Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Insights into Imaging
Published in: Insights into Imaging 1/2019

Open Access 01-12-2019 | Magnetic Resonance Imaging | Educational Review

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

Authors: Massimo Tonolini, Pietro Valerio Foti, Valeria Costanzo, Luca Mammino, Stefano Palmucci, Antonio Cianci, Giovanni Carlo Ettorre, Antonio Basile

Published in: Insights into Imaging | Issue 1/2019

Login to get access

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.
Literature
1.
Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22:785–801PubMedCrossRef
2.
Cano Alonso R, Borruel Nacenta S, Díez Martínez P, María NI, Ibáñez Sanz L, Zabía Galíndez E (2009) Role of multidetector CT in the management of acute female pelvic disease. Emerg Radiol 16:453–472PubMedCrossRef
3.
Potter AW, Chandrasekhar CA (2008) US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics 28:1645–1659PubMedCrossRef
4.
Swart JE, Fishman EK (2008) Gynecologic pathology on multidetector CT: a pictorial review. Emerg Radiol 15:383–389PubMedCrossRef
5.
Ditkofsky NG, Singh A, Avery L, Novelline RA (2014) The role of emergency MRI in the setting of acute abdominal pain. Emerg Radiol 21:615–624PubMedCrossRef
6.
Ayyala RS, Khwaja A, Anupindi SA (2017) Pelvic pain in the middle of the night: use of MRI for evaluation of pediatric female pathology in the emergent setting. Emerg Radiol 24:681–688PubMedCrossRef
7.
Pedrosa I, Zeikus EA, Levine D, Rofsky NM (2007) MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics 27:721–743 discussion 743-753PubMedCrossRef
8.
9.
Iraha Y, Okada M, Iraha R et al (2017) CT and MR imaging of gynecologic emergencies. Radiographics 37:1569–1586PubMedCrossRef
10.
Katsura M, Sato J (2018) Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists. Radiographics 38:450–461PubMedCrossRef
11.
Yitta S, Hecht EM, Mausner EV et al (2011) Normal or abnormal? Demystifying uterine and cervical contrast enhancement at multidetector CT. Radiographics 31:647–661PubMedCrossRef
12.
Saksouk FA, Johnson SC (2004) Recognition of the ovaries and ovarian origin of pelvic masses with CT. Radiographics 24(Suppl 1):S133–S146PubMedCrossRef
13.
Bazot M, Bharwani N, Huchon C et al (2017) European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 27:2765–2775PubMedCrossRef
14.
Forstner R, Thomassin-Naggara I, Cunha TM et al (2017) ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol 27:2248–2257PubMedCrossRef
15.
Kao LY, Scheinfeld MH, Chernyak V et al (2014) Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol 202:904–911PubMedCrossRef
16.
Kubik-Huch RA, Weston M, Nougaret S et al (2018) European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of leiomyomas. Eur Radiol 28:3125–3137PubMedPubMedCentralCrossRef
17.
Foti PV, Farina R, Palmucci S et al (2018) Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging 9:149–172PubMedPubMedCentralCrossRef
18.
Jungmann PM, Agten CA, Pfirrmann CW et al (2017) Advances in MRI around metal. J Magn Reson Imaging 46:972–991PubMedCrossRef
19.
Foti PV, Ognibene N, Spadola S et al (2016) Non-neoplastic diseases of the fallopian tube: MR imaging with emphasis on diffusion-weighted imaging. Insights Imaging 7:311–327PubMedPubMedCentralCrossRef
20.
Bonde AA, Korngold EK, Foster BR et al (2016) Radiological appearances of corpus luteum cysts and their imaging mimics. Abdom Radiol (NY) 41:2270–2282CrossRef
21.
Di Salvo DN (2003) Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med 22:69–89PubMedCrossRef
22.
Foti PV, Attina G, Spadola S et al (2016) MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging 7:21–41PubMedCrossRef
23.
Kanso HN, Hachem K, Aoun NJ et al (2006) Variable MR findings in ovarian functional haemorrhagic cysts. J Magn Reson Imaging 24:356–361PubMedCrossRef
24.
25.
Bazot M, Darai E (2017) Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertil Steril 108:886–894PubMedCrossRef
26.
Jeong YY, Outwater EK, Kang HK (2000) Imaging evaluation of ovarian masses. Radiographics 20:1445–1470PubMedCrossRef
27.
Wasnik AP, Menias CO, Platt JF et al (2013) Multimodality imaging of ovarian cystic lesions: review with an imaging based algorithmic approach. World J Radiol 5:113–125PubMedPubMedCentralCrossRef
28.
Mohaghegh P, Rockall AG (2012) Imaging strategy for early ovarian cancer: characterisation of adnexal masses with conventional and advanced imaging techniques. Radiographics 32:1751–1773PubMedCrossRef
29.
Lubner M, Menias C, Rucker C et al (2007) Blood in the belly: CT findings of hemoperitoneum. Radiographics 27:109–125PubMedCrossRef
30.
Lucey BC, Varghese JC, Anderson SW et al (2007) Spontaneous hemoperitoneum: a bloody mess. Emerg Radiol 14:65–75PubMedCrossRef
31.
Ho WK, Wang YF, Wu HH et al (2009) Ruptured corpus luteum with hemoperitoneum: case characteristics and demographic changes over time. Taiwan J Obstet Gynecol 48:108–112PubMedCrossRef
32.
Hallatt JG, Steele CH Jr, Snyder M (1984) Ruptured corpus luteum with hemoperitoneum: a study of 173 surgical cases. Am J Obstet Gynecol 149:5–9PubMedCrossRef
33.
34.
Taran FA, Kagan KO, Hubner M et al (2015) The diagnosis and treatment of ectopic pregnancy. Dtsch Arztebl Int 112:693–703 quiz 704-695PubMedPubMedCentral
35.
Lin EP, Bhatt S, Dogra VS (2008) Diagnostic clues to ectopic pregnancy. Radiographics 28:166–171CrossRef
36.
Ankum WM, Hajenius PJ, Schrevel LS et al (1996) Management of suspected ectopic pregnancy. Impact of new diagnostic tools in 686 consecutive cases. J Reprod Med 41:724–728PubMed
37.
Liu X, Song L, Wang J, Liu Q, Liu Y, Zhang X (2018) Diagnostic utility of CT in differentiating between ruptured ovarian corpus luteal cyst and ruptured ectopic pregnancy with hemorrhage. J Ovarian Res 11:5
38.
Parker RA 3rd, Yano M, Tai AW et al (2012) MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics 32:1445–1460 discussion 1460-1442PubMedCrossRef
39.
Yoshigi J, Yashiro N, Kinoshita T et al (2006) Diagnosis of ectopic pregnancy with MRI: efficacy of T2*-weighted imaging. Magn Reson Med Sci 5:25–32PubMedCrossRef
40.
Michalak M, Zurada A, Biernacki M et al (2010) Ruptured ectopic pregnancy diagnosed with computed tomography. Pol J Radiol 75:44–46PubMedPubMedCentral
41.
Takahashi A, Takahama J, Marugami N et al (2013) Ectopic pregnancy: MRI findings and clinical utility. Abdom Imaging 38:844–850PubMedCrossRef
42.
Chang HC, Bhatt S, Dogra VS (2008) Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 28:1355–1368PubMedCrossRef
43.
Breech LL, Hillard PJ (2005) Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet Gynecol 17:483–489PubMedCrossRef
44.
Balci O, Energin H, Gorkemli H et al (2019) Management of adnexal torsion: a 13-year experience in single tertiary center. J Laparoendosc Adv Surg Tech A 29:293–297PubMedCrossRef
45.
Duigenan S, Oliva E, Lee SI (2012) Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol 198:W122–W131PubMedCrossRef
46.
Huang C, Hong MK, Ding DC (2017) A review of ovary torsion. Ci Ji Yi Xue Za Zhi 29:143–147
47.
Ssi-Yan-Kai G, Rivain AL, Trichot C et al (2018) What every radiologist should know about adnexal torsion. Emerg Radiol 25:51–59PubMedCrossRef
48.
Lourenco AP, Swenson D, Tubbs RJ et al (2014) Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol 21:179–187PubMedCrossRef
49.
Rha SE, Byun JY, Jung SE et al (2002) CT and MR imaging features of adnexal torsion. Radiographics 22:283–294PubMedCrossRef
50.
51.
Petkovska I, Duke E, Martin DR et al (2016) MRI of ovarian torsion: correlation of imaging features with the presence of perifollicular hemorrhage and ovarian viability. Eur J Radiol 85:2064–2071PubMedCrossRef
52.
Bekci T, Polat AV, Aslan K et al (2016) Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries. Clin Imaging 40:1029–1033PubMedCrossRef
53.
Kato H, Kanematsu M, Uchiyama M et al (2014) Diffusion-weighted imaging of ovarian torsion: usefulness of apparent diffusion coefficient (ADC) values for the detection of haemorrhagic infarction. Magn Reson Med Sci 13:39–44PubMedCrossRef
54.
Moribata Y, Kido A, Yamaoka T et al (2015) MR imaging findings of ovarian torsion correlate with pathological haemorrhagic infarction. J Obstet Gynaecol Res 41:1433–1439PubMedCrossRef
55.
Dahmoush H, Anupindi SA, Pawel BR et al (2017) Multimodality imaging findings of massive ovarian edema in children. Pediatr Radiol 47:576–583PubMedCrossRef
56.
Praveen R, Pallavi V, Rajashekar K et al (2013) A clinical update on massive ovarian oedema - a pseudotumour? Ecancermedicalscience 7:318PubMedPubMedCentral
57.
58.
Varma A, Chakrabarti PR, Gupta G et al (2016) Massive ovarian edema: a case report presenting as a diagnostic dilemma. J Family Med Primary CareCrossRef
59.
Baron KT, Babagbemi KT, Arleo EK et al (2013) Emergent complications of assisted reproduction: expecting the unexpected. Radiographics 33:229–244PubMedCrossRef
60.
Jung BG, Kim H (2001) Severe spontaneous ovarian hyperstimulation syndrome with MR findings. J Comput Assist Tomogr 25:215–217PubMedCrossRef
61.
62.
Zivi E, Simon A, Laufer N (2010) Ovarian hyperstimulation syndrome: definition, incidence, and classification. Semin Reprod Med 28:441–447PubMedCrossRef
63.
Nicholson T, Basile A (2006) Pelvic congestion syndrome, who should we treat and how? Tech Vasc Interv Radiol 9:19–23PubMedCrossRef
64.
Kuligowska E, Deeds L 3rd, Lu K 3rd (2005) Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics 25:3–20PubMedCrossRef
65.
Phillips D, Deipolyi AR, Hesketh RL et al (2014) Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol 25:725–733PubMedCrossRef
66.
Ananthan K, Onida S, Davies AH (2017) Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg 53:886–894PubMedCrossRef
67.
Hangge PT, Gupta N, Khurana A et al (2018) Degree of left renal vein compression predicts nutcracker syndrome. J Clin Med 7:107PubMedCentralCrossRef
68.
69.
Desimpelaere JH, Seynaeve PC, Hagers YM et al (1999) Pelvic congestion syndrome: demonstration and diagnosis by helical CT. Abdom Imaging 24:100–102PubMedCrossRef
70.
Coakley FV, Varghese SL, Hricak H (1999) CT and MRI of pelvic varices in women. J Comput Assist Tomogr 23:429–434PubMedCrossRef
71.
Knuttinen MG, Xie K, Jani A et al (2015) Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues. AJR Am J Roentgenol 204:448–458PubMedCrossRef
72.
Asciutto G, Mumme A, Marpe B et al (2008) MR venography in the detection of pelvic venous congestion. Eur J Vasc Endovasc Surg 36:491–496PubMedCrossRef
73.
Metadata
Title
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
Authors
Massimo Tonolini
Pietro Valerio Foti
Valeria Costanzo
Luca Mammino
Stefano Palmucci
Antonio Cianci
Giovanni Carlo Ettorre
Antonio Basile
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 1/2019
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1186/s13244-019-0808-5

Other articles of this Issue 1/2019

Insights into Imaging 1/2019 Go to the issue

Educational Review

A closer look at the stoma: multimodal imaging of patients with ileostomies and colostomies

Educational Review

Complications of hepatic echinococcosis: multimodality imaging approach

Educational Review

Cancer genome landscape: a radiologist’s guide to cancer genome medicine with imaging correlates

Educational Review

Primary myelofibrosis: spectrum of imaging features and disease-related complications

Educational Review

Emergency imaging in paediatric oncology: a pictorial review

Pictorial Review

Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: a pictorial review