Pelvic ultrasound is the first-line imaging investigation in gynaecology for women of all ages. It is readily available, inexpensive, radiation-free, relatively less time consuming and easily repeatable. Abdominal and vaginal scanning techniques can be used with colour Doppler and 3D/4D scans for definitive diagnosis.
Rapid advances in ultrasound technology characterizes uterine, ovarian, Endometrial and tubal Pathologies with precision and ease.
Uterine fibroids, uterine adenomyosis and ovarian cysts are easily diagnosed and followed up by ultrasound. Tubal diseases like hydrosalphinx/pyosalphinx are detected well with ultrasound. The position of intrauterine contraceptive devices is best done with trans vaginal ultrasound and 3D imaging when the string is no longer felt or seen on clinical examination.
Transvaginal ultrasound for endometrial evaluation combined with colour Doppler helps in diagnosis the abnormal endometrial condition and deciding the correct treatment for patients with abnormal uterine bleeding and postmenopausal bleeding.
Sonohysterosalpingography (Sono-HSG): involves airless, sterile, saline infusion through a soft plastic catheter in the cervix with simultaneous endo-vaginal Ultrasound. It allows excellent visualisation of the endometrial cavity and its lining. Saline sonography shows endometrial polyps and intracavitary fibroids better when combined with routine 2D/3D sonography.
CT has its limitation in terms of radiation exposure and lesser soft tissue contrast in setting of pelvic imaging.
MRI (Magnetic Resonance Imaging) has a distinct role in gynaecological imaging. It is best for delineating the morphology and orientation of pelvic structures. 
MRI merits include wider field of view, excellent soft tissue contrast and multi planar imaging capability with no risk of radiation. MRI is an ideal modality for mapping of multiple uterine fibroids, defining the exact extent of adenomyosis and Pelvic endometriosis.
MRI is useful in characterizing the type of fibroid degeneration and in Staging of Endometrial and cervical malignancy. MRI clinches the diagnosis of ovarian dermoid cyst and endometriotic cyst by its tissue characterization properties. Uterine congenital anomalies are evaluated with baseline 2D ultrasound followed by 3D imaging / MRI imaging. Imaging plays a definite role in classification of uterine anomaly.
Ultrasound is the imaging modality of choice for the female pelvis. High-resolution imaging of transvaginal ultrasound provides high diagnostic accuracy for pelvic pathology.
However, if there are some shortcomings with ultrasound modality, such as the limited of view, obscuration of pelvic organs by the presence of bowl gas, inherent limitations dependent on patient size, enlarged uterus with hybrid pathologies, then MRI is the problem solving imaging tool in gynaecology.
For more info, contact Dr. Kalpana Subbarayan, MBBS DNB, Radiologist at 146B, Mettupalayam Road, Coimbatore – 641043. For appointment ring 0422-420100.
Imaging In Gynaecology At Womens Center By Motherhood
