X-ray signs of diseases of the reproductive system

Radiation methods are widely used in gynecological practice. Tactics of their use are developed taking into account anamnesis and clinical picture of the disease. The appointment is carried out by a gynecologist after consultation with a specialist in the field of radiation diagnosis.

For violations of the menstrual-ovarian cycle, preference is given to radioimmunoassay. In the diagnosis of anomalies of the uterus and appendages, the study of their morphology in injuries and diseases, the main role is played by sonography. If necessary, it is followed by a computer or magnetic resonance imaging. A definitive value retains the survey radiography of the abdominal and pelvic organs. Radiographs allow to assess the state of the skeleton and to reveal its changes in developmental anomalies, birth injuries, inflammatory and tumor lesions.

On radiographs it is not so rare to find calcified fibroids of the uterus, especially in elderly women. Such a fibroid discards an intense, non-uniform, rounded shadow onto the image. A clearly visible shadow is also caused by dermoid cysts of the ovaries, if they contain bone inclusions and (or) teeth.

To study the patency of the fallopian tubes resort to X-ray or radionuclide metrosalpingography.

Violations of the menstrual-ovarian cycle. With all violations of the menstrual-ovarian cycle - the absence of menstruation (amenorrhea), changes in their intensity and rhythm, dysfunctional uterine bleeding - prescribe radioimmune tests to determine the concentration of sex hormones and gonadotropins in the blood. In parallel, the cytological examination of the vaginal contents is performed, and in some cases the histological examination of the endometrium. The results of using such a diagnostic complex in combination with clinical data allow us to establish the nature of the disorder of the menstrual cycle - the connection of disorders with the function of the ovaries, pituitary gland, hypothalamus.

To elucidate the features of dysregulation of the hormonal status, the radioimmunoassay is performed repeatedly with an interval of 5-7 days. In this way, you can set the time for ovulation (according to the maximum concentration of lutropin) and, taking it as a reference point, characterize the cyclical fluctuations of the hormonal status. At the same time, it is possible to detect a disruption in the maturation of the follicle, oppression of the progesterone phase of ovarian function, and other changes in the production of sex hormones and pituitary hormones. Research of this kind is carried out in special consultative centers of polyclinics, called "Marriage and family". Naturally, in addition to radioimmune tests, other various studies of the sexual sphere and the functions of the female organism related to childbearing are also conducted at these points. We also note that men are also examined here, since in 30% of cases they are responsible for the sterility of marriage.

At present, with the help of special instruments, transcervical catheterization of the tubes can be performed and the stenosis of the mouth and the isthmic part of the tube is eliminated. The morphology of the pipes is best determined by X-ray metrosalpingography. If the tube is obstructed, the contrast medium either does not enter it at all, or fills the tube only to the level of occlusion, here its shadow suddenly breaks off. The contrast medium does not penetrate into the abdominal cavity. Metrosalpingograms establish one- or two-sided obstruction and the place of plugging of the tube. With X-ray and radionuclide metrosalpingography, it is possible to detect "functional obstruction" of the tubes, associated with a decrease in their peristaltic activity or spastic narrowing.

Pre-excluded intersexuality, carried out gynecological examination, measured rectal temperature.

Damage and diseases of the uterus. A simple and effective way to monitor intrauterine contraceptives is sonography.

Contraceptives are predominantly spiral shaped; with prolonged use, they may fall out and even perforate the uterus with penetration into the abdominal cavity. On longitudinal sonograms, spirals are seen as segments of echopositive structures located along the midline.

Sonography is used to detect anomalies in the development of internal genitalia: duodenal and rudimentary uterus, underdevelopment of the ovaries. The presence of a two-lobed or two-legged uterus and patency of the tubes is confirmed by metrosalpingography. With its help, it is also possible to detect septa in the uterine cavity and additional strokes in endometriosis.

Ultrasound diagnosis of intrauterine pathology is based on the analysis of median structures. Intrauterine fusion, submucous fibroids, hyperplastic processes in the endometrium, polyps, malignant tumors are characterized by a uniform or uneven thickening of the uterine structures, sometimes with the formation of additional echogenic shadows.

Myoma of the uterus is manifested by its increase, deformation of the contours and additional rounded formations, more often lower echogenicity. Degenerative changes in the myomatous node cause the heterogeneity of its structure or even the picture of "honeycombs", which is a reflection of the small cavities that appeared in the node. In metrosalpingography, the fibroid gives a rounded or irregularly shaped filling defect in the shadow of the enlarged uterine cavity. Defect has clear arched borders.

In the diagnosis of inflammatory, including tuberculosis, lesions of the female sexual sphere, ray methods are of subsidiary importance. In patients with endometritis and salpingo-oophoritis, a hyperthermia zone is recorded during thermography over the small pelvis. Metrosalpingography makes it possible to establish fusion, dividing the uterine cavity into separate parts, deformation of the fallopian tubes, their elongation, constriction, fragmentation. Pipes are often shifted to the top and to the sides. Sometimes they become impassable and turn into inflammatory exudate filled bags (saktosalpinks). In these voiced cavities, a contrast agent accumulates. Transition of inflammation to the surrounding cellulose can lead to the development of a pelvic abscess. The prevalence and nature of pathological changes in this case is best determined by computer tomograms.

Non-invasive cancer and microcarcinoma of the uterus on sonograms and computer tomograms are indistinguishable. Tumors up to 1 cm in size are determined mainly by MRI. Larger cancer nodes are revealed during sonography, as they lead to an increase and deformation of the organ. The tumor can be hypoechoic or according to the acoustic structure does not differ from the surrounding tissue. Violation of the homogeneity of the knot shadow is a consequence of necrosis and hemorrhages in its thick. Computer or magnetic resonance tomograms provide especially valuable information. They allow not only to detect the tumor, but also to establish its germination into the stroma, involvement of the parameter, involvement of the lower uterine segment and vagina in cervical cancer, metastasis in the pelvic lymph nodes. In these cases, CT is performed by the method of amplification: intravenously, 20-40 ml of contrasting water-soluble substance are injected rapidly and a series of tomograms is performed. If necessary, clarify the prevalence of the tumor and its relationship to pelvic vessels resort to pelvic angiography. CT is important for planning radiotherapy and further monitoring the dynamics of the process.

The use of sonography and CT significantly facilitated the recognition of polycystosis and the ovarian cyst. In polycystic ovaries are enlarged and contain multiple cysts with a diameter of 3-8 mm. Kistoma stands out as a rounded formation with distinct internal contours. Its ehost structure is different. The most uniform image of retention cysts, in which there are usually no septa and dense inclusions. Papillary cystadenomas cause a picture of liquid contents and parietal papillary growths. Dermoid cysts are displayed as formations with a complex internal structure, in which both liquid contents and dense areas are defined. Ovarian cancer has no bright sonographic signs, and it is recognized in a relatively late stage of the disease as a dense echoinhomogeneous body. In connection with this at present, the practice includes the technique of puncture ovarian biopsy under the supervision of ultrasound or CT.