A new dimension in pelvic imaging...
Now at Parkside MR Center

One of the breakthroughs in MR technology has been the development of “fast scan” techniques. This, coupled with refinements in coil technology and software, necessitates a relook at MR’s contribution to imaging the female pelvis. Several clinical examples of the exceptional utility of MR in this area are presented below. Michael S. Siegfried, M.D., Director of Ultrasound at Lutheran General Hospital, provides the commentary in this update. Dr. Siegfried’s perspective of the role of MR comes with nearly twenty years experience in pelvic sonography.

John V. Phillips, M.D.
Medical Director

Click on any image below to see an enlargement of that image.

Pelvic ultrasound showed bilateral adnexal masses.
MR Diagnosis: Bilateral cystic teratomas.

Pelvic ultrasound demonstrated massive “ascites”.
MR Diagnosis: Cystic ovarian neoplasm.

Pelvic ultrasound demonstrated a vascular mass after D & C.
MR Diagnosis: Retained products of conception.

Newborn with imperforate anus.
MR Diagnosis: Duplication of the vagina and uterus with hydrometrocolpos.

Normal pelvic ultrasound and history of infertility.
MR Diagnosis: Uterine septum.

Patient with recently diagnosed cervical cancer.
MR Diagnosis: Stage IIA cervical carcinoma.

Pelvic ultrasound shows diffuse uterine enlargement.
MR Diagnosis: Adenomyosis

Pelvic ultrasound shows solid adnexal mass.
MR Diagnosis: Pedunculated fibroid.

Imaging Breakthrough

“For almost a quarter century, ultrasound has been an inexpensive, noninvasive, versatile and usually accurate method of evaluating the female pelvis. There are instances, however, when pelvic ultrasound is technically limited (e.g. bowel gas obscures some portions of the pelvis or image quality is extremely limited by the size of the patient) or does not correlate with the patient’s symptoms. Transvaginal scanning has added utility, but cannot be performed in all cases and can also be very difficult to perform in some patients. Finally, the ultrasound exam results may not explain the clinical presentation. For these reasons, we have found MR imaging of the pelvis to be an important adjunct to pelvic sonography.”

Michael S. Siegfried, M.D.
Director, Ultrasound
Lutheran General Hospital

Discussion

Pelvic ultrasound has long been the mainstay for evaluation of the female pelvis. When pelvic ultrasound is technically suboptimal or fails to answer the clinical question, MR imaging has emerged as the alternative choice for noninvasive evaluation of the uterus and adnexae. MRI, with its multiplanar capability, large field of view and high contrast resolution offers unique advantages in imaging the pelvis. It can help distinguish uterine from adnexal masses and leiomyomas from adenomyosis, as well as hormonal therapy effects on these entities. It is also the optimal imaging modality in staging cervical carcinoma, can evaluate complex congenital anomalies of the genitourinary tract and is especially helpful in problem solving in the pregnant patient (no x-rays are involved). It not only evaluates the uterus and ovaries, but can also provide valuable information about the surrounding soft tissues e.g. rectum, pelvic sidewalls and marrow spaces of the bony pelvis.

MRI of the pelvis usually requires no intravenous contrast and is often performed using fast scanning techniques generating 120 images for a standard exam in as little as 10 minutes. Scanning is preferred in one of our fast high field systems, but can also, in some instances, be done in our open MRI scanner.

To find out more about MRI of the female pelvis and other services at Parkside MR Center, call us at (847) 696-7900.