{"paper_id":"7bcf3da1-7966-4cdf-bca7-ad487dac0e94","body_text":"5252\nRadiology Section\nPrevalence of Female Pelvic Pathologies: \nCross-sectional Study among Patients \nUndergoing Magnetic Resonance \nImaging for Pelvic Assessment\nOriginal Article DOI: 10.7860/IJARS/2021/47633:2639\nInternational Journal of Anatomy, Radiology and Surgery. 2021 Apr, Vol-10(2): RO52-RO56\nINTRODUCTION\nA wide variety of pathologies affect the female genital tract. Patients \ncommonly present with complaints related to these pathologies \nsuch as menstrual irregularities, abnormal pelvic bleeding, pelvic \npain, infertility etc. Apart from the history and clinical examination, \nimaging plays a key role in the diagnosis and management of \nthese pathologies.\nMRI offers high contrast resolution, good soft tissue characterisation \n[1], provides multiplanar imaging capabilities and a larger field of \nview compared to ultrasonography and hence has recently become \na useful tool for the evaluation of female pelvic pathologies [2]. It \nis especially useful for identification of congenital abnormalities of \nthe uterus, evaluation of complex pelvic masses, sonographically \nindeterminate adnexal lesions, diagnosis of focal uterine lesions like \nleiomyomas and diffuse disorders like adenomyosis and detection \nas well as staging of gynaecological malignancies. MRI is also useful \nin postoperative follow-up, detecting tumour recurrence and in \ndifferentiating recurrence/residual from postoperative scarring [3]. \nMRI has additional advantages such as lack of ionising radiation \nand iodinated contrast material, and its ability to differentiate lesion \nfrom postoperative scarring in pelvic malignancies.\nTherefore, MRI is now often used as a problem-solving tool in \npatients where ultrasound findings are not definitive [4]. Complete \nknowledge of the MRI sequences, imaging features of physiologic \nvariations and pathologic conditions that affect the female pelvis \ncan be helpful in establishing an accurate diagnosis.\nHowever, in our experience, it is still an underutilised investigation \nin view of limited availability, in only the more advanced centres \nin the urban areas, lack of awareness amongst the clinicians of \nits utility and a perception of it being a prohibitively expensive \ninvestigation. This modality if used in a rational manner for \nappropriate indications, it can be cost-effective [5] and would serve \nfor early diagnosis of many female pelvic conditions which in the \nlong run would be helpful in improving early clinical management \nof many patients.\nConsidering this background, the study was undertaken to determine \nthe prevalence of various female pelvic pathologies among patients \nundergoing MRI for pelvic assessment, in the broader view of \ndemonstrating the wide spectrum of female pelvic pathologies that \ncan be diagnosed using MRI.\nMATERIALS AND METHODS\nA cross-sectional study carried out at Department of Radiodiagnosis \nof a tertiary care teaching hospital in Mumbai for a period of 1 year \ni.e., from 1st June 2013 to 31 st May 2014 among patients referred \nto the MRI department for assessment of female pelvic organ \npathologies. Institutional Ethics Committee approval was obtained \nbefore starting the study.\nInclusion and Exclusion criteria:  Patients with abnormal vaginal \nbleeding, infertility, suspected pelvic congenital anomalies and \nknown case of pelvic malignancy for staging and follow-up, referred \nfor MRI of the pelvis by the Gynaecology Department were included \nin the study. Also, patients in whom the ultrasound findings were \ninconclusive or to confirm those findings or MRI was anticipated \nto provide additional relevant clinical or pathological information \nwere included. However, claustrophobic patients, patients having \ncontraindications for MRI, those in whom contrast could not be \nadministered and patients who were unwilling to participate in the \nstudy were excluded. All the patients referred for MRI pelvis and \nfulfilling the inclusion and exclusion criteria were included in the \nstudy sample. Written informed consent was obtained from the \nstudy participants.\nA pre-designed proforma was used for data collection. Information \non patient age and clinical presentation was noted. MRI of the pelvis \nDEvEnDRa vIkaS kulkaRnI 1, SuShant haRI BhaDanE 2, ajay MRutyunjaya BanI 3, aMol MuRlIDhaR jagDalE 4\n \nKeywords: Benign and malignant lesions, Pelvic malignancy, Vaginal bleeding\nABSTRACT\nIntroduction: A wide variety of pathologies affect the female \ngenital tract. Magnetic Resonance Imaging (MRI) has recently \nbecome a useful tool for the evaluation of female pelvic \npathologies owing to certain benefits over ultrasonography. \nThis modality, in the long run would be helpful in improving early \ndiagnosis and clinical management of many patients.\nAim: To demonstrate the wide spectrum of female pelvic \npathologies that can be diagnosed using MRI.\nMaterials and Methods: It was a cross-sectional study carried \nout at Department of Radiodiagnosis among 75 patients \nreferred to the MRI department for assessment of female pelvic \norgan pathologies. Appropriate MRI sequences and multiplanar \nimaging were performed for every patient and findings noted in \na pre-designed proforma.\nResults: On MRI, 46 (61.3%) patients had Uterine and Cervical \npathology and 32 (42.7%) patients had Adnexal pathology \namong others. Vaginal pathologies were noted in 10 (13.3%) \npatients. Rectal and urinary bladder pathologies were seen in \n5 (6.7%) and 1 (1.3%) patients respectively.\nConclusion: The study shows that MRI was especially useful in \ndetecting a wide spectrum of female pelvic pathologies including \nbenign lesions such as fibroids, congenital mullerian anomalies, \nadenomyosis and endometriosis; and malignancies.\n\n\nwww.ijars.net Devendra Vikas Kulkarni et al., Prevalence of Female Pelvic Pathologies\nInternational Journal of Anatomy, Radiology and Surgery. 2021 Apr, Vol-10(2): RO52-RO56 5353\nPathology n (%)\nBenign lesions (n=36)\nCongenital anomalies 17 (37.0%)\nHypoplastic 4 (23.5%)\nAgenesis 4 (23.5%)\nArcuate 2 (11.8%)\nBicornuate 2 (11.8%)\nDidelphys 2 (11.8%)\nSeptate 1 (5.9%)\nUnicornuate 1 (5.9%)\nMalformation 1 (5.9%)\nFibroid 12 (26.1%)\nClassification of fibroids based on location\nIntramural 8 (66.6%)\nIntramural+Sub serosal 1 (8.33%)\nSubmucosal 2 (16.6%)\nSubserosal 1 (8.33%)\nClassification of fibroids based on morphology\nDegenerated 4 (33.3%)\nDegenerated+Simple 1 (8.3%)\nSimple 7 (58.3%)\nArterio-Venous malformation 2 (4.3%)\nRetained placenta 2 (4.3%)\nAdenomyosis 4 (8.7%)\nDiffuse 3 (75.0%)\nFocal 1 (25.0%)\nGestational trophoblastic neoplasia 2 (4.3%)\nEndometrial polyp 1 (2.17%)\nMalignant lesions (n=10)\nCervical and endometrial carcinoma 10 (21.7%)\n[Table/Fig-2]: Distribution of patients according to Uterine pathologies (n=46).\nvariables values\nAge (years) 35.5±16.0 \n(Range 1.2 months-80 years)\nClinical presentation\nVaginal bleeding 19 (25.3%)\nAmenorrhoea 10 (13.3%)\nMenstrual disturbances 26 (34.7%)\nPelvic pain 38 (50.7%)\nInfertility 6 (8.0%)\nLump in abdomen 12 (16.0%)\nUrinary complains 3 (4.0%)\nRectal bleeding 5 (6.7%)\nPathologies\nVaginal pathology 10 (13.3%)\nUterine and cervical pathology 46 (61.3%)\nAdnexal pathology 32 (42.7%)\nUrinary bladder pathology 1 (1.3%)\nRectal pathology 5 (6.7%)\nMiscellaneous pathology 5 (6.7%)\n[Table/Fig-1]: Patient characteristics; the total is not 75 as some patients had \nmore than one clinical presentation and more than one pelvic pathology.\nwas performed on a 3T Philips Achieva MRI scanner. Appropriate \nMRI sequences and multiplanar imaging were performed for every \npatient. A phased array torso surface coil was strapped around \nthe lower abdomen and pelvis of the patient. A slice thickness \nof 4  mm with a slice gap of 1 mm was selected. A saturation \nband was placed along the anterior abdominal wall to reduce the \nmotion artifacts produced due to respiratory movements.\nFollowing was the protocol of MRI sequences conducted:\na) T2 Weighted Turbo Spin Echo (T2W TSE) Sagittal.\nb) T2W TSE Axial.\nc) T2W TSE Coronal \nd) T1W TSE Axial \ne) T1 W TSE with fat saturation axial\nIn few patients, additional sequences were obtained: \nf) Postgadolinium T1W TSE with fat saturation \ng) Dynamic postgadolinium T1 TSE with fat saturation \nh) 3D T2W sequence\ni) Diffusion Weighted Imaging\nj) T2W TSE with fat saturation\nA true anatomical sagittal scan was first obtained by planning on \nthe three plane survey images. If uterus was the organ of interest, \nthen coronal and axial scans were obtained along the uterine axis \nand perpendicular to it. If there was no specific organ of interest or \nan irregular adnexal lesion, then true anatomical coronal and axial \nscans were obtained.\nSTATISTICAL ANALYSIS\nData analysis and generation of graphs was done using MS-Excel. \nQuantitative and qualitative data was represented in form mean (SD) \nand frequency (%) respectively.\nRESULTS\nThe present study was conducted among 75 female patients \nwho came to the Radiology Department with pelvic pathologies. \nThe mean age of the study patients was 35.5±16.0 years [Range \n1.2 months-80 years]. In this study, 48 (64%) patients were in the \nreproductive age group i.e. 20-49 years. The most common clinical \npresentation was pelvic pain seen in 38 (50.7%) patients. On MRI, \n46 (61.3%) patients had uterine pathology and 32 (42.7%) patients \nhad adnexal pathology among others. Thus, most common site \nin our study was utero-cervical region followed by Adnexa.[Table/\nFig-1] Overall, our study showed that benign pelvic pathologies \n(82.6%) were more common than malignant pathologies (17.4%).\nThe distribution of patients according to uterine pathologies is given \nin [Table/Fig-2]. Out of 46 patients with uterine pathologies, benign \npathologies were more common, seen in 36 (78.2%) patients than \nmalignant pathologies in 10 (21.7%) patients.\nAmong the benign pathologies, congenital anomalies were the \nmost common, noted in 17 (37.0%) patients. Most common \ncongenital anomalies were hypoplastic uterus and uterine agenesis \nseen in four patients each (23.5%). In our study, total 12 patients \nout of 46 i.e., 26.1% had fibroids. Most common location of fibroid \nwas intramural seen in 66.6% of patients followed by submucosal \nlocation in 16.6% patients. Based on morphology, 33.3% patients \nhad degenerated fibroids and uncomplicated/simple fibroids were \nseen in 58.3% patients [Table/Fig-2]. Two patients had adenomyosis \nwith intramural fibroid, one patient had congenital arcuate uterus \nwith subserosal fibroid and one patient had gestational trophoblastic \nneoplasia with arteriovenous malformation. Among the malignant \npathologies, cervical carcinoma was seen in six patients and \nendometrial carcinoma was noted in four patients.\nIn this study, benign ovarian masses were more common than \nmalignant ovarian lesions [Table/Fig-3]. Out of 75 patients, 22 (29.3%) \nhad benign ovarian pathologies out of which largest number of \ncases i.e., seven were simple cysts accounting for 31.8%.\n\nDevendra Vikas Kulkarni et al., Prevalence of Female Pelvic Pathologies www.ijars.net\nInternational Journal of Anatomy, Radiology and Surgery. 2021 Apr, Vol-10(2): RO52-RO565454\nVaginal pathologies were seen in 10 (13.3%) patients. Four \npatients out of these had Congenital Septum+Haematocolpos \nand two patients had congenital hypoplastic vagina. There was \none patient each of a congenital malformation, fistula, cyst and \ncarcinoma.\nTotal 18 (24%) patients had pelvic malignancies. Amongst them, \n6 (33.3%) patients had cervical malignancy, 4 (22.2%) patients had \nendometrial carcinoma, 4 (22.2%) patients had ovarian carcinoma, \n3 patients (16.6%) had rectal carcinoma and one patient had vaginal \nmalignancy.\nThere were five patients with miscellaneous pelvic pathologies. \nAmong these, there was one patient each of presacral teratoma, \npelvic AVM’s with large pelvic haematoma, perineal tear, post-\nhysterectomy collection in operative bed, mesenteric cyst.\nDISCUSSION\nThe mean age of our study patients was 35.5 years. Pelvic \npathology requiring imaging was more common in middle aged \nfemales. A study by Schwartz LB et al., was also conducted in \nsimilarly aged patients [6]. Most of the patients with leiomyoma \nand adnexal pathologies were 20-49 years (61.5%). In our study, \npelvic pain was the chief presenting complaint in 50.7% of \npatients followed by menstrual disturbances in 34.7% and vaginal \nbleeding in 25.33% of patients. However, in studies by Schwartz \nLB et al., and Szklaruk J et al., the commonest presenting \ncomplaint was bleeding [6,7]. In general, our study showed that \nbenign pathologies (82.6%) were more common than malignant \npathologies (17.4%). These findings are consistent with study by \nChoudhary S et al., [8].\nAmong the benign pathologies, congenital anomalies were most \ncommon (37%). Type I Mullerian duct anomaly was most common \nfinding in our study. Sagittal and axial planes were most important \nin diagnosing Type I Mullerian duct anomalies. Two patients \nhad combined uterine didelphys with transvaginal septum with \nhaematocolpos along with absent kidney on the side ipsilateral \nto the haematocolpos. These cases belonged to a group of rare \ncongenital anomalies of the urogenital tract involving Mullerian \nducts and Wolffian structures, and characterised by the triad \nof didelphys uterus, obstructed hemivagina and ipsilateral renal \nagenesis known as Herlyn Werner Wunderlich Syndrome [Table/\nFig-4] [9]. In a study conducted by Saleem SN, uterine anomalies \nwere identified in 0.17% fertile women and 3.5% infertile women. \nThe prevalence of uterine anomalies in the general population was \naround 0.5% [10].\nIn patients with gynaecological complaints, leiomyoma was \nthe most common finding. All the uncomplicated leiomyoma \nhad low signal intensity compared to myometrium on T2WI. \nFat suppressed T1W images are used to differentiate between \n[Table/Fig-4]: Herlyn Werner Wunderlich Syndrome MRI T2 Axial; a,c) T2 Coronal; \nb) Surview images; d) reveal uterus didelphys (green arrow), Obstructed right \nhemivagina (blue arrow) and absent right kidney (red arrow)\nPathology n (%)\nBenign lesions (n=22)\nCongenital 3 (13.6%)\nSimple cyst 7 (31.8%)\nComplex cyst 1 (4.5%)\nHaemorrhagic cyst 4 (18.2%)\nDermoid cyst 2 (9.1%)\nTheca lutein cyst 1 (4.5%)\nCystadenoma 4 (18.2%)\nMalignant lesions (n=4)\nCystadenocarcinoma 2 (7.4%)\nSolid malignancy 2 (7.4%)\n[Table/Fig-3]: Distribution of patients according to ovarian pathologies.\nred degeneration of fibroid and fatty changes, as fibroids with \nred degeneration maintain their hyperintense signal even on fat \nsuppressed images. Study done by Togashi K et al., shows that \nleiomyoma is more common than rest of uterine pathologies \n[11]. Similar to our study, Murase E et al., reported in their study \nthat leiomyoma occur most commonly in the myometrium of the \nuterine corpus [12].\nAdenomyosis was the third most common benign uterine pathology \nafter congenital anomalies and leiomyoma. On MRI, the diffuse \nform of adenomyosis presented with thickening of the junctional \nzone. Areas of adenomyosis were seen as bright foci and cyst-like \nhigh signal intensity areas which represent heterotopic endometrial \nglands or haemorrhagic foci. Focal adenomyosis was seen as a \nhypointense focal uterine lesion abutting the junctional zone. In \ncomparison to leiomyomas, it was less well-defined and poorly \nmarginated. Diffuse adenomyosis was more common than the \nfocal adenomyosis. These findings were similar to study done by \nReinhold C et al., [13].\nIn our study, 22 patients had benign ovarian pathology, most of \nthem were simple cysts followed by haemorrhagic cyst and benign \ncystic ovarian lesions. All the simple cysts appeared hypointense \non T1W images and hyperintense on T2W images. All of them \nwere incidental findings. There were two patients of dermoid cyst. \nAccording to study by Koonings PP et al., mature cystic teratoma \nare the most common germ cell tumours and the most common \novarian neoplasm [14]. Kurman RJ et al., reported similar findings \nstating that unlike other germ cell tumours of the ovary, they have a \nwider age distribution and may be encountered from infancy to old \nage [15]. In our study, the cases had unilateral tumour. However, \nKurman RJ et al., reported bilateral tumour in 8% to 15% of \ncases [15].\nOut of 75 patients included in this study, 18 patients (24%) had \nmalignancy. Most common malignancy in our study was cervical \nfollowed by endometrial and ovarian malignancies. Cervical cancer \nis the second most common gynaecological malignancy worldwide \nand is the most common pelvic malignancy in Indian women as \nshown in a study by Somalwar SA et al., [16]. MR imaging has \nproven to be an excellent modality to evaluate tumour size, extent, \nand nodal involvement [17]. In this study, for one patient, the tumour \nwas confined to the cervix and was in stage IB2. Two patients \nbelonged to stage II out of which one was IIA and one was IIB \n\nwww.ijars.net Devendra Vikas Kulkarni et al., Prevalence of Female Pelvic Pathologies\nInternational Journal of Anatomy, Radiology and Surgery. 2021 Apr, Vol-10(2): RO52-RO56 5555\nIn our study, 42.7% had adnexal pathology, either primary or \nsecondary. Amongst these, two patients had hydrosalpinx and \none patient had haematosalpinx. One case was diagnosed as \nadnexal mass lesion in present study which proved to be broad \nligament fibroid after surgery and histopathology. Amongst \npatients with congenital adnexal pathologies, two patients had \natypical MRKH syndrome with absent ovaries and one had \ncongenital malformation. One patient was a 26-year-old female \nwith complaints of bleeding PV and MRI revealed a large right \novarian neoplastic lesion, with possibility of germ cell tumour \ngiven, which was histopathologically proven as yolk sac tumour. \nAnother patient was a 49-year-old female with complains of \npain in abdomen and difficulty in micturition with two episodes \nof postmenopausal bleeding. USG revealed a solid cystic pelvi-\nabdominal mass. MR revealed a large solid mass with cystic \nand necrotic areas with the right ovary not separately seen, \nwith moderate ascites, omental deposits s/o malignant ovarian \nneoplasm. MRI was extremely useful in diagnosing ovarian \nlesion and differentiating benign from malignant lesions. This is \n[Table/Fig-5]: Carcinoma endometrium stage Ia MRI reveals T2 sagittal; a) T2 FAT \nSAT Axial; c) Postcontrast T1 axial; d) Postcontrast T1 sagittal; b) reveal endometrial \nlesion (green arrow) without myometrial invasion (red arrow)\nin accordance to study done by Kim MY et al., of CT and MRI of \novarian tumours with emphasis on differential diagnosis [20].\nLimitation(s)\nAs our study was conducted in a tertiary care hospital, a wide \nspectrum of female pelvic pathologies was available for MRI \nassessment including a few rare anomalies. However, the study \npatients were not selected randomly and therefore, the prevalence \nrates cannot be generalised is a limitation of our study.\nCONCLUSION(S)\nThe study involved MRI assessment of mostly women in the \nreproductive age group commonly presenting with complaints \nsuch as pelvic pain and menstrual disturbances. On MRI, \nfemale pelvic pathologies were most commonly noted in the \nuterine and cervical region followed by adnexal region. Among \nother pathologies noted were in the vagina, rectum and urinary \nbladder. In general, our study showed that benign pathologies \nwere more common than malignant pathologies. MRI with its \nvarious sequences, excellent soft tissue contrast and multiplanar \nimaging capacity is helpful in covering a wide spectrum of pelvic \npathologies especially when USG findings are inconclusive. Hence, \nit has now become a useful adjunctive tool in the evaluation of \nfemale pelvic pathologies.\nREFERENCES\nSiegelman ES, Outwater EK. Tissue characterisation in the female pelvis by [1] \nmeans of MR imaging. Radiology. 1999;212(1):05-18. \nAscher SM. MR imaging of the female pelvis: The time has come. Radiographics: [2] \nA review publication of the Radiological Society of North America, Inc. \n1998;18(4):931-45.\nEbner F, Ranner G, Fluckiger F. Distinguishing of scar tissue from recurrent tumour [3] \nafter therapy of tumours of the female pelvis. Der Radiologe. 1994;34(7):384-\n89.\nNational Guideline C. ACR Appropriateness Criteria & reg; abnormal vaginal [4] \nbleeding Rockville MD: Agency for Healthcare Research and Quality [Online]. \n[cited 2014 May 19]. Available from: http://www.guideline.gov/content.\naspx?id=32629 \nYu KK, Hricak H. Can MRI of the pelvis be cost effective? Abdominal Imaging. [5] \n1997;22(6):597-601.\nSchwartz LB, Zawin M, Carcangiu ML, Lange R, McCarthy S. Does pelvic [6] \nmagnetic resonance imaging differentiate among the histologic subtypes of \nuterine leiomyomata? Techniques and Instrumentation. 1998;70(3):580-87.\nSzklaruk J, Tamm EP , Choi H, Varavithya V. MR imaging of common and [7] \nuncommon large pelvic masses. RadioGraphics. 2003;23:403-24.\nChaudhry S, Reinhold C, Guermazi A, Khalili I, Maheshwari S. Benign and [8] \nmalignant diseases of the endometrium. Topics in Magnetic Resonance Imaging: \nTMRI. 2003;14(4):339-57.\nOrazi C, Lucchetti MC, Schingo PM, Marchetti P , Ferro F. Herlyn-Werner-[9] \nWunderlich syndrome: uterus didelphys, blind hemivagina and ipsilateral renal \nagenesis. Sonographic and MR findings in 11 cases. Pediatric Radiology. \n2007;37(7):657-65.\nSaleem SN. MR imaging diagnosis of uterovaginal anomalies: Current state of [10] \nthe art. Radiographics: A review publication of the Radiological Society of North \nAmerica, Inc. 2003;23(5):e13.\nTogashi K, Ozasa H, Konishi I, Itoh H, Nishimura K, Fujisawa I, et al. Enlarged [11] \nuterus: Differentiation between adenomyosis and leiomyoma with MR imaging. \nRadiology. 1989;171(2):531-34.\nMurase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine [12] \nleiomyomas: Histopathologic features, MR imaging findings, differential diagnosis, \nand treatment. Radiographics: A review publication of the Radiological Society of \nNorth America, Inc. 1999;19(5):1179-97.\nReinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, et al. [13] \nDiffuse adenomyosis: Comparison of endovaginal US and MR imaging with \nhistopathologic correlation. Radiology. 1996;199(1):151-58.\nKoonings PP , Campbell K, Mishell DR Jr, Grimes DA. Relative frequency of [14] \nprimary ovarian neoplasms: A 10-year review. Obstet Gynaecol 1989;74:921.\nKurman RJ. Blaustein’s Pathology of the Female Genital Tract. New York: [15] \nSpringer; 1994.\nSomalwar SA, Joshi S, Kawthalkar A, Bhalerao A, Jatin S, Somalwar A. Analysis [16] \nof Genital Tract Malignancies in postmenopausal Indian Women. J South Asian \nFeder Menopause Soc. 2013;1(2):66-69.\nVan Nagell JR Jr, Roddick JW Jr, Lowin DM. The staging of cervical cancer: [17] \nInevitable discrepancies between clinical staging and pathologic findings. Am J \nObstet Gynaecol. 1971;110:973-78. \nNandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in [18] \nIndia. Indian J Med Res. 2009;130:219-21.\nwith parametrial invasion. One patient belonged to stage IVA. These \nfigures correlated with the higher incidence of carcinoma cervix \nthan carcinoma endometrium in Indian population. The national \ncancer registry programme stated in their 2009 report that there \nwere 90,708 cases of carcinoma cervix in 2007 in India making \ncarcinoma cervix the commonest malignancy affecting female \ngenital tract [18].\nEndometrial carcinomas were diagnosed as confined to \nthe endometrium when the junctional zone appears intact. \nMyometrial invasion was diagnosed when junctional zone was \nindistinct. A smooth interface between the endometrium and \nmyometrium was considered to represent intact myometrium. \nHowever, irregularity of interface was considered as myometrial \ninvasion. Both T2W and postcontrast images were used for \nstaging purpose [Table/Fig-5]. Study conducted by Lee et al \nshowed similar findings with maximum patients in stage IB group \n(43%) followed by stage IA (34%) [19]. Cervical stromal invasion \nwas not seen in any patient. Also, two patients had associated \nfibroids. Patients having Stage I and II Ca Endometrium were \ntreated with radical hysterectomy with/without lymph node \ndissection. Advanced cases were treated with surgery as well as \nradiotherapy and chemotherapy.\n\nDevendra Vikas Kulkarni et al., Prevalence of Female Pelvic Pathologies www.ijars.net\nInternational Journal of Anatomy, Radiology and Surgery. 2021 Apr, Vol-10(2): RO52-RO565656\nPaRtICulaRS oF ContRIButoRS:\n1. Assistant Professor, Department of Radiology, SMBT Institute of Medical Sciences and Research Centre, Dhamangoan, Nashik, Maharashtra, India.\n2. Professor, Department of Radiology, SMBT Institute of Medical Sciences and Research Centre, Dhamangoan, Nashik, Maharashtra, India.\n3. Assistant Professor, Department of Radiology, SMBT Institute of Medical Sciences and Research Centre, Dhamangoan, Nashik, Maharashtra, India.\n4. Professor, Department of Radiology, SMBT Institute of Medical Sciences and Research Centre, Dhamangoan, Nashik, Maharashtra, India.\nPlagIaRISM ChECkIng MEthoDS: [Jain H et al.]\n•  Plagiarism X-checker: Nov 06, 2020\n•  Manual Googling: Dec 12, 2020\n•  iThenticate Software: Feb 17, 2021 (13%)\nEtyMology:  Author OriginnaME, aDDRESS, E-MaIl ID oF thE CoRRESPonDIng authoR:\nDr. Devendra Vikas Kulkarni,\nAssistant Professor, Department of Radiology, SMBT Institute of Medical Sciences \nand Research Centre, Dhamangoan, Nashik, Maharashtra, India.\nE-mail: devendrakulkarni2485@gmail.com\nDate of Submission: nov 05, 2020\nDate of Peer Review: Dec 14, 2020\nDate of Acceptance: jan 22, 2021\nDate of Publishing: apr 01, 2021\nauthoR DEClaRatIon:\n•  Financial or Other Competing Interests:  None\n•  Was Ethics Committee Approval obtained for this study?  Yes\n•  Was informed consent obtained from the subjects involved in the study?  Yes\n•  For any images presented appropriate consent has been obtained from the subjects.  Yes\nLee EJ, Byun JY, Kim BS, Koong SE, Shinn KS. Staging of early endometrial [19] \ncarcinoma: assessment with T2-weighted and gadolinium-enhanced T1-\nweighted MR imaging. Radiographics : A review publication of the Radiological \nSociety of North America, Inc. 1999;19(4):937-45; discussion 46-7.\nKim MY, Rha SE, Oh SN, Jung SE, Lee YJ, Kim YS, et al. MR Imaging findings [20] \nof hydrosalpinx: a comprehensive review. Radiographics: A review publication of \nthe Radiological Society of North America, Inc. 2009;29(2):495-507.","source_license":"CC0","license_restricted":false}