Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis—part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion

Abstract

Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation.The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.

Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis

“…By contrast, in corpus luteal cyst rupture, the hemoperitoneum is more likely to appear in intermediate signal on T1-weighted sequence, with a sentinel clot in high signal (Fig. 4 ) [ 35 – 37 ].…”

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part II: Non-Obstetric Complications

“…When the torsion is of low grade, it will first impair the venous and lymphatic drainage, making the arterial waveforms detectable [ 91 ]. After inconclusive US, MRI represents a better technique by which to assess suspected OT, depicting both direct and indirect findings more clearly [ 3 , 92 ]. A retrospective study, evaluating the diagnostic accuracy of MRI for OT in pregnancy, reported sensitivity, specificity, positive and negative predictive values of 100%, 77.8%, 90.5% and 100% [ 93 ].…”

“…The pathognomonic and most specific feature is a twisting of the ovarian pedicle, presenting as a beak-like protrusion adjacent to the ovarian mass or to the enlarged ovary. However, it is only identified in less than one-third of patients through CT and MRI [ 92 , 94 ]. In the early stages, an asymmetric enlarged oedematous ovary with central follicular stromal and peripherally displaced follicles in a string-like appearance (“pearl string sign”) is well demonstrated by MRI, especially on T2-weighted sequences.…”

The Female Genital Tract on MDCT: A Pictorial Review of Normal Anatomy and Incidental Abnormalities

“…The normal fallopian tubes are not visualized on CT unless they are dilated with fluid, pus, or blood. 10 The identification of a well-visualized or dilated fallopian tube should prompt the radiologist to look for the underlying cause pathology. The normal fallopian tubes, however, may sometimes be seen in the presence of ascites.…”

“…14 There exists considerable overlap between the imaging appearances of hemorrhagic and luteal cysts, and the wall of corpus luteal cysts appears thicker than that of follicular cyst on the postcontrast study. 10…”