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MRI of the female pelvis: Benign disease

Dr. Seng ThipphavongAssistant Professor, University of Toronto

UHN/MSH/WCH

Organ Imaging Review October 3, 2012

No financial disclosures

Objectives

• Review pelvic MRI protocol and anatomy

• Review common benign disease entities

• Show unusual benign tumours

• Highlight acute pelvic pathology

MRI Protocol

• Ax T1• Cor, Sag, Ax T2• DCE• Buscopan or

glucagon

MRI Protocol

• Ax T1• Cor, Sag, Ax

T2• DCE• Buscopan or

glucagon

MRI Protocol

• Ax T1• Cor, Sag, Ax

T2• DCE• Buscopan or

glucagon

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Normal MRI - uterus

• Zonal anatomy

• Junctional zone

• Cervix

MRI Indications

• Uterine anomalies• Fibroids• Endometriosis, adenomyosis• Adnexal mass• Benign tumours• Acute conditions

Congenital uterine anomalies

• Agenesis• Obstructed horn• Didelphys• Complete septum• Pregnancy with uterine anomaly

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Fibroids

• Cystic degeneration• Cervical fibroid• Pedunculated ‘mass’• Pre-treatment (surgery, UFE)

planning• Growing fibroids

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Adenomyosis

• Diffuse vs focal• Lacks pseudocapsule• Ultrasound vs MRI

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Endometriosis

• Endometrioma• Kissing ovaries• Sigmoid mass• Urinary bladder mass• Abdominal wall• Invasive

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Adnexal masses

• Dermoid• Fibroma/fibrothecoma

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Acute conditions

• Post-UFE complications• Pregnancy related• Torsion

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Unusual…

• Nonovarian cystic mass• Fatty myometrial mass• Prolapsing pelvic mass

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Summary

• Review pelvic MRI protocol and anatomy

• Review common benign disease entities

• Show unusual benign tumours

• Highlight acute pelvic pathology