chapter  4
52 Pages

Uterus and Vagina

WithSuzanne L. Palmer, Nicole F. Darcy, Claire L. Templeman, Allison D. Salibian

The presenting symptoms associated with pelvic pathology are typically nonspecific and differentially broad, including gynecologic, obstetrical, and non-gynecologic etiologies. Ultrasound (US) remains the first-line imaging modality for the evaluation of the female patient presenting with most gynecological symptoms, including abnormal vaginal bleeding, pelvic pain, and followup of a previously detected abnormality or congenital

anomaly [1-4]. US is well suited for the evaluation of the female pelvis due to its availability, high resolution, ability to focus the examination, and relatively lower cost when compared to computed tomography (CT) and magnetic resonance imaging (MRI). Due to excellent soft tissue contrast, MRI is widely accepted as a useful problem-solving tool if pelvic US is incomplete or indeterminate. MRI is able to differentiate uterine zonal anatomy; accurately identify, localize, and characterize fibroids; confirm the diagnosis of adenomyosis; and evaluate complex uterine anomalies. In the presence of

CONTENTS

4.1 Introduction ................................................................................................................................................................... 63 4.2 Imaging Techniques ..................................................................................................................................................... 64 4.3 Anatomy and MRI Appearance of the Normal Uterus ........................................................................................... 68 4.4 Embryology and Anomalies ....................................................................................................................................... 71 4.5 Benign Diseases of the Myometrium ......................................................................................................................... 80

4.5.1 Leiomyomas ..................................................................................................................................................... 80 4.5.2 Adenomyosis ................................................................................................................................................... 82 4.5.3 Therapy and Post-Therapy Changes ............................................................................................................ 83

4.6 Malignant Diseases of the Myometrium ................................................................................................................... 86 4.6.1 Uterine Sarcomas ............................................................................................................................................ 86

4.7 Benign Diseases of the Endometrium ....................................................................................................................... 91 4.7.1 Hyperplasia and Polyps ................................................................................................................................. 91 4.7.2 Tamoxifen-Related Changes .......................................................................................................................... 92

4.8 Malignant Diseases of the Endometrium .................................................................................................................. 93 4.8.1 Endometrial Carcinoma ................................................................................................................................. 93

4.9 Benign Diseases of the Cervix .................................................................................................................................... 98 4.10 Malignant Diseases of the Cervix .............................................................................................................................. 98

4.10.1 Cervical Carcinoma ........................................................................................................................................ 98 4.11 Benign Diseases of the Vagina .................................................................................................................................. 102

4.11.1 Cysts ................................................................................................................................................................ 102 4.11.2 Benign Vaginal Tumors ................................................................................................................................ 103

4.12 Malignant Diseases of the Vagina ............................................................................................................................ 104 4.12.1 Primary Vaginal Cancer............................................................................................................................... 104 4.12.2 Vaginal Metastases ....................................................................................................................................... 105 4.12.3 The Fallopian Tubes ...................................................................................................................................... 105

4.13 Summary ...................................................................................................................................................................... 107 Acknowledgments ................................................................................................................................................................. 108 References ................................................................................................................................................................................ 108

newly diagnosed endometrial cancer, MRI is the imaging study of choice if imaging is indicated for treatment planning. MRI can evaluate the extent of pelvic disease and be used to assess the depth of myometrial and endocervical tumor extent, both before and at follow-up [3]. Although not as accurate for evaluating cervical stromal invasion by cervical cancer, MRI is preferred over CT and US for pretreatment planning of invasive cervical cancer [4].