Diagnostic and Interventional Radiology in Gynecological and Obstetric Diseases

Description

This book focuses on the role of diagnostic and interventional radiology in obstetrical and gynecological diseases. It provides relevant information on each topic, considering both diagnostic and interventional radiology, which now belong to the same professional unit.  Each chapter begins with a brief introduction to the most relevant clinical aspects of the pathology. Diagnostic examinations are also discussed, with a focus on the radiological studies (US/CT/MR) functional to subsequent procedures. This is followed by an interventional section, which clarifies the indications, contraindications, techniques (including choice of materials) and follow-up. Lastly, clinical cases are provided, together with multiple-choice review questions.  Given its scope, the book will appeal to radiologists, gynecologists and obstetricians, as well as to residents in these specialties.  Foreword Preface Introduction Contents Part I: Imaging 1: Imaging in Gynecology 1.1 Introduction 1.2 Imaging Methods 1.2.1 Ultrasound 1.2.2 X-Ray 1.2.3 Magnetic Resonance Imaging 1.2.4 Computed Tomography 1.3 Gynaecologic Haemorrhages 1.3.1 Gynaecologic Causes of Haemoperitoneum 1.3.1.1 Haemorrhagic Ovarian Cyst Corpus Luteum Cyst Endometriotic Cysts 1.3.1.2 Ectopic Pregnancy 1.3.1.3 Caesarean Scar Pregnancy 1.3.2 Gynaecological Causes of Vaginal Haemorrhage 1.3.2.1 Uterine Artero-Venous Malformations 1.3.2.2 Post-Partum Haemorrhage 1.3.2.3 Cervical Pregnancy 1.4 Uterine Disorders 1.4.1 Adenomyosis 1.4.2 Leiomyoma 1.4.3 Endometrial Polyps 1.4.4 Endocervical Polyps 1.4.5 Endometrial and Cervical Cancer 1.5 Adnexal Masses 1.5.1 Complication: Adnexal Torsion 1.6 Pelvic Pain 1.6.1 Pelvic Inflammatory Disease 1.6.2 Pelvic Congestion Syndrome 1.6.3 Thrombosis of the Gonadal Veins 1.6.4 Peritoneal Inclusion Cysts References 2: Imaging in Obstetrics 2.1 Introduction 2.2 Placental Pathology 2.2.1 Placental Morphology 2.2.2 Placental Thickness and Location 2.2.3 Cord Insertion Abnormalities 2.2.4 Vasa Previa 2.2.5 Placental Cyst 2.2.6 Placental Abruption 2.2.7 Placenta Accreta Spectrum Disorders 2.3 Ectopic Pregnancy 2.4 Gestational Trophoblastic Disease 2.4.1 Complete and Partial Hidatiform Mole 2.4.2 Gestational Trophoblastic Neoplasia 2.4.3 Placental Nontrophoblastic Tumors References Part II: Interventional Radiology in Woman 3: Embolic Agents in Interventional Radiology in Gynecological and Obstetric Diseases 3.1 Embolic Materials 3.1.1 Temporary Embolic Agents 3.1.1.1 Absorbable Gelatin Sponge (Gelfoam) 3.1.1.2 Avitene 3.1.2 Permanent Embolic Agents 3.1.2.1 Polyvinyl Alcohol 3.1.2.2 Microsphere 3.1.2.3 Liquid Embolic Agents Glue Liquid Polymers Phil Onyx Alcohol 3.1.2.4 Metal Coils and Plugs Coils 3.1.2.5 Sclerosing Agents 3.2 Complications 3.2.1 Complications Related to Angiographic Procedure 3.2.2 Complications Secondary to Embolization References 4: Radioprotection 4.1 Introduction 4.2 Damage Mechanisms of Ionizing Radiation 4.3 The Dosimetric Quantities 4.4 Radiation Protection of Patients 4.4.1 Radiation Protection in Diagnostic Imaging 4.4.2 Radiation Protection in Image-Guided Interventions 4.4.3 Patient Shielding 4.5 Occupational Radiation Protection 4.6 Pregnant Patients and Personnel References 5: Pharmaceutical Aspects: Pre-, Peri-, and Post-procedural 5.1 Introduction 5.2 Peri-procedural Antithrombotic Management in Gynecological and Obstetric IR 5.2.1 Anticoagulation Management Strategies for Elective Procedures 5.2.2 Antiplatelet Management Strategies for Elective Procedures 5.3 Peri-procedural Sedation and Analgesia Management in Gynecological and Obstetric IR 5.3.1 General Anesthesia 5.3.2 Epidural Anesthesia 5.3.3 Spinal Anesthesia 5.3.4 Local Surface Anesthesia 5.3.4.1 Hypnotic Sedatives 5.3.4.2 Opioid Analgesics 5.3.4.3 Non-opioid Analgesics 5.4 Uterine Artery Embolization for Uterine Fibroids Bibliography 6: Ethics and Safety 6.1 Introduction 6.2 Interventional Radiology and Ethical Issues 6.3 The Interventional Radiology Suite 6.4 Adverse Events and Errors in Interventional Radiology 6.5 Safety Checklist in Interventional Radiology 6.6 Safety Steps Related to Interventional Radiology Procedures 6.7 The Informed Consent 6.8 Conclusion References Part III: Gynecological Pathologies 7: Management of Fallopian Tube’s Obstructions 7.1 Introduction 7.2 Aetiology 7.3 Radiological Anatomy 7.4 Diagnostic Techniques 7.4.1 Hysterosalpingography 7.4.1.1 Technique 7.4.1.2 HSG Findings Normal Findings Pathological Findings 7.4.2 Laparoscopy 7.4.3 Hysterosalpingo Contrast Sonography 7.4.4 C. Trachomatis Antibody Test 7.4.5 Endoscopic Techniques 7.4.6 Magnetic Resonance 7.5 Therapeutic Techniques 7.5.1 Proximal Tubal Occlusion 7.5.1.1 Interventional Fallopian Tube Cannulation 7.5.1.2 Microsurgical Tubo-cornual Anastomosis 7.5.2 Distal Tubal Occlusion References 8: Embolics and Sclerosis in Pelvic Congestion Syndrome 8.1 Introduction 8.2 Patient Preparation 8.2.1 Anesthesia and Pain Control 8.3 Technique 8.3.1 Venous Approach 8.3.2 Vessels to Embolize 8.3.3 Embolic Agents 8.3.4 Embolization Techniques 8.3.5 Phlebographic Study and Classification 8.3.6 Embolization with Coils or Vascular Plugs 8.3.7 Embolization with a Mixture of Glue and Lipiodized Oil 8.3.8 Embolization with Gelfoam 8.3.9 Sclerotherapy 8.3.10 Balloon-Occluded Technique 8.4 Clinical Outcomes 8.5 Complications 8.6 Conclusions References 9: Endovascular Embolization of Uterine Myomas and Adenomyosis 9.1 Introduction 9.2 Epidemiology and Clinical Features of Uterine Fibroids and Adenomyosis 9.2.1 Fibroids 9.2.2 Adenomyosis 9.3 Treatment Options and Clinical Indications to Uterine Artery Embolization 9.4 Technical Aspects 9.4.1 Type of Vascular Access 9.4.2 Uterine Arteries Catheterization and Anatomy Evaluation 9.4.3 Embolization Materials 9.5 Adverse Events 9.5.1 Procedural Complications 9.5.2 Impact on Pregnancy 9.6 Pain Management Protocols During Uterine Fibroid Embolization 9.7 Imaging and Clinical Follow-Up 9.8 Conclusions References 10: Percutaneous Ablation of Uterine Myomas 10.1 Introduction 10.2 Percutaneous Techniques 10.2.1 Microwave Ablation 10.2.2 Radiofrequency Ablation 10.2.3 Cryotherapy Ablation 10.3 Outcomes 10.3.1 Percutaneous Microwave Ablation 10.3.1.1 Clinical and Technical Success 10.3.1.2 Complications 10.3.1.3 Fertility 10.3.2 Radiofrequency Ablation 10.3.2.1 Clinical and Technical Success 10.3.2.2 Complications 10.3.2.3 Fertility 10.3.3 Cryotherapy Ablation 10.3.3.1 Clinical and Technical Success 10.3.3.2 Complications 10.3.3.3 Fertility 10.4 Technical Comparison 10.5 Conclusion References 11: High-Intensity Focused Ultrasound Surgery of Uterine Myomas 11.1 Introduction 11.2 Physical Principle and Biological Effects 11.3 Imaging Guidance 11.4 Indications and Contraindications 11.5 Procedure 11.6 Literature Data 11.7 Conclusions References 12: Embolization of Uterine Arteriovenous Malformations 12.1 Introduction 12.2 Pathophysiology of Uterine AVMs 12.3 Clinical Presentation 12.4 Diagnosis 12.4.1 Laboratory Findings 12.4.2 Transvaginal Ultrasound 12.4.3 DCE-MRI and CECT 12.4.4 Angiography 12.5 Conservative Treatment 12.6 Endovascular Treatment (UAE) 12.7 Surgical Treatment 12.8 Conclusion References 13: Malignancies: Collections Drainage, Biopsies, and Endovascular Bail-Out Treatments 13.1 Introduction 13.2 Collections Drainage 13.2.1 IR Treatment 13.2.2 Technique 13.2.3 Ascites 13.2.4 Lymphocele 13.2.5 Abscess 13.2.6 Pleural Effusion 13.2.7 Urinary Tract 13.2.8 Biliary Tract 13.3 Biopsies 13.3.1 Indications 13.3.2 Sampling, Guide, and Technique 13.3.2.1 Sampling 13.3.2.2 Image-guidance 13.3.2.3 Technique 13.3.2.4 Complications 13.4 Endovascular Bail-Out Treatment 13.5 Conclusion References Part IV: Obstetrical Pathologies 14: Embolization of Scar Pregnancies and Extrauterine Implants 14.1 Introduction 14.2 Direct Chemical Injection 14.3 Endovascular Treatment 14.3.1 Introduction 14.3.2 Patient Selection Criteria 14.3.3 Pre-treatment Imaging Evaluation 14.3.4 Procedure 14.4 HIFU 14.5 Prevention of EP References 15: Interventional Radiology in Postpartum Hemorrhage: Rescue Strategies 15.1 Definitions and Epidemiology 15.2 Etiology of PPH 15.3 Management of PPH 15.3.1 Prevention 15.3.2 First-Line Measures 15.3.3 Second-Line Measures 15.3.4 Third-Line Measures 15.4 Embolization 15.4.1 Preprocedural CT Evaluation 15.4.2 Target Arteries 15.4.3 Technique 15.4.4 Embolic Agents 15.4.5 Outcomes and Complications References 16: Interventional Radiology in Postpartum Hemorrhage: Prevention Strategies 16.1 Definitions 16.2 Introduction 16.3 Preventive Strategies 16.3.1 Embolization Approach 16.3.1.1 Preventive Embolization After Cesarean Delivery 16.3.1.2 Preventive Embolization Before Cesarean Delivery 16.3.2 Balloon Occlusion Approach 16.3.2.1 Iliac Artery Balloon Occlusion 16.3.2.2 Aortic Balloon Occlusion 16.3.2.3 Balloons Technique Comparison 16.4 Radiation Dose Reduction Protocols and Safety References