PELVIC MRI GALLERY
Myometrial mass on ultrasound. Fibroid ?
Uterine fibroid or leiomyoma could be readily diagnosed by ultrasound. MRI could play a major role in assessing indeterminate adnexal masses, rapid growing uterine mass, atypical sonographic findings, treatment planning for symptomatic patients, and therapy monitoring such as post-embolization. The left image shows a pedunculated posterior uterine fibroid previously mistaken as adnexal mass. The discovery of a tiny submucosal fibroid and Tarlov’s cyst in sacrum are additional bonus. The right image shows a gigantic submucosal pedunculated fibroid with moderate myxoid degeneration.
Complex ovarian cyst on transvaginal ultrasound. Rule out malignancy.
MRI has a high accuracy (>90%) in diagnosing ovarian malignancy. The “sunset shading” appearance of the fluid content usually indicates haemorrhagic condition such as endometriotic or haemorrhagic cyst. Mural nodules, T2 heterogeneity of the fluid, septation, and mosaic pattern on MRI strongly indicate non-benign condition. The cystadenocarcinoma at left shows a characteristic mural nodule and “sunset-shading” fluid content. The right image shows classical fat-fluid level in a large ovarian dermoid which is a benign condition.
Newly diagnosed Ca corpus. For MRI staging.
In 2018, FIGO revised the staging of cervical and endometrial cancer, allowing the use of imaging to obtain data regarding tumour size, nodal status, and local or systemic spread. MRI offers excellent soft tissue contrast in answering these questions. Diffusion-weight imaging (DWI) and Dynamic contrast-enhanced (DCE) with subtraction further improve early tumour detection and lymph node characterization. The right image shows synchronous FIGO IA endometrial and right ovarian endometrioid adenocarinoma. The left image shows characteristic FIGO IB endometrial cancer.
Severe menorrhagia. Rule out adenomyosis.
Adenomyosis is due to ectopic endometrial tissue in the myometrium, which frequently leads to dysmenorrhea, menorrhagia, dyspareunia, and chronic pelvic pain. Ultrasound is the primary imaging modality with high sensitivity. However, a dedicated MRI pelvis could not only give a high diagnostic confidence like the left image, but also offer a comprehensive view and mapping of the pelvic condition, including deep pelvis endometriosis like the image at right.
Bilateral nipple discharge with increased prolactin level. To rule out prolactinoma.
MRI is the preferred imaging tool to assess the pituitary gland for both pituitary microadenoma and macroadenoma. The right image shows a characteristic hypo-enhanced appearance of a microadenoma presumably a prolactinoma. On contrary, the left image shows a characteristic “snow-man” macroadenoma which could lead to bitemporal hemianopia or “tunnel vision”. Indeed, MRI instead of CT scan is recommended for pituitary imaging.