may show high attenuation due to blood or debris accumulation, or collection from contrast enhancement [ 30 ]. In malignant tumors, bleeding can be caused by the cancer itself, abnormal tumor vasculature, tumor regression, or event anti-tumor treatments (chemo and radiation therapy), and other drugs commonly used in oncological patients (such as immunotherapies and anticoagulants) [ 31 ].…”

“…In malignant tumors, bleeding can be caused by the cancer itself, abnormal tumor vasculature, tumor regression, or event anti-tumor treatments (chemo and radiation therapy), and other drugs commonly used in oncological patients (such as immunotherapies and anticoagulants) [ 31 ]. Two reports [ 30 , 32 ] noted that an ovarian cyst complicated by bleeding will show fluid-fluid or fluid-debris levels, with an attenuation range of 25–100 HU. It was previously documented that the CT appearance of the individual locules and within the same locule of an ovarian tumor may vary due to the differences in protein content and hemorrhage [ 15 ].…”

Acute pelvic pain: A pictorial review with magnetic resonance imaging

“…[ 10 ] In postmenopausal women, >5 mm is considered abnormal if the patient has AUB or >9 mm in the case of asymptomatic patients. [ 1 ] On DWI, the endometrium is visualized as a hyperintense layer due to high water content in the stromal cells and the “T2 shine-through effect.” [ 11 ] The T2 shine-through effect refers to high signal intensity on DWI that is not due to diffusion restriction but due to high T2 signal that occurs in normal tissue because of long T2 decay. The inner myometrium, called the junctional zone, contains compact muscle with a sparse extracellular matrix.…”

“…Abnormal uterine bleeding (AUB) is the most common presentation in 1/3 rd of patients after acute pelvic pain. [ 1 ] Although transvaginal, the US allows for the examination of the internal structures of the uterus, its inability to demonstrate the zonal anatomy and tissue characterization is a significant drawback. MRI is superior to ultrasound and CT in the ancillary description of uterine pathologies in patients presenting to the emergency department with acute pelvic pain and genital bleeding.…”

“…MR is an emerging modality for various reasons, such as exquisite soft-tissue resolution, its capability of multiplanar imaging, characterization, high sensitivity, and lack of ionizing radiation. [ 1 , 2 ] The sensitivity of MRI in identifying acute uterine pathologies is 96.6%. [ 3 ] The knowledge of clinical presentation and imaging appearances of discrete emergent uterine conditions is necessary for a radiologist to arrive at a diagnosis.…”