All signs in Radiology from Radiopedia

Gynac
1) The bridging vessel sign : appearance of vessels coursing from the uterus into an adjoining pelvic mass (a
vascular bridge). This sign helps to differentiate a pedunculated subserosal uterine leiomyoma from other
juxtauterine masses of ovarian, adnexal or bowel origin.
Colour and power Doppler shows the vessels as flow signals extending from the uterus into the adjoining pelvic
mass.
MRI shows the vessels as curvilnear tortuous flow voids.
The bridging vessel sign indicates the uterine origin of the pelvic mass. The vessels represent feeding vessels
that arise from the uterine arteries and course through the myometrium to supply large exophytic myomas. It is
reported to have a high sensitivity and specificity for the diagnosis of large (>3 cm) subserosal leiomyomas.

2) Cogwheel sign : Thickening loops of the Fallopian tube seen on cross section. There are infolding projections
(sometimes look like nodules) into the Fallopian tube lumen which is likened to that of a cogwheel. The sign is
typically described on USG and is indicative of tubal inflammation in PID with a pyosalpinx or a hydrosalpinx.

3) Dot-dash pattern (dermoid mesh) is one of the characteristic sonographic appearances of an ovarian dermoid
cyst. It refers to the short and long echogenic lines which are often seen within a dermoid cyst and are due to the
presence of hair.
4) Cervical funneling is a sign of cervical incompetence and represents the dilatation of the internal part of the
cervical canal and reduction of the cervical length.
> 50% funneling before 25 weeks is a/w approximately 80% risk of preterm delivery.
Good scanning technique is essential, as excessive pressure with the probe, or presence of a distended bladder
may artificially narrow the canal. Preferably, a TVS is recommended for accurate assessment of cervical length
and measurement of funneling.
Measurement :
 percentage funnelling: funnel length/(functional cervical length + funnel length)
 shape of funneling: V-shaped or U-shaped. U-shaped funneling have higher risk of preterm delivery
 depth and width of the funnel: V-shaped funnel has a depth with no width; however, U-shaped funnel
has the width as an important parameter

5) Mushroom cap sign is one of the important signs of deep rectosigmoid endometriosis seen on T2 weighted MRI
sequence. It indicates the submucosal involvement in rectosigmoid region.
MRI : Hypertrophic muscularis propria appears as heterogeneous
low signal intensity surrounded by high signal intensity of mucosa and submucosa. This gives characteristic
appearance of mushroom cap.

6) Popcorn calcification : amorphous calcifications often with rings and arcs that resemble popped corn kernels.
This type of calcification may be seen in many radiological settings including :
 chondroid lesions (e.g enchondroma, chondrosarcoma)
 fibrous dysplasia
 pulmonary hamartomas
 degenerating fibroadenomas of the breast
 calcified uterine fibroid
They are also seen in metaphyses and epiphyses of long bones of children with osteogenesis imperfecta. In this
case, they represent scalloped lucencies with sclerotic margins

7) The ring of fire sign aka ring of vascularity signifies a hypervascular lesion with peripheral vascularity on colour
or pulsed doppler examination of the adnexa due to low impedance high diastolic flow.
This sign can be seen in
 corpus luteum cyst (more commonly)
 ectopic pregnancy
8) Rokitansky nodule / dermoid plug : A solid protuberence projecting from an ovarian cyst in the context of a
mature cystic teratoma. It often contains calcific, dental, adipose, hair and/or sebaceous components
9) T2 dark spot sign : is an MRI appearance of endometriomas seen as a result of chronic haemorrhage.
The sign is useful in differentiating a solitary endometrioma v/s a functional haemorrhagic ovarian cyst, as both
might show high T1 signal with T2 shading.
The T2 dark spot, described in the sign, is seen within the cyst, often against the cyst wall, but not within the
cyst wall itself (which is usually of low T2 signal due to hemosiderin-laden macrophages and fibrous component
of the cyst wall).

10) Shading sign is an MRI finding typically seen in an endometrioma. It may also be seen with some endometrioid
tumours (e.g endometrioid carcinoma of the ovary)
a) It helps to distinguish endometriomas from other blood containing lesions (e.g. haemorrhagic corpus
luteum cysts), with a sensitivity of 90-92%, a specificity of 91-98% and a diagnostic accuracy of 91-96%.
b) The sign is seen on T2 weighted sequences of lesions, that are hyper-intense on T1, and consists of low
signal (T2 shortening) affecting variable portions of the cyst.
c) It may involve only a small portion of the cysts, typically layering dependently.
Alternatively it may involve the entire cyst.
d) The signal is due to high concentration of protein and iron within the endometrioma from recurrent
haemorrhage. The degree of shading can vary from faint to complete signal loss.

Hemorrhagic adnexal cyst (most commonly, a corpus luteum cyst) :

a. They are usually solitary and thin walled may be bright on T1-WI and are brighter on T2-WI than are
endometriomas.
b. Marked loss of signal intensity on T2-weighted images is not usually seen with hemorrhagic cysts, since
they do not repeatedly bleed. Without recurrent hemorrhage and concentration of contents  viscosity
of the cyst remains lower, and shading is unlikely to be present.
When noted with endometriosis, lesions demonstrating a shading sign may be less likely to respond to medical
treatment

11) Tip of the iceberg sign refers to one of the characteristic appearances of an Ovarian dermoid cyst.
If there are echogenic cyst contents of sebum and hair, they cause marked posterior acoustic attenuation so
that only the superficial part of the cyst is seen.
Just like an iceberg, you may only be able to see a small piece of the structure, with a much larger piece deeper.
The intense acoustic shadowing in an ovarian dermoid may also be caused by calcifications (such as teeth) or by
fat in a Rokitansky nodule if present.