Medical Lecture Note: Fielding: Gynecologic Imaging (Expert Radiology Consult Series)

When Elsevier approached me with the idea of a textbook of gynecologic imaging I was ecstatic that a publisher was interested in promoting women's health care and a little worried that there just was not a need for another textbook. Then I started looking carefully at the reading rooms where the on-call radiologists work. Virtually every night two textbooks were open, one devoted to ultrasound and the other to computed tomography (CT), both with images depicting gynecologic pathology. Imaging of the female pelvis remains challenging because of the anatomic complexity; the varied appearance of gynecologic diseases on CT, ultrasound (US) and magnetic resonance imaging (MRI); and, often, the urgency of the clinical situation. I contacted my co-editors, Drs. Brown and Thurmond, and we began to plan.

Organization of Gynecologic Imaging is based on the questions and comments we have received during our course lectures, board review sessions, literature assessment, and interactions with both practicing radiologists and trainees. Our textbook is divided into sections reviewing CT, US, and MRI techniques; normal anatomy; and disease states. Particular attention is devoted to basic protocols that will provide the most critical clinical information. This includes Doppler imaging, CT contrast administration, and MR pulse sequences. Some types of benign disease of the pelvis have distinctive imaging features and thus are presented separately from malignant disease. Topics include infection, infertility, uterine masses, and pelvic floor dysfunction. We have also included images of disease states beyond the gynecologic tract that may mimic expected clinical findings. Cancers involving the uterus, cervix, ovaries, fallopian tubes, and vulva are explored, with clear depictions of disease, including line drawings and color prints of clinical findings. We have included the most current TMN staging system for each cancer adjacent to corresponding images. Chapters are also devoted to new and evolving techniques in the diagnosis of cancer, including positron emission tomography (PET) and MR diffusion imaging both during and after therapy. Current American College of Radiology Appropriateness Criteria are presented in an appendix.

As radiology has expanded to become the primary diagnostic and staging test for many gynecologic diseases, so has its role in therapy. Uterine artery emobilization and focused ultrasound of fibroids, abscess drainage, and fallopian tube canalization are presented, with expert advice on patient preparation, technique, and communication with referring physicians.

Ultrasound is particularly challenging because of the transfer of real-time observations to images. With physicians performing less hands-on scanning, we risk losing our ability to confidently identify common diseases and especially the complications of early pregnancy. Several chapters in this book are devoted to pelvic ultrasound, with numerous high-quality images, including both grayscale and color Doppler.

Finally, we have included a chapter specifically devoted to radiation safety. We all want to decrease dose to our patients, but not at the expense of a diagnostic test. The authors of this chapter discuss specific steps to decrease dose and provide clinical scenarios and algorithms.

This book was written primarily for radiologists, gynecologists, and nurse practitioners who take care of women with pelvic disease. It provides a practical review of anatomy, appropriate imaging of benign and malignant disease of the female pelvis, and guidelines for patient management. In editing this book, we learned a great deal about our specialty. It is our hope that our readers will as well.

-- Julia R. Fielding, Douglas L. Brown, Amy S. Thurmond

Key Features

Get expert guidance on everything you may see on a day-to-day basis in the rehabilitation of joint replacements and sports injuries.
Apply evidence-based rehabilitation protocols to common sports conditions like ACL and meniscus injuries and post-surgical rehabilitation for the knee, hip, and shoulder.

Website Features

Get all you need to know about the latest advancements and topics in gynecologic imaging, including normal and variant anatomy, pelvic pain, abnormal bleeding, infertility, first-trimester pregnancy complications, post-partum complications, characterization of the adnexal mass, and gynecologic cancer.
Recognize the characteristic presentation of each disease via any modality and understand the clinical implications of your findings.
Consult with the best. Internationally respected radiologist Dr. Julia Fielding leads a team of accomplished specialists who provide you with today's most dependable answers on every topic in gynecologic imaging.
Identify pathology more easily with 1300 detailed images of both radiographic images and cutting-edge modalities-MR, CT, US, and interventional procedures.
Find information quickly and easily thanks to a consistent, highly templated, and abundantly illustrated chapter format.
Images: Browse a Library of all book images. Easily select, organize, and download your images into a presentation.
Videos: Access videos that demonstrate a variety of procedures.

Contents

Section One - Imaging Techniques, Pitfalls, and Normal Anatomy

Part One - Ultrasound

Chapter 1 - The Normal Pelvis on Ultrasound Imaging and Anatomic Correlations
Chapter 2 - Pitfalls in Gynecologic Ultrasound

Part Two - Computed Tomography

Chapter 3 - Computed Tomography: Normal Anatomy, Imaging Techniques, and Pitfalls
Chapter 4 - Dose Reduction Techniques in Multidetector Computed Tomography Body Imaging

Part Three - Magnetic Resonance Imaging

Chapter 5 - Magnetic Resonance Imaging of the Female Pelvis: Technique, Anatomy, and Pitfalls
Chapter 6 - Diffusion Magnetic Resonance Imaging

Part Four - Fluoroscopy

Chapter 7 - Hysterosalpingography: Techniques, Normal Anatomy, and Pitfalls

Section Two - Pelvic Pain

Chapter 8 - Approach to Pelvic Pain and the Role of Imaging
Chapter 9 - Endometriosis
Chapter 10 - Acute Pelvic Pain
Chapter 11 - Chronic Pelvic Pain
Chapter 12 - Pelvic Pain: Lower Urinary Tract—Urethral Diverticulum, Cysts, and Varix

Section Three - Abnormal Bleeding

Chapter 13 - Benign Endometrial Causes of Abnormal Bleeding
Chapter 14 - Adenomyosis
Chapter 15 - Uterine Leiomyomas

Section Four - Infertility

Chapter 16 - Infertility, Evaluation, and Treatment
Chapter 17 - Tubal Abnormalities
Chapter 18 - Mullerian Uterine Anomalies
Chapter 19 - The Ovary and Polycystic Ovary Syndrome
Chapter 20 - The Imaging of Contraception

Section Five - First-Trimester Pregnancy Complications

Chapter 21 - Ultrasound of the Normal and Failed First-Trimester Pregnancy
Chapter 22 - Ectopic Pregnancy
Chapter 23 - Retained Products of Conception
Chapter 24 - Gestational Trophoblastic Neoplasia

Section Six - Postpartum Complications

Chapter 25 - Postpartum Complications
Chapter 26 - Vaginal Fistulas
Chapter 27 - Imaging of Pelvic Floor Dysfunction

Section Seven - Characterization of the Adnexal Mass

Chapter 28 - Approach to Imaging the Adnexal Mass
Chapter 29 - Benign Ovarian Masses
Chapter 30 - Malignant Ovarian Masses

Section Eight - Gynecologic Cancer

Chapter 31 - Use of Positron Emission Tomography Imaging in Gynecologic Cancers
Chapter 32 - Uterine Cancers
Chapter 33 - Cervical Cancer
Chapter 34 - Ovarian and Fallopian Tube Cancer
Chapter 35 - Carcinoma of the Vagina and Vulva

Section Nine - Pediatric Imaging

Chapter 36 - Gynecologic Imaging of the Pediatric Patient

Section Ten - Interventional Radiology in Gynecology

Chapter 37 - Drainage and Biopsy Procedures
Chapter 38 - Magnetic Resonance–Guided Ultrasound Surgery of Uterine Leiomyomas
Chapter 39 - Uterine Artery Embolization
Chapter 40 - Fallopian Tube Catheterization
Chapter 41 - Ultrasound-Guided Treatment of Ectopic Pregnancy

Appendix

Selections from the ACR Appropriateness Criteria
Relative Radiation Level Information
Clinical Condition: Abnormal Vaginal Bleeding
Acute Pelvic Pain in the Reproductive Age-Group
Endometrial Cancer of the Uterus
Staging and Follow-up of Ovarian Cancer
Staging of Invasive Cancer of the Cervix

About the Authors

Julia R. Fielding, MD, Professor of Radiology, Division Chief of Abdominal Imaging, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Douglas L. Brown, MD, Professor of Radiology, Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Amy S. Thurmond, MD, Director, Medical Women's Imaging Department, Siker Medical Imaging and Intervention of Portland, Portland, Oregon.

Product Details