Comprehensive CT services offered in the NYU Department of Radiology utilize stateof- the art multi-detector CT scanners as well as PET/CT. Over the past decade, MRI has also emerged as a potent diagnostic tool for evaluation of the female pelvis. Its multiplanar imaging capability, reproducibility of imaging planes, larger field of view, superior contrast resolution, and potential for tissue characterization are some advantages MRI holds over ultrasound for evaluation of uterine and adnexal disorders. MRI can serve as a very powerful problem-solving tool when ultrasound findings are equivocal. In addition, due to its lack of ionizing radiation, and aided by the development of ultrafast imaging sequences, MRI now is accepted as a promising tool for evaluation of the fetus, and can play an important role in prenatal diagnosis and pregnancy management. It is also useful in the evaluation of nonpregnancyrelated disorders in the pregnant patient. Accordingly, MRI for all obstetric and gynecologic applications is offered at both Tisch Hospital and Bellevue Hospital. Additionally, the use of high field strength MR imaging (3 Tesla (T)) for evaluation of female pelvic disorders is an area under investigation at NYU. Due to the increasing interest in, and importance of, MRI in Women’s Imaging, the current applications of MRI in Obstetrics and Gynecology are described in more detail below.
APPLICATIONS OF MR IMAGING IN OBSTETRICS AND GYNECOLOGY
THE UTERUS
Ultrasound is the imaging modality of choice for the evaluation of the enlarged uterus and suspected uterine fibroids. However, associated sound attenuation may impede one’s ability to completely characterize the size and location of fibroids as well as involvement of the endometrial cavity. MRI is an important problem-solving modality when the ultrasound is ambiguous (FIGURE 1) or when intervention is undertaken. MRI can help to predict the likely response to uterine artery embolization based on a fibroid’s signal intensity characteristics and degree of vascularity, and may also be useful to demonstrate the degree of response after the procedure is performed (FIGURE 2). MRI is also helpful in differentiating fibroids from adenomyosis, an important distinction which may alter patient management (FIGURE 3). Another very important role of MR is in differentiating a solid adnexal mass from a pedunculated fibroid (FIGURE 4), which may also significantly impact patient management. MRI is also extremely useful in characterizing congenital anomalies of the uterus when ultrasound or hysterosalpingography is equivocal (FIGURE 5). Lastly, MRI is superior to ultrasound in staging of endometrial and cervical carcinoma.
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Figure 5. Congenital Anomalies of the Uterus. (A) Image from a hysterosalpingogram performed on a patient with history of recurrent pregnancy loss demonstrates division of the endometrial canal. However, it is uncertain if this represents a bicornuate uterus or septate uterus. (B) T2W TSE image of the uterus in the same patient demonstrates division of the uterine cavity with a smooth fundal uterine contour (arrow), features consistent with a septate uterus.
Figure 6. Adnexal Dermoid. (A) T1W image of the pelvis in a patient with an adnexal mass on physical examination demonstrates a high signal intensity mass in the left adnexa (arrow). (B) When fat suppression is performed, there is loss of signal in a component of this mass (arrow), confirming the presence of fat in this dermoid.
Figure 7. Adenocarcinoma of the Ovary. (A) T2W TSE image of the pelvis in a patient with a palpable adnexal mass demonstrates a large
complex cystic mass in the right adnexa (m). This mass contains mural papillary excrescences (arrow). (B) Fat-suppressed image with gadolinium demonstrates
contrast enhancement in these mural papillary excrescences (arrow), a feature consistent with malignant neoplasm. At surgery, this represented a serous papillary
adenocarcinoma of the ovary.