Interactive Transcript
0:01
Okay, so now let's look at
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a case of kissing ovaries.
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So remember that kissing ovaries really
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happens when there are adhesions near
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the ovaries that draw the ovaries
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together to the midline of the pelvis.
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And the ovaries themselves might be abnormal
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or the ovaries may just be deviated towards the
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midline because of adhesions from endometriosis.
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So this is a reproductive
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age woman with endometriosis.
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So I'm just going to start off by looking
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at the sagittal T2-weighted images.
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So this is a really good sequence
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just to get an overview of what's
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going on in general in the pelvis.
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And it's usually the first sequence that we
0:41
get because it's what we use for planning.
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Okay.
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So here we've got the urinary bladder
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here anteriorly, and then we've
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got the cervix and the uterus, and
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the uterus is kind of retroverted.
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Then we've got this structure back here, which
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you can see on the other sequences as well.
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And then the rectum is back here.
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So obviously we know that there's
1:01
something strange going on.
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We've got sort of this tubular
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cystic-looking structure.
1:06
So now we go over to the axial T2
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weighted images and I like to start
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by looking for normal ovaries.
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So here we've got the common iliac vessels
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bilaterally, and typically the ovaries are
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situated lateral to the common iliac vessels.
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They can be a little bit higher than this
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point in some patients, which is why I
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like to get a full T2 axial series of the
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whole pelvis, starting at the IMA, just
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in case the ovaries are displaced higher.
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But typically you'd find them in this general
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area, but lateral to the common iliac vessels.
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So we're scrolling down, scrolling down,
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we're scrolling down, and now we're
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starting to get into this very bizarre
1:51
looking disorganized structure, and
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we're not seeing any normal ovaries.
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So here we've got a structure that looks
2:00
like it's kind of tubular looking, it
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might represent a dilated tube, and
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it's really hard to see a normal ovary.
2:10
And it looks as though there's
2:11
maybe a second structure here.
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So we can see round ligaments here that are kind
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of drawn into the middle of the pelvis where
2:20
normally they'd be a little bit more lateral.
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And then we've got a second structure here.
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That's quite large, very similar
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appearance with lots of fluid in it.
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and no normal ovary.
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Okay.
2:33
So no normal ovaries.
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And we see that the round ligaments are kind
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of drawn more centrally towards the pelvis.
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So that gives us a clue that maybe these
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structures that we're looking at are the
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ovaries and they're just grossly abnormal.
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And you almost get the sense that there might be
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little follicles here on the T2-weighted images.
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So the next step is let's evaluate the
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signal characteristics of what we
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think are grossly abnormal ovaries.
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So on T2, we can see potentially some small
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follicles here, maybe we'll have to check on
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T1 what they're actually like, and then maybe
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some other little follicles here still don't
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know, haven't looked at the T1, but we can
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see that there's a fluid-fluid level in what
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looks like an enlarged left ovary.
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So notice that you've got some high
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signal fluid, which is layering
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dependently and superficially.
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And then we've got this intermediate
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signal fluid, which occupies the
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rest of the cyst and is lower signal.
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So this is T2 shading.
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The other example I showed you was much
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more dramatic in terms of the decrease
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in T2 signal, but this is a nice example
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of a fluid-fluid level with T2 shading.
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And then we've got another area that's a
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little bit more dark in terms of T2 signal.
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So on the bottom here we've got pre and post
3:56
contrast T1 weighted images with fat saturation.
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So now we need to look at whether the
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T2 signal corresponds to hemorrhage.
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And quite obviously you can see that.
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Without contrast, there is markedly increased
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T1 signal in both of those ovaries.
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So the areas that we thought maybe were
4:15
follicles, let's see what they look like.
4:18
So you can see that maybe anteriorly here
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and here, we've got some high signal.
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So those are probably hemorrhage.
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These guys here posteriorly maintain low signal.
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So those are probably normal follicles.
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But we've got lots of hemorrhagic products.
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So this is a nice example of kissing ovaries.
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And we've probably also got on the right side,
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we've got this kind of tubular structure here.
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Let's see what it looks like on the sagittal.
4:46
Yeah, again, it looks kind
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of superficial and tubular.
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I would be happy calling this a distended
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fallopian tube on the right, and you can
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see that there's some blood in it, so this
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is a hematosalpinx, and that's also a
4:58
common feature in endometriosis, and I will
5:02
talk about that a little bit more as well.
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But very nice example of kissing ovaries,
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very kind of florid example in this case
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as well, but hopefully you got some tips on
5:14
what to look for and how to use the different
5:16
sequences to arrive at your conclusion.
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Thanks again.
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