Magnetic resonance imaging in women with pelvic pain from gynaecological causes: a pictorial review

Abstract This article illustrates causes of pelvic pain in girls and women that may be inadequately diagnosed by ultrasound (US) and more adequately assessed by magnetic resonance imaging (MRI). We describe MRI features necessary for detecting disease and helpful in differential diagnosis. Special attention is paid to correlating age and pathology by subdividing the population into four categories: girls up to prepubertal age, pubertal girls, women of reproductive age and postmenopausal women. US is the first-line imaging modality in children and women with pelvic pain, and computed tomography (CT) is usually requested, especially in emergency settings, in patients in whom US is inadequate for diagnosis. However, MRI should be considered at least in urgent, if not in emergent, care given the wide range of female pelvic disorders that can be correctly assessed thanks to the excellent soft-tissue contrast, high spatial resolution and ability to depict blood products. Moreover, MRI should be preferred in children and women of reproductive age because of the absence of radiation exposure. Riassunto Questo articolo illustra le cause del dolore pelvico di natura ginecologica che possono non essere correttamente individuate o che sono dubbie all’ecografia e che appaiono meglio identificabili con risonanza magnetica (RM). Verranno forniti gli elementi di semeiotica RM necessari per la diagnosi e quelli utili per la diagnostica differenziale. Verrà, inoltre, prestata una particolare attenzione nel correlare età e patologia suddividendo la popolazione femminile in 4 categorie: neonate e bambine fino all’età pre-pubere, ragazze al menarca, donne in età fertile e donne in menopausa. L’ecografia è solitamente il primo esame utilizzato nei bambini e nelle donne con dolore pelvico e nei casi dubbi è la tomografia computerizzata ad essere impiegata, in particolare in emergenza. Tuttavia, quando l’ecografia non sia risolutiva bisognerebbe prendere in considerazione la RM, se non in emergenza almeno nei casi di urgenza differibile, in quanto essa è in grado di identificare un ampio spettro di patologie responsabili del dolore pelvico di natura ginecologica grazie alla sua eccellente risoluzione spaziale e di contrasto e alla capacità di identificare i prodotti di degradazione della emoglobina. Non bisogna inoltre dimenticare che la RM dovrebbe essere preferita nei bambini e nelle donne in età riproduttiva a causa dell’assenza di radiazioni ionizzanti. Similar content being viewed by others References/Bibliografia Sivit CJ (1997) Imaging children with acute right lower quadrant pain. Pediatric Clin North Am 44:575–589 Balan P (2006) Ultrasonography, computed tomography and magnetic resonance imaging in the assessment of pelvic pathology. Eur J Radiol 58:147–155 Greenberg SB, Bhutta S, Braswell L, Chan F (2011) Computed tomography angiography in children with cardiovascular disease: low-dose technique and imaging quality. Int J Cardiovasc Imaging, in press Kinkel K, Frei KA, Balleyguier C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298 Siegel MJ (1992) Acute appendicitis in childhood: the role of US. Radiology 202:341–342 Berry J, Malt RA (1984) Appendicitis near its centenary. Ann Surg 200:567–575 Lim R (2009) Vesicoureteral reflux and urinary tract infection: evolving practices and current controversies in pediatric imaging. AJR Am J Roentgenol 192:1197–1208 De Sousa G, Wunsch R, Andler W (2008) Precious pseudo-puberty due to autonomous ovarian cysts: a report of ten cases and long-term follow-up. Hormones 7:170–174 Westernhout FC jr, Hodgman JE, Anderson G, Sack RA (1964) Congenital hydrocolpos. Am J Obst Gynecol 89:957–961 MacBeth WA, Rubin J (1963) Hydrocolpos in infancy. Br J Roengtenol 50:887–889 Bellah RD, Griscom NT (1989) Torsion of normal uterine adnexa before menarche: CT appearance. AJR Am J Roentgenol 152:123–124 Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22:785–801 Kiechi-Kohlendorfer U, Maurer K, Unsinn KM, Gassner I (2006) Fluid-debris level in follicular cyst: a pathognomonic sign of ovarian torsion. Pediatr Radiol 36:421–425 Nussbaum AR, Sanders RC, Hartmann DS et al (1988) Neonatal ovarian cysts: sonographic-pathologic correlation. Radiology 168:817–821 Ulfelder H (1968) Agenesis of the vagina. A discussion of surgical management and functional and morphologic comparison of end results, with and without skin grafting. Am J Obstet Gynecol 100:745–751 Shaked O, Tepper R, Klein Z, Beyth Y (2008) Hydrometrocolpos: diagnostic and therapy dilemma. J Pediatr Adolesc Gynecol 21:317–321 Baltarowich OH, Kurtz AB, Pasto ME et al (1987) The spectrum of sonographic findings in haemorrhagic ovarian cysts. AJR Am J Roentgenol 148:901–905 Thomassin-Naggara I, Toussaunt I, Perrot N et al (2011) Characterization of complex adnexal mass: Value of adding perfusional- and diffusion-weighted imaging to conventional MRI imaging. Radiology 258:793–803 Donnez O, Jadoul P, Squifflet J et al (2007) Didelphic uterus in obstructed hemivagina: recurrent hematometra in spite of appropriate classic surgical treatment. Gynecol Obstet Invest 63:98–101 Grover S (2006) Pelvic pain in the female adolescent patients. Aust Fam Physician 35:850–853 Singh A, Danrad R, Hahn PF et al (2007) MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics 27:1419–1431 Kalish GM, Patel MD, Gunn ML et al (2007) Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain. Ultrasound Q 23:167–175 Martin C, Magee K (2006) Ovarian torsion in a 20-year-old patient. CJEM 8:126–129 Crossman SH (2006) The challenge of pelvic inflammatory disease. Am Fam Physician 73:859–864 Thomassin-Naggara I, Dubernard G, Lafont C et al (2008) Imagerie de l’infection pelvienne. J Radiol 89:134–141 Kim MY, Rha SE, Jung SE et al (2009) MR Imaging findings of hydrosalpinx: a comprehensive review. Radiographics 29:495–507 Quan M, Johnson R, Rodney WM (1983) The diagnosis of acute pelvic pain. West J Med 139:110–113 Pedrosa I, Zeikus E, Levine D (2007) MR imaging of acute right lower quadrant pain in pregnant and non pregnant patients. Radiographics 27:721–743 Simoens S, Hummelshoj L, D’Hooghe T (2007) Endometriosis: cost estimates and methodological perspective. Hum Reprod Update 13:395–404 Bazot M, Thomassin I, Hourani R (2004) Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2:180–185 Azziz R (1989) Adenomyosis: current perspectives. Obstet Gynecol Clin Noth Am 16:221–235 Adams J, Reginald PW, Franks S et al (1990) Uterine size and endometrial thickness and the significance of cystic ovaries in women with pelvis pain due to congestion. Br J Obstet Gynaecol 97:583–587 Belencky a, Bartal G, Cohen M, Bachar GN (2002) Ovarian varices in healthy female kidney donors: incidence, morbidity and clinical outcome. AJR Am J Roentgenol 179:625–627 Kuligowska E, Deeds L, Lu K (2005) Pelvic pain: overlooked and under diagnosed gynaecologic conditions. Radiographics 25:3–20 Murase E, Siegleman ES, Outwater EK et al (1999) Uterine leiomyomas: histopatologic features, MR imaging findings, differential diagnosis and treatment. Radiographics 19:1179–1197 Lipinski JK, Adam AH (1981) Ultrasonic prediction of complication following normal vaginal delivery. J Clin Ultrasound 9:17–19 Nalaboff KM, Pellerito JS, Ben-Levi E (2001) Imaging of endometrium: disease and normal variants. Radiographics 21:1409–1424 Maestre MA, Manzano CD, Lòpez RM (2004) Postmenopausal endometrial tuberculosis. Inter J Obstet Gynecol 86:405–406 Gungorduk K, Ulker V, Sahbaz A et al (2007) Postmenopausal tuberculosis endometritis. Infect Dis Obstet Gynecol 2007:27028 Sutherland AM (1980) Surgical treatment of tuberculosis of the female genital tract. Br J Obstet Gynecol 87:610–612 Yanagizawa R, Inoue S, Kishi H et al (1992) A case of urinary retention due to tuberculous pyometra. Nippon Hinyokika Gakkai Zasshi 83:690–693 Siegelman ES, Outwater EK, Banner MP et al (1997) High resolution MR imaging of the vagina. Radiographics 17:1183–1203 Moifo B, Garel C, Weisgerber G et al (2005) Kyste de Gartner communiquant avec la vessie et le vagin, associé à un diaphragme vaginal complet. J Radiol 86:170–172 Author information Authors and Affiliations Corresponding author Additional information This paper was presented at the International Congress of the Radiological Society of North America in Chicago, IL (RSNA 2008) and selected for AMA PRA Category 1 Credit Exhibit (ID:6006867; space number LL-OB 2699-H11) and was discussed at lunchtime. Rights and permissions About this article Cite this article Valentini, A.L., Gui, B., Basilico, R. et al. Magnetic resonance imaging in women with pelvic pain from gynaecological causes: a pictorial review. Radiol med 117, 575–592 (2012). https://doi.org/10.1007/s11547-011-0773-7 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s11547-011-0773-7