Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 5  |  Page : 627-634  

Magnetic resonance imaging in the evaluation of female pelvis


Department of Radio-diagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India

Date of Web Publication13-Oct-2016

Correspondence Address:
Pratiksha Yadav
Dr. D. Y. Patil Medical College, Hospital and Research Centre, Sant Tukaram Nagar, Pimpri, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.192151

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  Abstract 


Background: Magnetic resonance imaging (MRI) is an excellent noninvasive technique to evaluate the female pelvis due to its high spatial resolution, excellent tissue contrast, and multiplanar imaging capability. Radiologists often evaluate a wide range of pelvic masses during routine clinical practice. Objective: Aim and objective of the study is to evaluate the importance of MRI in the pelvic masses and to characterize the MRI findings in female pelvic masses. Materials and Methods: We prospectively performed MRI in our institute in 58 patients which detected pelvic pathologies or pelvic masses on clinical examination and/or ultrasonography. These lesions were examined for size, shape, signal intensity, character, and postcontrast enhancement. Secondary signs such as ascites, lymphadenopathy, and invasion of the adjacent organs were observed. Results: MRI was significantly superior to ultrasound in the evaluation of the tumor extension, myometrium invasion, detection of lymph nodes, and parametrical involvement anorectal carcinoma. Overall accuracy for detection of lesion by MRI was 97%, and sensitivity for the diagnosis of malignancy was 94%. Conclusion: MRI is an excellent investigation to evaluate the female pelvic masses due to its high spatial resolution, excellent tissue contrast, and multiplanar imaging capability. It is a very good modality for the tumor staging and follow-up of the cases. Certain key imaging features of uterine or adnexal pathologies on MRI are helpful in the specific diagnosis or narrow down the differential diagnosis. Characterization of uterine and ovarian tumors helps in the surgical planning.

Keywords: Cervix, fibroid, ovarian, pelvic, tumors


How to cite this article:
Yadav P. Magnetic resonance imaging in the evaluation of female pelvis. Med J DY Patil Univ 2016;9:627-34

How to cite this URL:
Yadav P. Magnetic resonance imaging in the evaluation of female pelvis. Med J DY Patil Univ [serial online] 2016 [cited 2024 Mar 29];9:627-34. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2016/9/5/627/192151




  Introduction Top


Radiologists routinely evaluate a wide range of pelvic masses and other pelvic lesions during routine practice. Ultrasonography is the first modality of choice for evaluation of female pelvis, however there are some shortcomings of this modality such as limited field of view, bowel gasses obscuring the pelvic organs, and body habitus of the patients. One of the most problematic diagnoses is the evaluation of large pelvic masses (>5 cm in size). These pelvic masses most commonly arise from the uterus, cervix, ovaries, and fallopian tubes. In addition, pelvic masses may arise from the urinary system, gastrointestinal system, adjacent soft tissues, and metastases. Thus, the differential diagnosis for female pelvic masses is extensive. The site of origin, imaging characteristics, and clinical history may all help to narrow the differential diagnosis. Magnetic resonance imaging (MRI) is very helpful in work up of these lesions, their location, origin, and relationship to adjacent organ, peritoneal or extraperitoneal involvement, lymph nodes, and lateral pelvic wall involvement. The application of MRI in pelvic masses goes beyond lesion detection to the extension of mass and assessment of disease staging. Establishing correct diagnosis and accurate staging is important to plan the treatment of the patient.[1] This article presents a pictorial as well as literature review of MRI images of such pelvic masses.


  Materials And Methods Top


We prospectively performed MRI in 58 patients over the period of 1 year, who were detected to have pelvic pathologies or pelvic masses on clinical examination and/or ultrasonography. All MRI were done on 1.5 Tesla MAGNETOM Avanto machine of Siemens with 60 cm bore size, system length 160 cm with Zero Helium boil-off technology. Axial images were obtained using 256 x 256 matrix, 32 cm field of view and 4mm slice thickness. Coronal T2-weighted image (T2WI) and short T1 inversion recovery (STIR), sagittal T2WI and axial T2WI, T1WI, and STIR images were taken. Fat-suppressed T1W sequences before and after intravenous injection of gadolinium were also taken wherever needed. These lesions were examined for size, shape, signal intensity, character, and postcontrast enhancement. Secondary signs such as ascites, lymphadenopathy, and invasion of the adjacent organs were observed.


  Results Top


MRI was significantly superior to ultrasound in the evaluation of the tumor extension, myometrium invasion, detection of lymph nodes, and parametrical involvement. There were 12 patients detected with uterine fibroid (leiomyoma), 2 patients had fibroid with simple ovarian cyst, 9 patients of cervical carcinoma, 5 cases of adenomyosis, 1 case of adenomyosis with hemorrhagic ovarian cyst, 3 cases of endometrial carcinoma, 2 cases of Mullerian tumor of uterus, 8 patients of complex ovarian cyst, 6 cases of simple ovarian cysts, 4 cases of dermoid, 2 cases of fibroma, 6 cases of ovarian malignancy, and 2 cases of anorectal carcinoma [Figure 1]. Overall sensitivity for detection of lesion by MRI was 100%, specificity was 98.41%, positive predictive value 98.39%, and negative predictive value 100%. Leiomyoma or fibroids were seen as well-defined uterine masses on MRI. On T2W MR images leiomyomas were well-demarcated, hypointense lesions, however, its signal intensity depends on the presence of necrosis, hemorrhage, calcification, or cystic degeneration [Figure 2]. On T1W MR images, these were isointense relative to adjacent myometrium and showed variable postcontrast enhancement. Adenomyosis can be diffuse or focal uterine masses. On MRI, they were seen as thickening of the endometrial–myometrial junctional zone forming an ill-defined low signal intensity lesion [Figure 3]a and [Figure 3]b. Uterine sarcomas were large and heterogeneous masses with areas of hemorrhage and cystic necrosis; it can give variable postcontrast enhancement in MRI. Sagittal T2W MR image of a 55-year-old patient having a history of subtotal hysterectomy for uterine mass showed a heterogeneous mass involving the entire uterine corpus and tumor invasion to the urinary bladder [Figure 4]. MRI findings of endometrial carcinoma may be an exophytic tumor or diffuse endometrial thickening. These tumors have intermediate to low signal intensity on T1WI and low signal intensity on T2WI [Figure 5]a. On dynamic contrast-enhanced MRI endometrial carcinoma enhances less than myometrium in the early phase and on delayed scan, there was less distinction in enhancement [Figure 5]b. Pelvic and inguinal lymph nodes also seen in the MRI, which helps in the staging of the disease [Figure 5]c. On MRI, Mullerian tumor appears as a large polypoidal mass, which completely obliterate the architecture of uterus, there was dilatation of endocervical canal [Figure 6]a. These lesions were in homogeneously low intensity on T1WI and showed heterogeneous appearance on T2WI [Figure 6]a. On postcontrast study, it showed heterogeneous enhancement [Figure 6]b. On T2WI cervical carcinoma were relatively hyperintense mass and easily distinguishable from low signal intensity stroma, on T1WI these were isointense to normal cervix [Figure 7]a. On dynamic contrast enhanced MRI small masses homogeneously enhanced and earlier than normal cervical stroma [Figure 7]b. Large tumors were frequently necrotic and may or may not enhance, often give heterogeneous enhancement or peripheral rim enhancement [Figure 8]a and [Figure 8]b. Sometimes, cervical carcinoma may occur in the cervical stump after partial hysterectomy [Figure 9]. Paraovarian/paratubal cysts were typically thin-walled unilocular cysts, which appeared hypointense on T1WI, and hyperintense on T2WI [Figure 10]. Benign serous cystadenomas were unilocular cysts, however, thin septae may occur. If the diameter of cyst is <4 cm, entirely cystic component, thin walled and no exocystic or endocystic vegetation they are more suggestive of benign tumors [Figure 11]. On malignant epithelial tumors, there were thick, irregular wall, thick septae [Figure 12]a and [Figure 12]b, solid components, and papillary projections [Figure 12]c and [Figure 12]d present. If the maximum size of the mass is more than 6 cm, it is highly suggestive of malignant cystadenoma [Figure 13]a and [Figure 13]b. On MRI, mature teratomas showed variable findings from cystic to complex solid cystic mass consist of all the three germ cell layers or it may be noncystic mass containing fat. On MRI, these tumors showed high signal intensity on T1WI [Figure 14]a due to high-fat content, signal intensity on T2WI is variable [Figure 14]b, on STIR it showed hypointense or mixed signal intensity [Figure 14]c. Fibrothecomas are solid masses mimicking malignant masses. These tumors showed low signal intensity on T1WI and very low signal intensity on T2WI [Figure 15]. Large rectal masses extend to the pelvic sidewall, vagina, and bladder, a case of anorectal carcinoma which was invading the posterior wall of vagina [Figure 16].
Figure 1: Pie chart of pelvic pathologies in females

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Figure 2: Fibroid: Sagittal short T1 inversion recovery T2-weighted magnetic resonance imaging showing two well-defined hypointense lesions consistent with intramural fibroids, one in the anterior wall and another in the posterior wall of myometrium

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Figure 3: Adenomyosis: Sagittal T2-weighted image showing focal adenomyosis in the posterior wall of uterus, disruption of endometrial–myometrial junction and endometrial tissue seen in myometrium (a). On postcontrast T1-weighted image does not show enhancement (b)

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Figure 4: Uterine malignancy: Sagittal T2-weighted magnetic resonance image of a 55-year-old patient having history of subtotal hysterectomy showed heterogeneous mass involving the entire uterine corpus with urinary bladder invasion by tumor

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Figure 5: Endometrial carcinoma: Sagittal T2-weighted magnetic resonance imaging (a) of a 53-year-old woman with bleeding per vagina showed a heterogeneous mass involving the endometrium, disrupted endometrial–myometrial junction and myometrial invasion by tumor. Postcontrast sagittal T1-weighted image (b) heterogeneous enhancement of endometrium and myometrium. Axial postcontrast T1-weighted image (c) right inguinal lymph node. Biopsy revealed adenocarcinoma

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Figure 6: Mullerian tumor: T2-weighted image magnetic resonance imaging (a) a well-defined lobulated predominantly hyperintense mass seen involving the cervix with expansion of the cervical endometrium. Contrast-enhanced T1-weighted image (b) intense heterogeneous enhancement of the lobulated mass

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Figure 7: Carcinoma of cervix: T2-weighted sagittal magnetic resonance imaging (a) heterogeneous mass involving cervix and vagina with collection in uterine cavity in a 52-year-old patient came with complaint of postmenopausal bleeding, postcontrast enhancement of the tumor (b) consistent with cervical carcinoma Stage IIIa

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Figure 8: Carcinoma of cervix: Magnetic resonance imaging T1-weighted image sagittal (a) and coronal postcontrast T1-weighted image (b) cervical mass involving anterior and posterior wall of the cervix and involving the lower uterine myometrium and invading the upper vagina and involving pelvic side walls Stage IIIb

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Figure 9: Carcinoma of cervix: Sagittal short T1 inversion recovery T2-weighted image in a 62-year-old posthysterectomy patient. Heterogeneous-lobulated mass seen involving the cervical stump

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Figure 10: Paraovarian cyst: T2-weighted axial magnetic resonance imaging of a 32-year-old female showing left paraovarian thin-walled cystic lesion, left ovary is separately seen from cyst. No septa seen in the cyst

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Figure 11: Benign serous cystadenoma in a 43-year-old woman. T2-weighted image coronal image showing multilocular cyst in the left ovary, no solid component seen

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Figure 12: Ovarian cystadenocarcinoma: Coronal magnetic resonance imaging T2-weighted image (a) and T1-weighted image (b) shows bilateral adnexal masses which show multiple nodular vegetations on internal surface. Postcontrast T1-weighted image coronal (c) and sagittal (d) peripheral rim enhancement and enhancement of the nodular vegetations

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Figure 13: Malignant (low malignant potential) serous cystadenoma: Magnetic resonance imaging T2-weighted image coronal (a) and axial (b) a large cystic lesion in left ovary (more than 6 cm), with septations, mild ascites also seen

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Figure 14: Mature teratoma: Magnetic resonance imaging T1-weighted image axial (a) and T2-weighted image axial (b) a well-defined mass in the right ovary which shows predominantly hyperintense mass in both T1-weighted and T2-weighted images. It shows mixed predominantly hypointense mass on short T1 inversion recovery T1-weighted image coronal image (c) s/o fat content

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Figure 15: Fibrothecoma in a 39-year-old woman. T2-weighted axial image showing low signal intensity solid mass with specks of increased signal intensity in its central part involving the left adnexa

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Figure 16: Postcontrast T1-weighted image of a 58-year-old woman showing anorectal carcinoma. Heterogeneous-enhancing mass involving the anorectal region

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  Discussion Top


Leiomyoma or fibroid is the most common uterine neoplasm, most commonly seen in middle-aged women (20–30% in patients over 30 years).[1] Clinical signs and symptoms depend on the size, location, and number of the leiomyomas. Pain and menorrhagia are the most common clinical features; it may be the cause of infertility. These neoplasms are classified into intramural (within the substance of myometrium), submucosal (projecting into the endometrial canal), or subserosal (beneath the serosa).[1] These usually involve the uterine myometrium but may involve the cervix. On T2W MR images leiomyomas are well demarcated, hypointense lesions; however, its signal intensity depends on the presence of necrosis, hemorrhage, calcification, or cystic degeneration. On T1W MR images, these are isointense relative to adjacent myometrium and show variable postcontrast enhancement. Differential diagnosis of leiomyoma is adenomyosis, focal myometrial contraction, or solid adnexal masses.[2] Treatment depends on symptoms and age of the patient. Surgical treatment may be myomectomy or hysterectomy. Uterine artery embolization is also a treatment choice in a premenopausal symptomatic patient with multiple fibroids, who does not want surgery.

Adenomyosis is characterized by the presence of ectopic endometrial tissue in the uterine myometrium with subsequent hyperplasia of the myometrium. Usually seen in multiparous women, more than 30 years of age.[3] Clinical features are menorrhagia, abnormal vaginal bleeding, and dysmenorrhea, which are similar to leiomyomas. Differentiation from leiomyoma is important because treatment of both diseases is different. MRI is an excellent modality to differentiate these two entities because of its excellent tissue contrast. Adenomyosis can be diffuse or focal. MRI shows thickening of the endometrial–myometrial junctional zone forming an ill-defined low signal intensity lesion. MRI findings of adenomyosis occasionally mimic those of uterine malignancy or ovarian cancer. Furthermore, malignancy occasionally develops in otherwise benign adenomyosis.[4] Differential diagnosis is leiomyoma, endometrial carcinoma, adenomatoid tumor of the uterus. Treatment of adenomyosis depends on their symptoms, and extension of the disease, which can be surgery, dilatation, and curettage or conservative treatment.

Benign lipomatous tumor of the uterus is known as lipoma when they contain fat. They are known as leiomyolipoma when it contains fat cells and smooth muscles.[5] Pure lipomas of uterus are very rare. It most commonly occurs in postmenopausal women. They are mostly asymptomatic or may present with pelvic pain or vaginal bleeding.[6] MRI is a good modality for the characterization of lipoma they are hyperintense on T1WI as well as T2WI and show hypointense lesions on fat-suppressed T1WI.

Sarcomas of the uterus are highly malignant. They are rare malignancies accounting for 3–5% of uterine malignancies.[7] MRI is helpful in the preoperative assessment of tumor extension, uterine size, and extrauterine extension. MRI features are nonspecific and sometimes indistinguishable from endometrial carcinoma.[7],[8] Uterine sarcomas are usually large and heterogeneous with areas of hemorrhage and cystic necrosis; it can give variable postcontrast enhancement in MRI. Most of the sarcomas are primary, however, malignant transformation may occur in leiomyoma.

Abnormal vaginal bleeding in premenopausal women and vaginal bleeding in postmenopausal women are associated with high risk for endometrial carcinoma or endometrial hyperplasia. Endometrial carcinomas are typically diagnosed on endometrial biopsy or dilatation and curettage. Sensitivity of transvaginal ultrasonography in premenopausal women and patient with hormone replacement therapy is less because of the variation of normal endometrial thickness with circulating concentration of hormone. MRI is the most accurate imaging technique for the preoperative assessment of endometrial cancer because of its superb soft-tissue contrast resolution. MRI is useful to evaluate the tumor extension, myometrial invasion, lymph nodal involvement, and metastasis.[1] MRI findings of endometrial carcinoma may be an exophytic tumor or diffuse endometrial thickening. These tumors have intermediate to low signal intensity on T1WI and low signal intensity on T2WI. On dynamic contrast-enhanced MRI, endometrial carcinoma enhances less than myometrium in the early phase and on delayed scan there is less distinction in enhancement.[1] Benign and malignant endometrial tumors may overstretch the cavity and may cause myometrial thinning, which should not be mistaken as myometrial invasion. Diagnostic criteria of myometrial invasion are irregular endometrial junctional zone interface on T2WI or contrast enhancement on postgadolinium T1WI or disruption of the junctional zone.[9] Differential diagnosis of endometrial carcinoma is endometrial hyperplasia, endometrial polyp, cervical carcinoma, and mesenchymal tumor of the uterus. Treatment of endometrial carcinoma is surgery with radiotherapy. In advanced cases, treatment may be local radiotherapy with chemotherapy.[10]

Uterine carcinosarcoma (Mullerian tumor) are rare and highly aggressive malignant tumors that consist of epithelial and mesenchymal elements. The presentation is nonspecific with symptoms of other pelvic pathology.[11] These are typically present with vaginal bleeding and pyometra abdominal pain and polypoidal mass in postmenopausal women.[12] On clinical examination, enlargement of uterus with polypoidal mass lesion was seen through endocervical canal. On MRI, these masses appear as a large polypoidal mass, which completely obliterate the architecture of uterus, there is dilatation of endocervical canal. These lesions are inhomogeneously low intensity on T1WI and show heterogeneous appearance on T2WI.[13] On postcontrast study, it shows heterogeneous enhancement.

Cervical carcinoma is the third most common gynecological malignancy.[14] Five-year survival rates vary between 92% for Stage I disease and 17% for Stage IV disease.[14] Nearly 90% of all cervical carcinomas are squamous cell carcinoma followed by adenocarcinoma (5–10%). MRI has excellent soft tissue contrast resolution, which is superior modality than computed tomography and ultrasound in the evaluation of cervical carcinoma. It is valuable in the assessment of the tumor size, depth of cervical invasion, tumor extent, and parametrial invasion. The sagittal T2WI is helpful to evaluate the extent of cervical tumor and it is an extension into the uterine corpus. Accurate evaluation of tumor is helpful in staging of cervical carcinoma, which is crucial in determining appropriate treatment planning of the patient. MRI is the best imaging modality that can accurately determine tumor location, size, depth of the stromal invasion, extension into lower uterine segment, parametrial invasion, and lymph nodal metastasis.[15],[16] On T2WI, tumors are relatively hyperintense mass and easily distinguishable from low signal intensity stroma, on T1WI these are isointense to normal cervix. On dynamic contrast-enhanced MRI, small masses enhance homogeneously and earlier than normal cervical stroma. Large tumors are frequently necrotic and may or may not enhance, often give heterogeneous enhancement or peripheral rim enhancement.

The International Federation of Gynecology and Obstetrics major categories of classification of cervical carcinoma are as follows:[17]





  • Stage Ia cervical carcinoma – Preclinical invasive carcinoma that can be diagnosed only by means of microscopy
  • Stage Ib cervical carcinoma – A clinically visible lesion that is confined to the cervix
  • Stage Ib1 – Primary tumor not >4.0 cm in diameter
  • Stage Ib2 – Primary tumor >4.0 cm in diameter
  • Stage IIa cervical carcinoma – Spread into the upper two-third of the vagina without parametrial invasion
  • Stage IIb cervical carcinoma – Extension into the parametrium but not into the pelvic sidewall
  • Stage IIIa cervical carcinoma – Extension into lower one-third of the vagina, without spread to the pelvic sidewall
  • Stage IIIb cervical carcinoma – Extension into the pelvic sidewall and/or invasion of the ureter, with the latter resulting in a nonfunctioning kidney or hydronephrosis
  • Stage IVa cervical carcinoma – Extension of the tumor into the mucosa of the bladder or rectum
  • Stage IVb cervical carcinoma – Spread of the tumor beyond the true pelvis and/or by metastasis to distant organs.a


Nonneoplastic ovarian masses are usually functional cysts (follicular or corpus luteal cysts). Sometimes, corpus luteum cysts show internal hemorrhage. Simple cysts are smooth in outline cystic lesions, which are hypointense on T1WI and hyperintense on T2WI, however when hemorrhage occurs they show high signal intensity on T1WI and intermediate to high signal intensity on T2WI.

Paraovarianor paratubal cysts are type of adnexal cyst that does not occur from ovary. These cysts arise from the Wolffian duct remnants of the mesovarium.[18] They are located within the broad ligament, adjacent to ipsilateral ovary. Hydatid cysts of Morgagni arise from the fimbriated end of the fallopian tube. They usually account for 10–20% of all adnexal masses, usually seen in the third or fourth decade. They are typically thin-walled unilocular cysts, which appear hypointense on T1WI, and hyperintense on T2WI. Torsion or rupture of the cystic mass can occur. Rarely, it may complicate by torsion or hemorrhage.[19]

Endometrioma are the masses of endometrial tissue outside the uterus, most commonly seen on the surface of the ovary. They are seen in the females of reproductive age and present with the chronic pelvic pain and infertility. The appearance on MRI depends on the concentration of iron and protein in the fluid.[16] Most endometriomas are very high signal on T1WI and very low signal on T2WI and high signal on T1 fat-suppressed images. MRI showed sensitivity of 90–92% and specificity of 91–98% for the diagnosis of endometrioma in adnexal masses.[16]

The ovary can give rise to a wider variety of tumor, which can be cystic, solid, or combination of both. Ovarian tumors are classified on the basis of tumor origin as epithelial tumors (serous and mucinous tumor, clear cell carcinoma, Brenner tumor), germ cell tumors (teratomas, dysgerminoma, embryonal carcinoma), sex cord stromal tumors (fibrothecoma, granulosa cell tumor), and metastatic tumors.[20] Ultrasonography is the primary investigation of choice, however, MRI is helpful in further evaluation of the lesion, and postcontrast T1WI is valuable to detect cyst wall, septae, and solid areas.[21] Malignant germ cell tumors are usually large complex masses with cystic and solid component. MRI findings of sex cord – stromal tumors vary from small solid masses to large multicystic masses.[20]

Epithelial ovarian tumors represent 60% of all ovarian neoplasm and 85% of malignant ovarian neoplasm.[22] Epithelial tumors are primarily cystic associated with varying proportion of solid component when malignant. Two most common epithelial tumors are serous and mucinous cystadenomas. Benign mucinous cystadenomas are unilocular or multilocular cysts with thin septae. Mucinous cystadenomas show variable MRI signal intensity on T1WI depending on the content. Benign serous cystadenomas are usually unilocular cysts, however, thin septae may occur. If the diameter of cyst is <4 cm, entirely cystic component, thin walled and no exocystic or endocystic vegetation, they are more suggestive of benign tumors. Imaging features of malignant epithelial tumors are thick, irregular walls, thick septae, solid components, and papillary projections. If the maximum size of the mass is more than 6 cm, it is highly suggestive of malignant cystadenoma. There are associated ascites, adjacent organ invasion, and lymphadenopathy.

Germ cell tumor is the second most common group of ovarian neoplasm represent 15–20% of all ovarian neoplasm.[23] It includes teratoma, mature teratoma, dysgerminoma, endodermal sinus tumors, and choriocarcinoma. Mature teratoma is the only benign tumors of this group, and they are the most common in this group.[20] These tumors consist of mature tissue from two or more embryonic germ cell layers. On MRI, mature teratomas show variable findings from cystic to complex solid cystic mass consist of all the three germ cell layers or it may be noncystic mass containing fat. On MRI, these tumors are high signal intensity on T1WI due to high-fat content, signal intensity on T2WI is variable, on STIR it is how hypointense or mixed signal intensity immature teratoma predominantly consists of solid mass with internal hemorrhage or necrosis.

Sex cord-stromal tumors consist of approximately 8% of ovarian neoplasm. Most common types are granulosa cell tumors, fibrothecoma, and Sertoli–Leydig tumors. Granulosa cell tumors are the malignant estrogen-producing tumors. Fibroma and thecoma are the benign tumors are seen in both pre- and post-menopausal women.[20] These are solid masses mimicking malignant mass.[20] These tumors consist of collagen and show low signal intensity on T1WI and very low signal intensity on T2WI. Scattered area of high signal intensity may be seen due to edema or cystic degeneration. It may contain specks of calcification. Sertoli–Leydig cell tumors occur in young women, and they are of low-grade malignancy. On MRI, these tumors are well-defined enhancing solid mass.[20]

About one-third colorectal carcinoma occurs in the rectum. Adenocarcinoma of the rectum is usually present with bleeding per rectum or change in the bowel habits.[1] Large rectal masses extend to the pelvic sidewall, vagina, and bladder.


  Conclusion Top


MRI is an excellent investigation to evaluate the female pelvic masses due to its high spatial resolution, excellent tissue contrast, and multiplanar imaging capability. It is a very good modality for the tumor staging and follow-up of the cases. Certain key imaging features of uterine or adnexal pathologies on MRI are helpful in the specific diagnosis or narrow down the differential diagnosis. Characterization of uterine and ovarian tumors helps in the surgical planning.

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

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