X-ray signs of diseases of the reproductive system

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

In case of menstrual-ovarian cycle disorders, preference is given to radioimmunological examination. Sonography plays the main role in diagnostics of uterine and appendage anomalies, studying their morphology in case of injuries and diseases. If necessary, it is followed by computed tomography or magnetic resonance imaging. Survey radiography of abdominal and pelvic organs retains a certain importance. Radiographs allow to assess the condition of the skeleton and to identify its changes in case of developmental defects, birth injuries, inflammatory and tumor lesions.

Calcified uterine fibroids are not uncommon on X-rays, especially in older women. Such a fibroid casts an intense, non-uniform, rounded shadow on the image. Dermoid ovarian cysts also cause a clearly visible shadow if they contain bone inclusions and/or teeth.

To study the patency of the fallopian tubes, X-ray or radionuclide metrosalpingography is used.

Menstrual-ovarian cycle disorders. For all menstrual-ovarian cycle disorders - absence of menstruation (amenorrhea), changes in their intensity and rhythm, dysfunctional uterine bleeding - radioimmune tests are prescribed to determine the concentration of sex hormones and gonadotropins in the blood. In parallel, a cytological examination of the vaginal contents is performed, and in some cases, a 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 menstrual cycle disorder - the relationship of disorders with the function of the ovaries, pituitary gland, hypothalamus.

To determine the features of hormonal status dysregulation, radioimmunological research is performed repeatedly with an interval of 5-7 days. In this way, it is possible to determine the time of ovulation (by the maximum concentration of lutropin) and, taking it as a starting point, to characterize cyclic fluctuations in hormonal status. In this case, it is possible to identify a violation of follicle maturation, suppression of the progesterone phase of ovarian function and other changes in the production of sex hormones and pituitary hormones. Research of this kind is performed in special consultation centers of polyclinics called "Marriage and Family". Naturally, in addition to radioimmune tests, these centers also conduct other various studies of the sexual sphere and functions of the female body associated with childbirth. It should also be noted that men are also examined here, since in 30% of cases they are responsible for marital infertility.

Currently, transcervical catheterization of the tubes can be performed with the help of special instruments, and stenosis of the orifice and isthmic part of the tube can be eliminated. The morphology of the tubes is best determined by X-ray metrosalpingography. If the tube is obstructed, the contrast agent either does not enter it at all, or fills the tube only to the level of occlusion, where its shadow suddenly breaks off. The contrast agent does not penetrate into the abdominal cavity. Metrosalpingograms establish unilateral or bilateral obstruction and the site of blockage of the tube. X-ray and radionuclide metrosalpingography can detect "functional obstruction" of the tubes, associated with a decrease in their peristaltic activity or spastic constrictions.

Intersexuality was preliminarily excluded, a gynecological examination was performed, and rectal temperature was measured.

Uterine damage and diseases. A simple and effective way to monitor intrauterine contraceptives is sonography.

Contraceptives are mostly in the form of a spiral; with prolonged use, they may fall out and even perforate the uterus with penetration into the abdominal cavity. On longitudinal sonograms, spirals are visible as sections of echo-positive structures located along the midline.

Sonography is used to detect developmental anomalies of the internal genital organs: bicornuate and rudimentary uterus, underdevelopment of the ovaries. The presence of a bicornuate or bicornuate uterus and patency of the tubes is confirmed by metrosalpingography. It can also detect septa in the uterine cavity and additional passages in endometriosis.

Ultrasound diagnostics of intrauterine pathology is based on the analysis of midline structures. Intrauterine adhesions, submucous myomas, hyperplastic processes in the endometrium, polyps, malignant tumors are characterized by uniform or uneven thickening of the uterine structures, sometimes with the formation of additional echogenic shadows.

Uterine myomas are manifested by its enlargement, deformation of contours and additional rounded formations, often of reduced echogenicity. Degenerative changes in the myomatous node cause heterogeneity of its structure or even a "honeycomb" picture, which is a reflection of small cavities that have arisen in the node. During metrosalpingography, the myoma produces a round or irregular filling defect in the shadow of the enlarged uterine cavity. The defect has clear arcuate boundaries.

In diagnostics of inflammatory, including tuberculous, lesions of the female genital tract, radiation methods are of auxiliary importance. In patients with endometritis and salpingo-oophoritis, thermography registers a hyperthermia zone above the small pelvis. Metrosalpingography makes it possible to establish adhesions dividing the uterine cavity into separate parts, deformation of the fallopian tubes, their elongation, narrowing, fragmentation. The tubes are often displaced upward and to the sides. Sometimes they become impassable and turn into sacs filled with inflammatory exudate (sactosalpinx). Contrast agent accumulates in these encapsulated cavities. The transition of inflammation to the surrounding tissue can lead to the development of a pelvic abscess. The prevalence and nature of pathological changes in this case are best determined by computed tomograms.

Non-invasive cancer and microcarcinomas of the uterus are indistinguishable on sonograms and CT scans. Tumors up to 1 cm in size are determined mainly by MRI. Larger cancer nodes are detected by sonography, since they lead to enlargement and deformation of the organ. The tumor may be hypoechoic or indistinguishable in acoustic structure from the surrounding tissue. Violation of the homogeneity of the node shadow is a consequence of necrosis and hemorrhage in its thickness. Computer or magnetic resonance tomograms provide especially valuable information. They allow not only to detect the tumor, but also to establish its growth into the stroma, involvement of the parametrium, damage to the lower uterine segment and vagina in cervical cancer, metastases in the pelvic lymph nodes. In these cases, CT is performed using the enhancement technique: 20-40 ml of a water-soluble contrast agent is quickly administered intravenously and a series of tomograms are performed. If it is necessary to clarify the extent of the tumor and its relation to the pelvic vessels, pelvic angiography is used. CT is important for planning radiation therapy and further monitoring of the dynamics of the process.

The use of sonography and CT has significantly facilitated the recognition of polycystic disease and ovarian cysts. In polycystic disease, the ovaries are enlarged and contain multiple cysts with a diameter of 3-8 mm. A cystoma is distinguished as a rounded formation with clear internal contours. Its echostructure is different. The most homogeneous image is that of retention cysts, which usually lack 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 determined. Ovarian cancer does not have bright sonographic signs, and it is recognized at a relatively late stage of the disease as a dense echo-heterogeneous body. In this regard, the technique of puncture biopsy of the ovary under the control of ultrasound or CT is currently included in practice.