Ultrasound is key for gynaecological diagnosis
Ultrasound and MRI scans are an essential part of the investigation of gynaecological problems. Here consultant gynaecological surgeon Jonathan Pembridge and consultant radiologist Dr Balan Palaniappan, both of the Royal Glamorgan Hospital and Nuffield He
Ultrasound plays an important role in the evaluation of gynaecological problems. It can assess for possible causes of pelvic pain and abnormal or heavy menstrual bleeding and can help to provide a diagnosis.
A more recent development is Diffusion Weighted Imaging (DWI), which is an addition to MRI scanning and is shown to improve accuracy in the assessment of gynaecological cancer.
The use of ultrasound scanning within gynaecology began in the 1950s. The examination is a relatively quick, safe and pain-free procedure and is used to visualise the pelvis to assess the uterus or womb and ovaries.
It is also used during pregnancy to monitor the health and development of the embryo or foetus.
Normal vaginal bleeding or menstruation is part of a woman’s normal cycle during her reproductive years.
The menstrual cycle is normally every 21 to 28 days with bleeding for between two to seven days.
Abnormal menstruation may present as bleeding in between normal menstrual cycles or bleeding after intercourse.
It can also present as heavy or prolonged menstrual bleeding and irregular or infrequent bleeding.
Abnormal bleeding could occur following the menopause.
Heavy bleeding can affect one in four women between the ages of 15 and 50, which often affects a woman’s quality of life.
Ultrasound scans are the simplest way to diagnose some of the most common causes of menstrual irregularities. also Ultrasound scans can detect the presence and location of benign growths known as fibroids.
Fibroids can be of varying sizes, ranging from as small as several millimetres to many centimetres.
Fibroids may be managed with medication to shrink their size or by surgical treatments, known as a resection of fibroid or myomectomy.
Non-surgical interventions include uterine artery embolisation, which is a minimally invasive procedure guided by an X-ray camera, carried out by an interventional radiologist to reduce blood flow to the fibroids and to cause shrinkage in their size. Changes within the muscle wall of the womb may be detected on the scan, suggesting presence of a benign condition known as adenomyosis.
This is associated with heavy and painful bleeding. The ultrasound scan can also assess the lining of the womb or endometrium.
Abnormal thickening may be caused by a benign growth within the cavity of the womb known as a polyp or changes to the lining of the womb itself.
If these changes are identified, a procedure known as hysteroscopy Women who have vaginal bleeding following the menopause should be seen and assessed on an urgent basis.
An ultrasound scan is performed to assess the thickness of the lining of the womb (endometrium).
The presence of cancer is unlikely if the endometrium is thin on ultrasound examination.
If the endometrium is thickened or there is significant clinical suspicion, a biopsy should be performed, either by passing a small plastic tube into the cavity of the womb or in conjunction with hysteroscopy.
The ability to image in multiple planes in high resolution and newer scanning techniques such as Diffusion Weighted Imaging and Dynamic Imaging following an injection of contrast (dye) allow accurate assessment of normal anatomy, further assessment of abnormalities identified on ultrasound and accurate assessment of the nature and extent of cancer. Diffusion Weighted Imaging (DWI) is one of the newer MRI techniques that measures movement of water molecules within tissues.
In general terms, if the tissue is solid and is packed with cells, there is restriction of movement of water molecules and the tissue appears bright on DWI.
There is relatively free movement of water molecules within normal tissues and these appear dark on DWI.
Tumours, including cancer, are usually packed with cells with substantial restriction of water molecules and therefore stand out as bright abnormalities on DWI.
Diffusion Weighted Imaging is used as an adjunct to conventional MRI scanning and has been shown to improve accuracy of radiological assessment in gynaecological cancers.
It plays a role in the diagnosis of cancer, assessment of extent of disease, assessment of treatment response and to look for recurrence of cancer after treatment. MRI scanning following injection of contrast (dye) into blood vessels is long established and this technique is used to assess abnormal tissue such as cancer.
Dynamic Contrast Enhanced MRI (DCE-MRI) is a newer technique where sequential scanning is carried out after an injection of contrast.
Using this technique, the uptake and wash out of contrast from tissues can be assessed in a dynamic fashion.
Contrast flows in and out of cancer tissue differently to normal tissue due to the nature of the abnormal blood vessels that it contains and assessment of this difference is useful in diagnosis of cancer, assessment of extent of spread and when assessing for recurrence of cancer after treatment.
Ultrasound and MRI scans are an essential part of investigation of gynaecological problems such as abnormal vaginal bleeding.
Ultrasound is the initial investigation and following this an MRI scan may be required for further assessment.
Newer MRI techniques such as Diffusion Weighted Imaging and Dynamic Contrast Enhanced Imaging are used as adjuncts to conventional MRI and have been shown to improve diagnostic accuracy.
For more information, call Nuffield Health on 029 2083 6714. www.nuffieldhealth.com/hospitals/cardiff-and-vale