Diagnostic and Interventional Radiology in Gynecological and Obstetric Diseases

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