Learning objectives
To review the different types of vaginal neoplasia (primary and vaginal metastases) and their incidence.
To review the staging of primary vaginal cancer and its assessment with MRI.
To describe MRI features of vaginal metastases and differential diagnosis with primary tumors of the vagina.
Background
ANATOMY: Fig. 1 Fig. 2 Fig. 3 Fig. 4
It is attached at its upper end to the uterus,
just above the cervix.
The spaces between the cervix and the vagina are known as the anterior,
posterior,
and lateral vaginal sacs.
Because the vagina is attached to the uterus at a point higher in the back than in the front,
the posterior vaginal wall measures about 3 cm more than the anterior wall.
The vagina is attached to the lateral pelvic wall by endopelvic aponeurotic...
Findings and procedure details
MR IMAGING PROTOCOL Fig. 6
To review pelvis and value pelvic and inguinal lymph nodes:
Axial T1-weighted fast spin-echo .
Coronal,
sagital and axial T2-weihgted fast spin-echo.
To assess vaginal tumor and its invasion of adjacent tissues:
Oblique axial (perpendicular to long axis of vagina) T2-weighted high resolution images.
Optional:
Diffusion-weighted (b=400 and 800 sec/mm2).
Axial fat-saturated T2-weighted FIESTA (fast imaging with steady-state precession).
The use of gel to distend the vagina can upgrade the diagnose.
The use of intravenous contrast may not be advantageous...
Conclusion
Primary vaginal cancers are very infrequent and must be differentiated especially from metastases.
Although it usually comes with a clinical suspicion,
we must be as accurate as possible in the definition of the tumor and its extention.
The main utility of MRI in vaginal tumors is staging,
since most part of the primary tumors of the vagina have a similar appearance in MRI with the exception of the melanoma.
For this,
it is essential to have a high knowledge of the anatomy of the female...
Personal information
Guillermo García Galarraga:
- Deparment of radiology,
Hospital 12 de Octubre.
Madrid
-
[email protected]
References
Jyoti H.Parikh,
Desmond P.J.
Barton et al.
MR Imaging Features of Vaginal Malignancies.
Radiographics 2008; 28:49-63.
M.B.
Taylor et al.
Magnetic resonance imaging of primary vaginal carcinoma.Clinical Radiology (2007) 62,
549-555.
K.
Tsuda et al.
MR imaging of non-squamous vaginal tumors.
Eur.
Radiol.,1214-1218(1999).
A.L.Baert et al.
MRI and CT of female pelvis.
Sprinter.
2007
