Interactive Transcript
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Our next case is of a 49-year-old female who had
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a pelvic MRI for dysfunctional uterine bleeding.
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Again, T2-weighted imaging is going to be
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really important when you're considering the
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uterus and defining the different structures.
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In this particular patient, there are
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going to be a lot of findings.
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We also have a little bit of
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artifact from respiratory motion.
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So we can see here the endometrium is T2 bright.
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I actually have this sort of outpouching or
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bulging right here at the site of prior C
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section scar that's called an isthmocele.
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We'll see some examples
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of that later in the talk.
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We have some T2-bright Nabothian cysts,
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which are extraordinarily common.
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Okay, and we also have multiple
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classic appearing T2-dark fibroids,
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such as one here, another one here.
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These are myometrial-based.
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Then you have these other additional fibroids.
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This one's a little bit more T2 bright with some
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heterogeneity to it, another fibroid over here,
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and then another T2-bright fibroid, slightly
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heterogeneous, but even brighter than this one.
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So your T2-weighted imaging
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alone is not going to be able to
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necessarily tell you what's going on
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exactly what kind of fibroid
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or degeneration this is.
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You refer back to the chart
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that I showed you earlier.
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So you're going to need a little
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bit more images to consider as well.
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This is your T2 fat sat.
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I'm just going to run through this as well.
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This uterus, you can see your Nabothian
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cyst, your endometrium, and your fibroids.
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And in this one in particular, it
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looks a little bit brighter, right?
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And it has this dark spot now
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in this T2 fat-saturated, right?
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Fat-saturated image right here.
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Generally, when you're thinking about
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your in- and out-of-phase T1 images, which
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what we have down here, this is your India
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ink out-of-phase, in-phase is over here,
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we're thinking mostly for dermoids or
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ovarian masses to look for fatty content.
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But if you're trying to figure out
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what kind of fibroid this is, don't
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neglect your in- and out-of-phase.
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You can see right here, here is our
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indeterminate fibroid right here, which
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is T2 bright and dark signal right here.
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If you look when you're out of phase
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versus in phase, there's very
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clearly a drop in signal right here.
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So this contains macroscopic fat and that
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would make this a lipoleiomyoma as well.
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So this is a lipoleiomyoma on MRI
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on a background of multiple other
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fibroids of different subtypes.
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So a couple more sequences
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here, different views.
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You would need contrast to differentiate the
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other T2 bright or mildly T2 bright fibroid.
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We didn't have that in this particular case.
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But another finding I wanted to point
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out is your thickened junctional zone.
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This is a coronal image, so not the best
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one to measure a junctional zone off of.
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But you also have these T2-bright foci
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out here in the corner in a very poorly
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defined structure, not nearly as well
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defined as this fibroid is over here.
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Here we have another different view.
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This was an open book sequence, again, T2
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bright, and you can see these T2-bright foci in
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this somewhat ill-defined structure right here.
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So this is a little bit of adenomyosis.
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So this patient really does have it all.
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They have a lipoleiomyoma, classic
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fibroids, a little bit of adenomyosis as well.
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And then moving on to the ultrasound
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appearance of the same patient, you
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can see a classic fibroid over here.
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Remember, we're in transverse
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here, so the endometrium is going
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to come out in just a moment.
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It's going to be right here.
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That's what all of this bright signal
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is with increased through-transmission.
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That's the endometrium.
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Get a little bit further down and then we see
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this super echogenic structure right back here.
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Maybe even brighter than the adjacent fat.
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And that's going to be your
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correlate for the lipoleiomyoma.
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So again, this patient has it all.
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We've got our fatty fibroid, our
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classic fibroids, and adenomyosis.
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