1. Smooth Muscle
1.1. Uterine Leiomyoma
1.1.1. low T1 too
1.1.2. T2 signal can vary in subtypes
1.1.2.1. cystic
1.1.2.2. red
1.1.2.3. unusual
1.1.2.3.1. lipoleiomyoma
1.1.2.3.2. myxoid
1.1.3. most common benign gynae tumours
2. Fibrous Tissue
2.1. Fibroma
2.1.1. assoc with ascites
2.1.1.1. Meigs syndrome
2.2. Fibrothecoma
2.2.1. T1 hypo/iso
2.2.2. mild enhancement
2.2.3. can cause endometrial hyperplasia
2.3. Cystadenofibroma
2.3.1. solid component is T2 hypo
2.3.1.1. cause fibrous wall thickening
2.3.1.1.1. mild enhancement
2.3.2. appearances dependent on the cyst:solid ratio
2.3.3. can have malignant degeneration
2.3.3.1. remove
3. Mixed Cellularity
3.1. Brenner
3.1.1. contains
3.1.1.1. firbous tissue
3.1.1.2. calcification
3.1.1.3. assoc with
3.1.1.3.1. mucinous cystadenoma
3.1.1.3.2. epithelial neoplasms
3.1.1.4. show moderate enhancement
3.1.1.4.1. cf to fibrothecomas which look similar but do not enhance/mildy enhance
3.2. Struma Ovarii
3.2.1. specialised teratoma
3.2.1.1. thyroid tissue
3.2.2. cystic spaces show low T2
3.2.2.1. gelatinous cysts
3.2.2.2. may have T1 hyper cysts
3.2.2.2.1. haemorrhage
3.2.3. strong enhancement
3.2.4. fat
3.2.4.1. high T1/T2
3.2.4.2. signal drop out/chemical artefact shift
3.3. Krukenberg Tumour
3.3.1. metastatic tumours from stomach ca
3.3.2. bilateral
3.3.3. low T2 because
3.3.3.1. metastatic mucin filled signet ring cells
3.3.3.2. lots of collagen
4. Normal
4.1. What is adnexa
4.1.1. fallopian tubes
4.1.2. ovaries
4.1.3. structures that originate from the uterus and supporting ligaments
4.2. what's normally T2 hypo
4.2.1. junctional zone of uterus
4.2.2. vaginal, urethral and rectal muscularis
4.2.3. bladder detrusor muscle
5. Differentiating uterine vs ovarian
5.1. gonadal vessels seen?
5.1.1. ovarian
5.2. bridging vessels
5.2.1. tortuous vascular structures passing between uterus and the lesion
5.2.1.1. T1 + C
5.2.1.2. T2
5.2.2. likely to be uterine rather than ovarian
6. Blood Products
6.1. Endometrioma
6.1.1. shading sign
6.1.2. hypointense peripheral ring
6.1.3. malignant degeneration
6.1.3.1. solid mural nodule
6.1.3.1.1. enhances
6.1.3.2. loss of shading sign
6.2. Haematosalpinx
6.2.1. most common T2 hypo tubal lesion
6.2.1.1. strong assoc with pelvic endometriosis
6.2.2. specific sign
6.2.2.1. waist sign
6.2.2.1.1. small round projections
6.2.2.1.2. diametrically opposed indentations in the walls
6.2.2.1.3. represents
6.3. Haemorrhagic Cyst
6.3.1. pre-menopausal
6.3.2. mild T2 signal loss and no shading
6.3.3. will resolve after a few cycles
6.4. Cystic Adenomyosis
6.4.1. lots of cystic, glandular and haemorrhagic changes
6.4.2. Uterine
6.4.2.1. myometrial splaying around the lesion
6.4.2.2. bridging vessel sign
6.4.2.3. seperate ovaries