Interactive Transcript
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But before then, let's start with
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some uterine axis technology and
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that's going to be version inflection.
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Version is easy to remember
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because it has the V in the cervix.
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So version is cervix positioning.
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So if the cervix is antiverted, that means
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the internal aspect of the cervix is pointing
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anteriorly towards the bladder, or the external
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aspect is pointing posteriorly towards the rectum.
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Usually the uterus flexes in the
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same direction as the cervix.
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But not always.
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So, for example, if you have an anti-flexed
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uterus, the uterine body is going to be
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positioned anteriorly towards the bladder.
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Your most common positioning is going
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to be antiverted and anti-flexed,
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and then followed by retroverted.
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Retroflexed is the next most common.
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However, you can have any kind of
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mixture of positioning, and it can even
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change during any single examination.
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So if you're with me so far, it seems pretty
0:55
straightforward, but we're going to add a little
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bit more complexity because the positioning of
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the cervix that will help decide where the probe
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is positioned within the vagina, whether you're
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in the anterior or the posterior fornix, and
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that's going to alter the imaging appearance.
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And to explain that a little bit
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better, here's another little schema.
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So if you have an anteverted anti-flexed uterus
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right here, and this is your transvaginal
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probe, it's going to go in the anterior
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fornix right here, and that's going to create
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your standard image of the female pelvis.
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However, if it is a retroverted retroflexed
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uterus, you're not going to go into the
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posterior fornix here, and you can see that
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the probe itself is actually flipped here.
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And so that's going to make the cervix appear
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to come from the other side of the screen.
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And so as long as you keep that
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in mind, that is what's happening.
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You'll be able to interpret these images easily.
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So with that in mind, let's see some examples.
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So here we go back to our transabdominal view,
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the same uterus that we saw earlier, right?
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Vagina down here, cervix down here, anterior
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uterus up here, and a nice full bladder.
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Same patient on their transvaginal imaging.
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This is an anteverted, anti-flexed.
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So your cervix is somewhere down here.
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The internal os, we're going to estimate
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it somewhere around here, is pointing
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this way, which is towards the bladder.
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We don't see the bladder in this
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field of view because it's empty,
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but it'd be somewhere up here.
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The external os of the cervix is somewhere
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down here, and it's vaguely pointing
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towards the rectum, which is back here.
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The uterus itself, too, is also generally
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pointing anteriorly towards the bladder.
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So this is antiverted, anti-flexed, and
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this is the most common one you'll see.
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This is its positioning on CT.
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It's the same patient again.
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Antiverted, anti-flexed, and that
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goes to prove to you here.
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Here's your bladder right
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here in your sagittal view.
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Everything is pointing anteriorly towards
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the bladder or the front of the patient.
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Again, antiverted, anti-flexed.
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This, however, is a retroverted retroflexed,
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and you can see it looks like the cervix
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is coming from the opposite side of the
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screen, and on the imaging that is what's
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happening, but that is again because the
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probe goes into the posterior fornix of the
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vagina, and it is flipped or inverted, so
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the cervix will look like it's coming from
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over here on the right side of the screen.
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I find in these, it is often very hard
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to measure the uterus accurately because
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of the bend that often occurs with this.
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So it's often going to seem under
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measured because you're just very rarely
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going to get that cervix in the same
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field of view as the rest of the uterus.
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So just something to keep in mind if you're
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comparing a size of the uterus and it changes
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positioning on different imaging dates.
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One other thing to keep in mind when you
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are reading a retroverted retroflexed uterus
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is that this is still going to be the
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anterior part of the uterus right here.
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This is the posterior. This is anterior.
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So the bladder is still going to be somewhere
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located over here, but this is the anterior.
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This is the posterior.
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If you're locating where fibroids are
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or polyps or something like that,
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this is anterior. This is posterior.
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So on CT, here's that same uterus.
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This is the positioning it would render.
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So bladder right here, rectum back here, and
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this is the uterus and the cervix right here.
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So that's the equivalent.
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Okay, so now let's get to some trickier ones.
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So this one, the image field of view
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is honestly a little bit too big.
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They probably could narrow this up a
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little bit, but as you're looking here,
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this one almost looks curved in some ways.
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It's, here's the kind of cervical area,
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and then the body of the uterus is
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up here, the fundus is back here, and
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then it sort of curves around here.
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So here's the line that I drew to
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help find the endometrium itself,
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which is what I use as my marker.
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And in this case, we have a retroverted uterus.
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It's coming just barely, but from
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the right side of the screen.
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But it is anti-flexed.
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The body is flexed anteriorly.
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So retroverted anti-flexed.
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And there's this one.
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This one the field of view is honestly
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probably a little bit too small.
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I could have widened this
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one up a little bit more.
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But this is an example of
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an anteverted retroflexed.
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So the cervix is right here coming
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from this side of the screen.
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And then the body of the uterus is
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going posteriorly towards the rectum.
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So anteverted retroflexed.
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And so it's interesting, again, these
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can change during an examination,
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potentially, as long as that uterus
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isn't scarred in place due to adhesions.
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In this particular patient, this was
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them 10 months earlier. It was in a
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completely different position here.
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Right here, it was retroverted anti-flexed.
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And so, of course, then too, it
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can also change during an exam.
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That's why sometimes the technologist will
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start taking additional pictures that they
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already took of the endometrium or different
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measurements at the end of the exam, because
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that uterus flipped to a better imaging
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position where they could see it better.
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