MRI Imaging of the vagina and vulva: Pearls and pitfalls for the radiology resident

Congress:

ECR 2020

Poster Number:

C-01428

Type:

Educational Exhibit

Keywords:

Cysts, Cancer, eLearning, Education, MR-Diffusion/Perfusion, MR, Pelvis, Genital / Reproductive system female, Genitourinary, Developmental disease, Not applicable

Authors:

J. Lee, S. Freeman, H. C. Addley, J. Smith, P. L. Moyle; Cambridge/UK

DOI:

10.26044/ecr2020/C-01428

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-01428

Fig. 1: Sagittal T2WI of a normal vagina. (A) Anterior fornix (B) Posterior...

Fig. 2: Axial T2WI of normal vulva structures. Anterior fatty labia majora (LM). (A)...

Fig. 3: Axial T2WI slightly more caudal demonstrating the labia minora (A) and anus (B).

Fig. 4: Embryologic development. Diagram at left illustrates the fetal structures. The...

Learning objectives

To review the anatomy and embryology of the vagina and vulva. To describe and present MRI features of congenital, benign and malignant processes of the vagina and vulva.

Background

Diseases involving the vagina and vulva are relatively uncommon compared to other gynaecological conditions. They are however still prevalent and it is important for radiologists to be aware of these. In this poster, we will discuss the following topics, focusing on the use of magnetic resonance imaging (MRI) which has become the gold standard in pelvic imaging: - MRI protocol - Anatomy of the vagina and vulva - Embryology - Congenital conditions Vaginal septum Vaginal agenesis Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome - Benign lesions Paravaginal and vaginal...

Findings and procedure details

MRI protocol The commonest indication for MRI of the vagina and vulva is malignancy. The standard protocol used by our institution: T2 weighted sagittal and axial oblique sequences T1 weighted axial sequence through the whole pelvis (for lymph node and bone metastases) Coronal T2 fat-suppressed (fs) sequence for vulva cancers as it demonstrates the tumour well and its craniocaudal extent Diffusion-weighted imaging (DWI) b=1000 sec/mm2 with apparent diffusion coefficient (ADC) maps Use of buscopan (20mg IM) to reduce bowel peristalsis No breath-hold The imaging protocol...

Conclusion

The vagina is easily overlooked at ultrasound, computed tomography or MR imaging, especially if examination has been performed for non-gynaecological conditions. MRI provides excellent tissue characterisation but radiologists still need to intentionally assess these areas to recognise pathologic processes or incidental findings that are present. Understanding the embryology should lead to improved recognition of normal anatomy and congenital anomalies. By remembering to look beyond the uterus and cervix to the vagina and vulva, radiologists can improve their perception and interpretation of anatomy and disease.

Personal information and conflict of interest

J. Lee; Cambridge/UK - nothing to disclose P. L. Moyle; Cambridge/UK - Consultant at Addenbrooke's Hospital S. Freeman; Cambridge/UK - nothing to disclose H. C. Addley; Cambridge/UK - nothing to disclose J. Smith; Cambridge/UK - nothing to disclose

References

[1] Ferreira, D., Bezerra, R., Ortega, C., Blasbalg, R., Viana, P., Menezes, M. and Rocha, M. (2015). Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making. Radiologia Brasileira, 48(4),pp.249-259. [2] Breech, L. and Laufer, M. (2009). Müllerian Anomalies. Obstetrics and Gynecology Clinics of North America, 36(1),pp.47-68. [3] Walker, D., Salibian, R., Salibian, A., Belen, K. and Palmer, S. (2011). Overlooked Diseases of the Vagina: A Directed Anatomic-Pathologic Approach for Imaging Assessment. RadioGraphics, 31(6),pp.1583-1598. [4] Hosseinzadeh, K., Heller, M....