Character

Introduction

On observation the utrus has a smooth smooth external surface. It is relatively hard to palpation sinceit is a fibromuscular organ. It has a hollow endometrial The upper muscular portion is called the uterine corpus and the lower fibrous portion is the cervix

The body of uterus is mobile while the cervix is relatively fixed. The cervix is more fibrous and rigid than body of uterus

Character – by Ultrasound

Junctional Zone In Early Proliferative Phase

The normal sagittal view of the uterus is a transvaginal ultrasound, in the first week after menstruation and just prior to the next menstruation after the endometrium has been shed. It demonstrates that the endometrium becomes a single echogenic line consisting of opposing walls (orange) and is surrounded by a subendometrial halo of the junctional zone (tan). This layer is more compacted, and relatively hypovascular. This image is typical of the early proliferative phase. It is during this time that estrogen starts to rise and progesterone has fallen. The endometrium in this case measures about 3mms.

The Complex Endometrium

Triple Stripe – Trilaminar Appearance – Preovulation

The normal sagittal view of the uterus is a transvaginal ultrasound, 2 weeks after menstruation, and just prior to ovulation. It demonstrates that the uterus and more specifically the endometrium is more complex than just a simple columnar epithelium. This is an example of the trilaminar appearance of the endometrium and is characteristic of the appearance of the endometrium in the preovulatory phase. This pahse is also called the follicular phase, or proliferative phase. It is during this time that estrogen is the dominant hormonal influence. The appearance is also known as a “triple stripe”, and conversely, its presence is seen before progesterone is produced. If present with a 9mm+ diameter, it reflects an ideal potential lining for fertilization.. In this case it measured 1.2cms.

The Overipe Endometrium – Premenstrual

The normal sagittal view of the uterus is a transvaginal ultrasound, about 4 weeks after menstruation, and just prior to the next menstrauation when the endometrium is overripe. It demonstrates that the uterus and more specifically the endometrium is more complex than just a simple columnar epithelium. This is an example of the hyperechoic, homogeneous, thick endometrium characteristic of the secretory phase. It is during this time that progesterone is the dominant hormonal influence and estrogen influence is minimal. The endometrium in this case measures 1.2cms.

Endometrial Stripe and Junctional Zone in the Aging Uterus

The transvaginal ultrasound is from a 62 year old post menopausal patient who presents with pelvic discomfort. The ultrasound shows a small atrophied uterus. The myometrium (dark red) junctional zone (light red) and endometrial cavity (pink) are outlined. In the sagittal plane the uterus measures 3.4cms in cranoicaudal dimension by 2.4cms in anteroposterior dimension (a,b) In the axial dimension (c,d) the uterus measures 2.4cms. The endometrial stripe is measured in the sagittal plane and measures .7mms.

Character By CTscan

The character of the uterus is dependant on many aspects including the age, time of the month and the way the angle the uterus is scanned.

Normal Uterus in a 20 Year Old with Acute Transmural Colitis and Ascites

In this 20 yearold patient the myometrium is homogeneous and isodense with the soft tissues. The suendometria layer is hyperemic and likely is in the latter phase of the cysle and the endometrium and endometrial cavity is hypodense.

She presented with colitis and ascites which enabled detail of the uterus to be appreciated. Ovaries are well visualized a well

Image Courtesy Ashley Davidoff MD 45318

Sagittal Reconstruction

The sagittal reconstructed CT shows an anteverted uterus buoyed and cushioned by partly filled bladder (yellow) In this sagittal view the adult uterus measures about 10cms in craniocaudad span and 5cms in A-P dimension and the endometrial stripe measures about 1cms.

Characterization by MRI

T2 Weighted MRI in the Sagittal Plane

The normal sagittal view of the uterus is a T2 weighted MRI from a 16 year old female with pelvic pain. It demonstrates theta the uterus and more specifically the myometrium is more complex and consists of an outer part (dark red) and an inner more homogeneous part called the junctional zone Since a T2 weighted image is sensitive to water we understand from this image that the outer part since it has greater white signal contains more water, and likely more vascularity. The endometrial canal, cervical canal and vaginal cavity are outlined in yellow and the vaginal wall is pink.

T1 Weighted with Gadolinium

Normal

The uterus is pear shaped as depicted in this overlay sagital (a,b) and coronal (c,d) T 1weighte enhanced MRI study