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Magnetic resonance imaging structured reporting in infertility

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Presentation on theme: "Magnetic resonance imaging structured reporting in infertility"— Presentation transcript:

1 Magnetic resonance imaging structured reporting in infertility
Guillermina Montoliu-Fornas, M.D., Ph.D., Luis Martí-Bonmatí, M.D., Ph.D.  Fertility and Sterility  Volume 105, Issue 6, Pages (June 2016) DOI: /j.fertnstert Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

2 Figure 1 Diagram showing the structures that could be affected in endometriosis, anterior (A) and posterior (P) compartments: peritoneum (P), Douglas pouch (D, and vesicouterine (VU), vesicovaginal (VV), and rectovaginal (RV) septa. Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

3 Figure 2 Endometriosis. Endometrioma in left ovary, Douglas implant, and deep posterior endometriosis. (A) Sagittal T2-weighted high-resolution image shows the implant of the pouch of Douglas and uterosacral invovlement with fibrosis and retraction. (B) Sagittal T2-weighted image showing extensive involvement of rectosigmoid wall. (C) Transverse T2-weighted image demonstrating the left endometrioma with shading effect and rectal wall involvement. (D) 3D gradient-echo fat-suppressed T1-weighted image shows hyperintensity of the hemorrhagic component in the endometrioma (star) and in right uterosacral ligament implant (arrow). Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

4 Figure 3 Tubal obstruction: hematosalpinx and pyosalpinx. Bilateral tubal obstruction expansion due to endometriosis. (A) Transversal T2-weighted high-resolution image shows tubal expansion and hypointense hematic tube content (arrows; stars = ovaries). (B) Transversal 3D gradient-echo fat-suppressed T1-weighted image shows hyperintense content (arrows; U = uterus). (C) Transversal diffusion-weighted image, b-value 800. In another patient, the obstruction secondary to infectious process shows the purulent content with restricted diffusion (arrows). (D) Apparent diffusion coefficient map. Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

5 Figure 4 Müllerian anomalies. A fusion defect corresponding to a uterus didelphys. (A) Coronal T2-weighted high-resolution image shows the endometrial and cervical noncommunicating cavities, superficial cleft (arrow), and increased intercornual distance (horizontal line). (B) Transverse T2-weighted image shows noncommunicating endometrial cavities (R = rectum). (C) Transverse T2 image shows noncommunicating cervical cavities (arrows). (D) In a different case, in a T2-weighted coronal image, septate uterus is shown as a reabsorption defect with an incomplete uterine myometrial tissue septum (star), convex surface (arrows), and communicating cavities. Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

6 Figure 5 Fibroid. (A) Sagittal and (B) transverse T2-weighted images showing submucosal pedunculated mass (star = fibroid; P = pedicle), occupying the endometrial cavity. (C) Sagittal T2-weighted image in a different patient, demonstrating an intramural well defined fibroid (star) with homogeneous signal intensity, slightly hypointense in relation to the myometrium, and exerting compression of the endometrial cavity and cervical canal. Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

7 Figure 6 Adenomyosis. (A) Sagittal T2-weighted high-resolution image shows focal posterior adenomyosis with poorly defined boundaries and heterogeneous signal intensity due to small cystic lesions. (B) Sagittal fat-suppressed T1-weighted image shows hyperintensity (arrow) due to ectopic endometrial glandular bleeding focus. (C) Sagittal T2-weighted image showing diffuse adenomyosis in a different patient, with thickening of the endometrial-myometrial transitional zone >12 mm and loss of differentiation (arrows). (D) Transverse T2-weighted image in a different patient, showing that diffuse adenomyosis is predominantly hypointense with glandular cystic changes (arrows). Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

8 Figure 7 Isthmocele. (A) Sagittal T2-weighted high-resolution image shows postcesarean cystic saccular expansion on the isthmus (arrows) in continuity with the cervical channel containing prolapsing cervical mucosa. Note incidental Naboth cysts (circle). (B) Transverse T2-weighted image shows isthmocele containing cervical mucosa (circle). (C) In a different case, coronal T2-weighted image to uterus shows an irregularity of cervical wall with disruption of the mucosa and stromal penetration (arrows) after surgical instrumentation. (D) Transverse T1-weighted fat-suppressed image shows retention of hyperintense menstrual blood (circle). Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

9 Figure 8 Schematic representation of the diverse structures which should be systematically evaluated in pelvic magnetic resonance studies of infertility: ovary (1), oviduct (2), myometrium (3), uterine cavity (4), cervix (5), and vagina (6). Fertility and Sterility  , DOI: ( /j.fertnstert ) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions


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