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Advances Ib Ob/Gyn Cross Sectional Imaging. DR. SONAL GARG JASLOK HOSPITAL AND RESEARCH CENTRE, MUMBAI DR. SONAL GARG JASLOK HOSPITAL AND RESEARCH CENTRE,

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Presentation on theme: "Advances Ib Ob/Gyn Cross Sectional Imaging. DR. SONAL GARG JASLOK HOSPITAL AND RESEARCH CENTRE, MUMBAI DR. SONAL GARG JASLOK HOSPITAL AND RESEARCH CENTRE,"— Presentation transcript:

1 Advances Ib Ob/Gyn Cross Sectional Imaging

2 DR. SONAL GARG JASLOK HOSPITAL AND RESEARCH CENTRE, MUMBAI 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 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 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 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. 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. 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. 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. 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. Used to evaluate both muscular and connective tissue supports of the pelvis. Muscular defects along with POP and perineal descent can be assessed. 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 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 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. 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. 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 Gives more information to guide management and counselling when an abnormality is detected on ultrasound

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

14 CASE 1- RECURRENT PREGNANCY LOSS

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

19 CASE 1- PERSISTENT COLPOCEPHALY

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21 CASE 2- PROMINENT POSTERIOR CISTERNA MAGNA

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25 CASE 3- PRECIOUS PREGNANCY WITH SUSPECTED ARNOLD CHIARI MALFORMATION

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

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

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

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

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

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

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

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

36 THANK YOU


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