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Advances Ib Ob/Gyn Cross Sectional Imaging

Advances Ib Ob/Gyn Cross Sectional Imaging. DR. SONAL GARG JASLOK HOSPITAL AND RESEARCH CENTRE, MUMBAI. MRI evaluation of Pelvic floor disorders. Urinary and anal incontinence affects a large proportion of the female population

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Advances Ib Ob/Gyn Cross Sectional Imaging

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  1. Advances Ib Ob/Gyn Cross Sectional Imaging

  2. DR. SONAL GARG JASLOK HOSPITAL AND RESEARCH CENTRE, MUMBAI

  3. MRI evaluation of Pelvic floor disorders • Urinary and anal incontinence affects a large proportion of the female population • MRI is now the modality of choice for preop planning of pelvic floor repairs • Superior soft tissue evaluation of viscera, pelvic musculature and fascial investments • Guides detailed evaluation of repair in cases that do not resolve with conservative Rx.

  4. Normal position of the bladder base, vaginal vault and ano- rectal junction at rest Normal position of the bladder base, vaginal vault and ano- rectal junction with Valsalva

  5. ANAL SPHINCTER INJURIES • Internal and External Sphincter trauma seen in obstetric injuries leads to fecal incontinence. • Pelvic floor denervation secondary to vaginal delivery may lead to perineal descent and posterior compartment deficits.

  6. MRI of the ANAL SPHINCTERS • Recent advances in MRI technologies using the endoanal coil, rapid sequencing, and cinematic display have enabled dynamic defecography. • Used to evaluate both muscular and connective tissue supports of the pelvis. • Muscular defects along with POP and perineal descent can be assessed.

  7. At rest, the bladder base and Cervix is normal. The anal sphincter is open with an abnormally low placed anorectal junction The evacuation phase shows a large descending cystocele and Severe descending perineal syndrome

  8. Dynamic MRI in Stress Urinary Incontinence • Used to asses the functional and anatomic changes that occur during stress incontinence • Dynamic MRI guides management options- response with pessary or need for surgery

  9. Dynamic MRI A- MRI without pessary B- MRI with pessary (line represents the pubococcygeal line)

  10. Fast MRI with and without pessary while performing Valsalva A- Valsalva with pessary B- Valsalva without pessary (line represents posterior urethro-vesical angle)

  11. FETAL MRI- A Developing technique for the Developing patient

  12. What does it provide? • Offers complete evaluation of the fetus even in difficult situations like oligohydramnios, maternal obesity, limitations of fetal position etc. • Overcomes the problems of Calvarial and bone calcification which may obscure detail. • Gives more information to guide management and counselling when an abnormality is detected on ultrasound

  13. FETAL MRI- Advantages • Excellent spatial soft tissue resolution • Large field of view-Detailed evaluation of fetal and extra-fetal structures. • Three dimensional information with multiplanar imaging. • Established safety in second trimester • Limitations of fetal movement has been overcome by using HASTE sequences

  14. CASE 1- RECURRENT PREGNANCY LOSS

  15. FETAL MRI- Applications Central nervous system and spine pathologies: • Evaluation of Colpocephaly • Agenesis of the Corpus Callosum • Posterior fossa anomalies- is there Dandy Walker malformation? • Intra-axial and extra-axial mass lesions and fluid collections • Destructive brain lesions and haemorrhage • Spinal dysraphism- delineates the extent and level • Sacrococcygeal teratoma- Intrapelvic and abdominal extent of tumor, mass effect on adjacent organs

  16. CASE 1- PERSISTENT COLPOCEPHALY

  17. CASE 2- PROMINENT POSTERIOR CISTERNA MAGNA

  18. CASE 3- PRECIOUS PREGNANCY WITH SUSPECTED ARNOLD CHIARI MALFORMATION

  19. FETAL MRI- Applications Intrathoracic lesions: • CCAM- cystic nature, differentiates it from Congenital diaphragmatic hrenia containing bowel loops • Pulmonary sequestration • Congenital diaphragmatic hernia- extent, severity scores such as lung volumetry

  20. FETAL MRI- The future Diffusion tensor imaging and Perfusion studies: • Extremely sensitive and specific sequences to detect cerebral ischemia • Can determine the onset of ischemia and detailed extent of neural damage for prognosis and guiding management

  21. MRI guided High Intensity Focused Ultrasound- The New Kid on the Block

  22. What is HIFU? • Thermal ablation technique • Sound waves focused to deliver heat • Results in tissue necrosis and cell death

  23. What does the MR guidance provide? • 3D multiplanar imaging of the fibroid • Clearly identifies the position and extent of the fibroid, what portion has to be treated • Provides real time information about temperature changes of the treated fibroid to ensure ablation.

  24. MrgFUS- What are the advantages? • Non-invasive, does not require hospital stay • Uterus conserving • Offers good symptom relief and excellent quality of life

  25. MrgFUS- Inclusion Criteria • Women between 18 and 59 years • Weight less than 140 kg • Uterine size less than 24 weeks • Symptomatic fibroids- bleeding, pressure, pain, urinary symptoms etc.

  26. MrgFUS- Exclusion Criteria • Extensive scarring along the lower abdominal wall or surgical clips in the direct path of the beam. • Not yet approved for women seeking fertility • Pregnant patients

  27. THANK YOU

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