In our latest article, Professor Nazar Amso, a revered consultant obstetrician and gynaecologist, provides us with a detailed account on what gynaecological imaging involves, and which specific tests are generally performed in gynaecological imaging.
What exactly does gynaecological imaging entail?
Gynaecological imaging attempts to examine a part of the body with a specific test that gives additional information beyond the naked eye. Such tests may be carried out in the clinic during a consultation such as ultrasound and colposcopy, or in a dedicated setting such as a radiology department for CT and MRI scans. Procedures such as hysteroscopy or laparoscopy can be carried out in a dedicated treatment room or operating theatre, respectively.
What tests are normally carried out in the branch of gynaecological imaging?
Transabdominal scanning (TAS) and transvaginal scanning (TVS) are the most widely available techniques, and, in the past few years, TVS has taken prominence in the establishment of gynaecology one-stop clinics.
The vast majority of practitioners carry out 2-Dimensional (2D) scanning, whereby an ultrasound probe is placed over the lower abdomen or introduced into the vagina to examine the pelvic structures. TAS requires filling the bladder while TVS is done with an empty bladder.
The pelvis is examined systematically to determine the normality of the uterus, thickness of the lining of the womb, the appearance of the ovaries, as well as their activity during the menstrual cycle. 3-Dimensional (3D) scanning is a more sophisticated technique that allows the operator to obtain more detailed information on the uterine shape and the presence or not of uterine abnormalities such as a septum or polyps. It also allows better determination of the margin between the lining of the womb and muscle layer, which is particularly useful in adenomyosis.
Ultrasound-guided procedures, e.g., saline infusion sonography (SIS) or hystero-contrast-sonography (HyCoSy) are procedures that are performed in the office, and involve the introduction of normal saline or a contrast solution into the cavity to get more information on any intracavity lesion(s) in the former and assess tubal patency in the latter.
MRI is another excellent technique that is not operator-dependent, as is the case with ultrasound, and it allows us to see the different tissue planes of the body in greater detail. It requires the patient to attend the radiology department and lie down on a table where the MRI machine scans the body. The consultant radiologist interprets the images.
CT scanning is another useful technique commonly used in women with cancer or inflammatory conditions. It also requires the patient to attend the radiology department and the CT machine scans the body. The consultant radiologist interprets the images.
Colposcopy and vulvoscopy are techniques whereby the cervix or vulva are examined with a magnifying device (colposcope) that examines the surface in great detail and allows a targeted tissue biopsy to be taken and extracted.
Hysteroscopy is a technique that allows a thorough examination to take place of the inside of the uterine cavity with a narrow telescope and very often complements TVS. In many instances, when carried out as a diagnostic procedure, a hysteroscopy does not require general anaesthetic and is done in an office environment. However, in cases when a polyp or fibroid requires removal, general anaesthetic and admission to the hospital for a few hours are very likely needed.
Finally, laparoscopy is a technique that allows examination of the inside of the abdominal cavity with a narrow telescope and is always done under general anaesthetic. It is done for diagnostic and therapeutic purposes and requires admission to the hospital for a few hours.
What are the most common gynaecological emergencies where imaging is helpful?
The most common gynaecological emergencies where imaging is helpful include vaginal bleeding and pain in early pregnancy, (where miscarriage is the primary concern), acute severe pelvic pain, and heavy menstrual bleeding and flooding, which requires the woman to attend the hospital as an emergency.
How often should women go for gynaecological imaging?
There is no rule regarding how often a woman should have an imaging test, especially if she is well and healthy and without symptoms. However, many women in the perimenopause state decide, for their peace of mind, to have a TVS once a year to check their uterus and ovaries.
In these cases, there is no clinical indication, but simply personal choice. In situations where there is a known small or medium-sized cyst in the ovary that has been investigated and judged not to be serious, and the patient doesn’t wish to have surgery, a scan may be repeated at regular intervals such as every six to twelve months to ensure that it is not growing further.
Professor Nazar Amso is a highly esteemed consultant obstetrician and gynaecologist who specialises in gynaecological imaging. Consult with him today to book an appointment with him via his Top Doctors profile.