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Ding Y, Wang Y, Lyu Y, Xie H, Huang Y, Wu M, Chen F, Chen Z. Urogenital sinus malformation: From development to management. Intractable Rare Dis Res 2023; 12:78-87. [PMID: 37287654 PMCID: PMC10242390 DOI: 10.5582/irdr.2023.01027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
Urogenital sinus (UGS) malformation, also known as persistent urogenital sinus (PUGS), is a rare congenital malformation of the urogenital system. It arises when the urethra and vaginal opening fail to form properly in the vulva and fuse incorrectly. PUGS can occur as an isolated abnormality or as part of a complex syndrome, and is frequently associated with congenital adrenal hyperplasia (CAH). The management of PUGS is not well-established, and there are no standardized guidelines on when to perform surgery or how to follow up with patients over the long term. In this review, we discuss the embryonic development, clinical evaluation, diagnosis, and management of PUGS. We also review case reports and research findings to explore best practices for surgery and follow-up care, in hopes of increasing awareness of PUGS and improving patient outcomes.
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Affiliation(s)
- Yu Ding
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yaping Wang
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiqing Lyu
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yichen Huang
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Wu
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongzhong Chen
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Urogenital Development Research Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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2
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Huang XS, Fan SF, Xu JX, Xu YJ, Song X, Xiang JY, Xue LM. Primary vaginal signet ring cell carcinoma. BJR Case Rep 2023; 9:20220050. [PMID: 36873240 PMCID: PMC9976718 DOI: 10.1259/bjrcr.20220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/08/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022] Open
Abstract
Primary vaginal cancer is rare, accounting for only 2% of all gynecological malignant tumors. Primary vaginal cell carcinoma is mainly squamous cell carcinoma, accounting for about 90%, and adenocarcinoma only accounts for 8-10%. Primary signet ring cell carcinoma of vagina is rare and has not been reported in the literature. This paper reports a case of signet ring cell carcinoma in vagina.
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Affiliation(s)
- Xiao-Shan Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shu-Feng Fan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yong-Jie Xu
- Department of Computed Tomography and Magnetic Resonance Imaging, Handan First Hospital, Handan, China
| | - Xia Song
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jun-Yi Xiang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Li-Ming Xue
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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3
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Khetarpal S, Khetarpal A. Gartner’s Duct Cyst (Mesonephric Cyst) in Posterior Vaginal Wall. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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4
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Magnetic resonance imaging of Müllerian anomalies in girls: concepts and controversies. Pediatr Radiol 2022; 52:200-216. [PMID: 34152437 DOI: 10.1007/s00247-021-05089-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Female Müllerian anomalies are the result of failure of formation, fusion or resorption of the Müllerian ducts and are relatively common, with a prevalence of 5.5-7.0% in the general population. While some of these anomalies are asymptomatic, those presenting with obstruction require accurate identification for optimal clinical management including potential surgical treatment. MRI is a useful adjunct to sonography in the evaluation of Müllerian anomalies, typically allowing a more complete characterization of the malformation. Technical aspects, embryologic concepts and controversies regarding classification systems are highlighted in this review. Several Müllerian anomalies are discussed and illustrated in more detail utilizing various cases with pelvic MRI studies.
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5
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Albuquerque KS, Zoghbi KK, Gomes NBN, Libânio BB, Souza e Silva TX, de Araújo EM, Lewin F, Pedroso MHNI, Torres US, D'Ippolito G, Racy DJ, Bernardo GCO. Vaginal cancer: Why should we care? Anatomy, staging and in-depth imaging-based review of vaginal malignancies focusing on MRI and PET/CT. Clin Imaging 2022; 84:65-78. [DOI: 10.1016/j.clinimag.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 11/03/2022]
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6
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Hughes NJ, Kalkur S, Zhang J, Liyanage SH. Patient acceptability and quality of self-administered intravaginal gel for pelvic MRI. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211065223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: MRI of the pelvis can be limited for infiltrating lesions or those of same signal intensity as surrounding structures. Vaginal distension using aqueous gel counters this by defining the fornices, cervix and anterior rectal wall. This increases the accuracy of diagnosis and staging of various pelvic pathology, however, there is currently neither a universally accepted protocol for using gel nor focus on patient self-administration. Aims: To improve patient expectations regarding pelvic MRI with intravaginal gel, as well as the service we provide should they prefer self-administration and this produces vaginal distension of radiological quality equivalent to doctor-administration. Methods: Illustrated information explaining the benefits of gel and the technique of self-administration was sent to patients scheduled for pelvic MRI between March 2020 and April 2021 at our study centre. This included a questionnaire to assess understanding and preference for self-administration. Vaginal distension achieved on imaging was analysed using TeraRecon and compared between self and doctor-administered cases. Results: 38 of 45 patients opted for self-administration of gel. Those who identified as White British were more likely to self-administer. There was comparable quality of vaginal distension between self and doctor administered cases, with no significant difference between orthogonal measurements and retained gel volume. Conclusion: Self-administration of intravaginal gel for pelvic MRI is acceptable to patients and frees a doctor of this duty. It is a well tolerated technique which produces high quality vaginal distention on imaging. We recommend wider use of intravaginal and even rectal gel in the investigation of complex endometriosis and pelvic tumours.
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Affiliation(s)
- Noemi J Hughes
- Department of Obstetrics and Gynaecology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Sanjaya Kalkur
- Department of Obstetrics and Gynaecology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | | | - Sidath H Liyanage
- Department of Radiology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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7
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Nougaret S, Cunha TM, Benadla N, Neron M, Robbins JB. Benign Uterine Disease: The Added Role of Imaging. Obstet Gynecol Clin North Am 2021; 48:193-214. [PMID: 33573786 DOI: 10.1016/j.ogc.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Benign uterine diseases are very common gynecologic conditions that affect women mostly in reproductive age. Ultrasound examination is the first-line imaging technique, but MRI is more accurate for diagnosis, characterization, and patient management. In this review, we especially highlight the added value of MRI in the diagnosis of benign uterine disease, discuss their imaging characteristics, and describe the therapeutic options and the added value of MRI in the treatment planning.
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Affiliation(s)
- Stephanie Nougaret
- Montpellier Cancer Research Institute, Montpellier, France; Department of Radiology, Montpellier Cancer Institute, INSERM, U1194, University of Montpellier, 208 Avenue des Apothicaires, Montpellier 34295, France.
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, Lisboa Codex 1099-023, Portugal
| | - Nadia Benadla
- Department of Radiology, Montpellier Cancer Institute, INSERM, U1194, University of Montpellier, 208 Avenue des Apothicaires, Montpellier 34295, France
| | - Mathias Neron
- Department of Surgery, Montpellier Cancer Institute, 208 Avenue des Apothicaires, Montpellier 34295, France
| | - Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Venkatesan AM, Menias CO, Jones KM, Rauch GM, Stafford RJ, Klopp AH. MRI for Radiation Therapy Planning in Human Papillomavirus-associated Gynecologic Cancers. Radiographics 2019; 39:1476-1500. [PMID: 31498740 DOI: 10.1148/rg.2019180121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Locally advanced human papillomavirus (HPV)-associated gynecologic cancers, including cervical, vaginal, and vulvar cancers, are treated primarily with radiation therapy (RT). Cervical cancer remains a leading cause of cancer death among women worldwide. The superior soft-tissue resolution of MRI compared with other imaging modalities makes it an ideal modality for RT planning, execution, and follow-up of these malignancies. This superiority has been corroborated in the literature when comparing MRI-based RT planning to radiography-based conventional treatment planning approaches. In 2005, the Groupe Européen de Curiethérapie and the European Society for Radiation Therapy and Oncology guidelines underscored the central role of MRI for successful implementation of three-dimensional image-based cervical cancer brachytherapy. The delineation of both gross tumor volume and clinical tumor volume for brachytherapy is performed at the time of each brachytherapy application, on the basis of the findings depicted on anatomic MR images. Contemporary knowledge concerning the role of MRI for RT planning in HPV-associated gynecologic cancers warrants an understanding of the epidemiology and clinical manifestations of these cancers, as well as knowledge of MRI protocol for cancer staging, selection of RT candidates, brachytherapy implant assessment, posttreatment surveillance, and delineation of treatment-related complications. Technical requirements, patient preparation, and image acquisition protocols are detailed in this review, and imaging-based treatment protocols are summarized. Knowledge of these fundamental concepts enables the radiologist to play an important role in diagnosis, staging, and posttreatment follow-up, helping to guide radiation oncologists and other clinicians in the management of these malignancies.©RSNA, 2019.
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Affiliation(s)
- Aradhana M Venkatesan
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Christine O Menias
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Kyle M Jones
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Gaiane M Rauch
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - R Jason Stafford
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Ann H Klopp
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
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9
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Imaging of diseases of the vagina and external genitalia in children. Pediatr Radiol 2019; 49:827-834. [PMID: 30612158 DOI: 10.1007/s00247-018-4324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/29/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
A wide range of congenital or acquired conditions, some pretty rare, may affect the vulva and vagina in children. Swelling, visible or palpable masses and abnormal discharges are common symptoms of conditions affecting the vulva and/or the lower genital tract. The majority of these diseases are benign. Ultrasonography is pivotal to elucidate the anatomical origin of these conditions and make the diagnosis. Magnetic resonance imaging can be relevant to improve diagnostic confidence and, if needed, to plan more accurate surgical treatment. The aim of this pictorial essay is to review the related imaging findings to help make radiologists familiar with these conditions.
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10
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Lima M, Rio G, Horta M, Cunha TM. Primary vaginal malignancies: a single oncology centre experience. J OBSTET GYNAECOL 2019; 39:827-832. [DOI: 10.1080/01443615.2019.1579786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mariana Lima
- Department of Radiology, Centro Hospitalar de Lisboa Central (Hospital de Santo António dos Capuchos), Alameda de Santo António dos Capuchos, Lisboa, Portugal
| | - Gisela Rio
- Department of Radiology, Hospital de Braga, Braga, Portugal
| | - Mariana Horta
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, Lisboa, Portugal
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11
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Agarwal MD, Resnick EL, Mhuircheartaigh JN, Mortele KJ. MR Imaging of the Female Perineum. Magn Reson Imaging Clin N Am 2017; 25:435-455. [DOI: 10.1016/j.mric.2017.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Boruah DK, Sanyal S, Gogoi BB, Mahanta K, Prakash A, Augustine A, Achar S, Baishya H. Spectrum of MRI Appearance of Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome in Primary Amenorrhea Patients. J Clin Diagn Res 2017; 11:TC30-TC35. [PMID: 28893003 DOI: 10.7860/jcdr/2017/29016.10317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/08/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Mayer-Rokitansky-Kuster-Hauser (MRKH) synd-rome is a malformation in female genital tract due to interrupted embryonic development of para-mesonephric ducts leading to uterine and proximal vagina aplasia or hypoplasia. AIM To analyse the MRI findings in females suspected of MRKH syndrome in a primary amenorrhea workup. MATERIALS AND METHODS A cross-sectional study comprising of 11 patients of MRKH syndrome presented in a tertiary care centre from March 2016 to February 2017 evaluated in 1.5 Tesla MRI scanner. RESULTS Normal positioned small vestigial uterus demonstrated in two patients (18.2%) and complete uterine and proximal vaginal agenesis were noted in nine patients (81.8%). The mean volume of rudimentary right uterine bud was 2.26 mL ±3.3 (SD) and left uterine bud was 1.27 mL±1.1 (SD). The mean volume of right ovary was 4.74 mL±2.58 (SD) and left ovary was 4.65 mL±2.2 (SD). The mean developed vaginal length was 26.2 mm±6.34 (SD). CONCLUSION The rudimentary uterine buds associated with MRKH syndrome always maintained caudal relationship with ovary. Ovaries or rudimentary uterine buds can be ectopic and should be recognized with MRI before undergoing fertility treatment. Following MRI diagnosis, surgery allows patients to have sexual function with possible attainment of reproduction after assisted reproduction technique or surrogacy.
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Affiliation(s)
- Deb Kumar Boruah
- Assistant Professor, Department of Radiodiagnosis, Assam Medical College, Dibrugarh, Assam, India
| | - Shantiranjan Sanyal
- Consultant Radiologist, Department of Radiodiagnosis, Airedale General Hospital, Keighley, West Yorkshire, United kingdom
| | - Bidyut Bikash Gogoi
- Senior Resident, Department of Pathology, NEIGHR MS, Shillong, Meghalaya, India
| | - Kangkana Mahanta
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College, Dibrugarh, Assam, India
| | - Arjun Prakash
- Assistant Professor, Department of Radiodiagnosis, Bangalore Medical College, Bengaluru, Karnataka, India
| | - Antony Augustine
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College, Dibrugarh, Assam, India
| | - Sashidhar Achar
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College, Dibrugarh, Assam, India
| | - Hiranya Baishya
- Postgraduate Student, Department of Radiodiagnosis, Assam Medical College, Dibrugarh, Assam, India
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13
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Rios SS, Pereira LCR, Santos CB, Chen ACR, Chen JR, de Fátima B Vogt M. Conservative treatment and follow-up of vaginal Gartner's duct cysts: a case series. J Med Case Rep 2016; 10:147. [PMID: 27256294 PMCID: PMC4890494 DOI: 10.1186/s13256-016-0936-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/06/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In women, during embryologic development, the paired Müllerian (paramesonephric) ducts fuse distally and develop into the uterus, cervix, and upper vagina. If the Wolffian ducts persist in vestigial form, they can lead to Gartner's cysts, mainly located in the right wall of the vagina. This is one of the few studies of Gartner's cysts with a series of consecutive cases over a long period of time who were exclusively subject to clinical observation. Although Gartner's cysts are found in approximately 0.1 to 0.2% of women, controversy exists regarding the course of action to be taken. CASE PRESENTATION We describe the cases of four women who were 38-years old, 53-years old, 37-years old, and 49-years old at their first appointment and who were of mixed ethnicity, mixed ethnicity, black, and mixed ethnicity respectively. The follow-up of these patients ranged from 2 to 17 years. In these four cases the location of the cysts was the right wall of the vagina. Transvaginal ultrasound was the test of choice for diagnostic confirmation. In the cases presented in this study, the women were asymptomatic and chose to be observed clinically. CONCLUSIONS This is the first study reporting long-term clinical observation of these lesions. This study shows that conservative treatment can be a safe option for asymptomatic patients with vaginal Gartner's duct cysts.
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Affiliation(s)
- Salete S Rios
- Obstetrics and Gynecology Department, School of Medicine, University of Brasilia DF, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil.
| | - Lara Cristina R Pereira
- Obstetrics and Gynecology Department, School of Medicine, University of Brasilia DF, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Carla B Santos
- Obstetrics and Gynecology Department, School of Medicine, University of Brasilia DF, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Ana Carolina R Chen
- Obstetrics and Gynecology Department, School of Medicine, University of Brasilia DF, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Juliana R Chen
- Obstetrics and Gynecology Department, School of Medicine, University of Brasilia DF, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Maria de Fátima B Vogt
- Obstetrics and Gynecology Department, School of Medicine, University of Brasilia DF, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
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14
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Ssi-Yan-Kai G, Thubert T, Rivain AL, Prevot S, Deffieux X, De Laveaucoupet J. Female perineal diseases: spectrum of imaging findings. ACTA ACUST UNITED AC 2016; 40:2690-709. [PMID: 25896612 DOI: 10.1007/s00261-015-0427-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The female perineum, which is divided into the anterior urogenital triangle and the posterior anal triangle, is a surface structure often overlooked. Female perineal diseases may present with nonspecific clinical signs due to its close anatomical relationship between the different compartments. Diagnosis of the origin of a perineal disorder may also be a difficult problem encountered in pelvi-perineal imaging. Therefore, a precise knowledge of the female perineal anatomy and the associated disease processes is essential to radiologists, pathologists, and surgeons alike who are involved in the evaluation of the patient who presents with a perineal mass. Cross-sectional imaging plays a crucial role for proper management. Due to the robust contrast resolution of MR, MR imaging is the modality of choice for evaluation of the extent of a complex perineal lesion, its relationship to the adjacent structures. It has a greater sensitivity and specificity for the diagnosis than the other non-invasive imaging techniques and is helpful in guidance for surgical planning. The purpose of this article is to highlight the spectrum of imaging findings of female perineal diseases.
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Affiliation(s)
- Guillaume Ssi-Yan-Kai
- Service de Radiologie, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France.
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Anne-Laure Rivain
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Sophie Prevot
- Service d'Anatomie-Pathologie, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Jocelyne De Laveaucoupet
- Service de Radiologie, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
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15
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Ferreira DM, Bezerra ROF, Ortega CD, Blasbalg R, Viana PCC, de Menezes MR, Rocha MDS. Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making. Radiol Bras 2015; 48:249-59. [PMID: 26379324 PMCID: PMC4567364 DOI: 10.1590/0100-3984.2013.1726] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/08/2014] [Indexed: 12/18/2022] Open
Abstract
Magnetic resonance imaging is a method with high contrast resolution widely used in
the assessment of pelvic gynecological diseases. However, the potential of such
method to diagnose vaginal lesions is still underestimated, probably due to the
scarce literature approaching the theme, the poor familiarity of radiologists with
vaginal diseases, some of them relatively rare, and to the many peculiarities
involved in the assessment of the vagina. Thus, the authors illustrate the role of
magnetic resonance imaging in the evaluation of vaginal diseases and the main
relevant findings to be considered in the clinical decision making process.
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Affiliation(s)
- Daian Miranda Ferreira
- MD, Resident at Service of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Régis Otaviano França Bezerra
- Physician Assistants at Service of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Cinthia Denise Ortega
- Physician Assistants at Service of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Roberto Blasbalg
- PhD, Physician Assistant at Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Públio César Cavalcante Viana
- Physician Assistants at Service of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Marcos Roberto de Menezes
- PhD, Head of Unit of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Manoel de Souza Rocha
- Private Docent, Associate Professor, Department of Radiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Gould SW, Epelman M. Magnetic Resonance Imaging of Developmental Anomalies of the Uterus and the Vagina in Pediatric Patients. Semin Ultrasound CT MR 2015; 36:332-47. [PMID: 26296484 DOI: 10.1053/j.sult.2015.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Developmental anomalies of the uterus and the vagina are associated with infertility and miscarriage and are most commonly detected in the postpubertal age-group. These conditions may also present in younger patients as a mass or pain owing to obstruction of the uterus or the vagina. Associated urinary tract anomalies are common, as well. Accurate diagnosis and thorough description of these anomalies is essential for appropriate management; however, evaluation may be difficult in an immature reproductive tract. Magnetic resonance imaging technique pertinent to imaging of the pediatric female reproductive tract is presented and illustrated along with the findings associated with various anomalies.
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Affiliation(s)
- Sharon W Gould
- Department of Medical Imaging, Nemours/A.I. duPont Hospital for Children, Wilmington, DE.
| | - Monica Epelman
- Department of Medical Imaging/Radiology, Nemours Children׳s Hospital, Orlando, FL
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17
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Arrada A, Fontaine A, Garibaldi F, Mazet N, Langman B, Cheikh-Khelifa H, Vendrell JF, Rouanet JP, Filhastre M, Viala-Trentini M. IRM du périnée antérieur : anatomie et principales pathologies. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Abstract
OBJECTIVE The purpose of this article is to review the imaging features, particularly on MR images, useful in identifying primary gynecologic lymphoma. CONCLUSION Primary gynecologic lymphoma is rare. Nonetheless, the distinction between primary and secondary involvement is important because of critical differences in prognosis and treatment. The prospective diagnosis of primary gynecologic lymphoma enables immediate chemotherapy or radiation therapy and avoids unnecessary surgery, which delays treatment. Diagnostic imaging can be key in differentiating lymphoma from the far more common pelvic malignancies.
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19
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Epelman M, Dinan D, Gee MS, Servaes S, Lee EY, Darge K. Müllerian duct and related anomalies in children and adolescents. Magn Reson Imaging Clin N Am 2013; 21:773-89. [PMID: 24183525 DOI: 10.1016/j.mric.2013.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although many Müllerian duct anomalies do not require treatment, surgical intervention is sometimes necessary to enable sexual activity or to preserve fertility. The identification of these anomalies is important for optimal clinical management or surgical treatment. Magnetic resonance (MR) imaging is a robust method for adequately evaluating and characterizing uterine and vaginal anomalies. The information provided by MR imaging allows for a more complete understanding of the malformation, facilitating management decisions and potentially changing the outcome. In this article, the embryology, classification, and MR imaging findings of Müllerian duct and related anomalies in children and adolescents are reviewed.
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Affiliation(s)
- Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA.
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20
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Abstract
Gartner cyst is usually an asymptomatic vaginal cyst, measuring less than 2 cm, frequently found during a routine gynaecological examination. Very rarely, as these cysts are closed structures, they may increase in size because of mucus production. We describe here a case of a large Gartner cyst of approximately 8 cm, its differential diagnosis, investigation and vaginal surgical approach (with illustrations), that progressed uneventfully.
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Affiliation(s)
- Gonçalo Inocêncio
- Obstetrics Gynaecology Department, Centro Hospitalar do Porto - Maternidade Júlio Dinis, Porto, Portugal.
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21
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Angiomyxome agressif du pelvis et du périnée : à propos d’un cas. IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Hosseinzadeh K, Heller MT, Houshmand G. Imaging of the Female Perineum in Adults. Radiographics 2012; 32:E129-68. [DOI: 10.1148/rg.324115134] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Tzialidou-Palermo I, von Kaisenberg CS, Garcia-Rocha GJ, Schloesser HW, Baehr I, Schippert C. Diagnostic challenges of hemihematocolpos and dysmenorrhea in adolescents: obstructed hemivagina, didelphys or bicornuate uterus and renal aplasia is a rare female genital malformation. Arch Gynecol Obstet 2012; 286:785-91. [DOI: 10.1007/s00404-012-2392-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 05/16/2012] [Indexed: 11/28/2022]
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24
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Utility of preoperative examination and magnetic resonance imaging for diagnosis of anterior vaginal wall masses. Int Urogynecol J 2012; 23:1055-61. [PMID: 22302079 DOI: 10.1007/s00192-012-1666-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 01/06/2012] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The clinical evaluation of anterior vaginal wall masses can present a dilemma, as there are no well-defined pathways for diagnosis and management. Our objective was to evaluate the role and accuracy of preoperative exam and magnetic resonance imaging (MRI) for these masses. METHODS We identified women with a mass using billing codes for 10 years. We compared data from the preoperative evaluation to postoperative pathology if available. RESULTS Analysis after chart review on 47 women was performed. Of the 34 women who had surgery, 28 (82.4%) also underwent an MRI. MRI diagnosis was accurate in 22/28 women compared to histology, inconclusive in 4, and inaccurate in 2. Preoperative diagnosis, including exam, MRI, and cystourethroscopy, had a diagnostic accuracy of 94.1% compared to postoperative diagnosis. The positive predictive value of MRI alone was 91.7%. CONCLUSIONS Preoperative diagnosis using exam, MRI, and cystourethroscopy have a high diagnostic accuracy for anterior vaginal wall masses.
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25
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Magnetic resonance imaging in women with pelvic pain from gynaecological causes: a pictorial review. Radiol Med 2012; 117:575-92. [DOI: 10.1007/s11547-011-0773-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/21/2011] [Indexed: 11/30/2022]
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26
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Abstract
The superior tissue contrast and flexible imaging planes afforded by magnetic resonance imaging (MRI) versus competing technologies permit optimal depiction of the pelvic viscera. Targeted protocols developed for specific pelvic visceral organs highlight important anatomic features that may not be imaged by other modalities. Therefore, a solid understanding of normal and variant pelvic anatomy is crucial for appropriate interpretation of pelvic MRI studies. This article discusses the protocol strategies and relevant anatomy with commonly encountered anatomical variants in a segmented/organ-specific manner, using gender as a broad split given the substantial variance in relevant organs.
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Affiliation(s)
- Ashish P Wasnik
- Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0030, USA
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27
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Servaes S, Victoria T, Lovrenski J, Epelman M. Contemporary Pediatric Gynecologic Imaging. Semin Ultrasound CT MR 2010; 31:116-40. [DOI: 10.1053/j.sult.2010.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW Pediatric pelvic MRI has had dramatic advances in the past few years. This review documents studies demonstrating the accuracy of MRI for the evaluation of uterine and vaginal anomalies and discusses the salient changes to MRI methods that are particularly applicable to evaluating the pediatric patient with these developmental anomalies. RECENT FINDINGS MRI has high accuracy for evaluation of uterine and vaginal anomalies. Significant advances, such as volumetric imaging, increased resolution, decreased motion artifacts, and shorter examination time, have increased the access and utility of MRI for pediatric patients. SUMMARY MRI techniques have evolved markedly in the past several years, providing a robust method of evaluating uterine and vaginal anomalies in the pediatric patient.
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30
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Junqueira BLP, Allen LM, Spitzer RF, Lucco KL, Babyn PS, Doria AS. Müllerian duct anomalies and mimics in children and adolescents: correlative intraoperative assessment with clinical imaging. Radiographics 2009; 29:1085-103. [PMID: 19605658 DOI: 10.1148/rg.294085737] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Müllerian duct anomalies (MDAs) are congenital entities that result from nondevelopment, defective vertical or lateral fusion, or resorption failure of the müllerian (paramesonephric) ducts. MDAs are common, although the majority are asymptomatic, and have been classified by the American Society of Reproductive Medicine according to clinical manifestations, prognosis, and treatment. Accurate diagnosis of an MDA is essential, since the management approach varies depending on the type of malformation. In females, when a müllerian duct becomes obstructed, the patient may present with an abdominal mass and dysmenorrhea. If the patient is not treated in a timely fashion, the consequences can be severe, extending even to infertility. When an MDA is suspected, ultrasonography (US) should be performed initially to delineate any abnormalities in the genital tract. However, US cannot help identify the type of MDA. In contrast, magnetic resonance imaging is a valuable technique for noninvasive evaluation of the female pelvic anatomy and accurate MDA classification. If obstruction is present, surgical correction of the MDA may be required, and further counseling of the patient with regard to reproductive possibilities becomes important. Supplemental material available at http://radiographics.rsnajnls.org/cgi/content/full/29/4/1085/DC1.
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Affiliation(s)
- Beatriz L P Junqueira
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8
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31
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Pompili G, Munari A, Franceschelli G, Flor N, Meroni R, Frontino G, Fedele L, Cornalba G. Magnetic resonance imaging in the preoperative assessment of Mayer-Rokitansky-Kuster-Hauser syndrome. Radiol Med 2009; 114:811-26. [PMID: 19484353 DOI: 10.1007/s11547-009-0407-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 07/18/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated the accuracy of magnetic resonance imaging (MRI) in young women with primary amenorrhoea with suspected Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (congenital absence of both vagina and uterus and presence of normal ovaries). MATERIALS AND METHODS Fifty-eight women (age range 14-30 years, mean 20.9) with primary amenorrhea were studied with MRI performed with a 1.0-T superconducting magnet (Philips NT Intera). All patients were examined in the supine position using a phased-array coil (four channels). Turbo spin-echo T2-weighted images were acquired in the sagittal, axial and coronal planes with the following parameters: TR 4,750-6,686, TE 100-120, FOV 350-375, 4- to 5-mm sections with a 0.4- to 0.5-mm intersection gap and NSA 6. T1-weighted images were acquired in the axial and coronal planes (TR 470, TE 15, FOV 350, 4-mm sections with a 0.6-mm intersection gap, NSA 3). Two experienced radiologists evaluated all the examinations in consensus to assess the presence, position and morphology of vagina, uterus, ovaries and kidneys and any pelvic abnormalities. MRI results were judged on the basis of laparoscopic findings in 41 patients. RESULTS MRKH syndrome was confirmed in 56 patients with 100% sensitivity and specificity. MRI identified bilateral Müllerian buds in 34/56 (61%) and unilateral in 10/56 (18%) patients. MRI sensitivity was 81.42%, and there was good agreement with laparoscopy (k=0.55) and full agreement in the identification of cavitation between MRI and intraoperative sonography. Both ovaries were visualised in 54 patients, with regular morphology in 46 (82.1%), polycystic in 10 (17.8%), pelvic in 47 (83.6%) and extrapelvic in eight (14.5%). We found associated abnormalities of the upper urinary tract in six patients (solitary kidney in four and ptosis in two). CONCLUSIONS MRI is a useful diagnostic tool in the preoperative evaluation of MRKH syndrome and is less expensive and invasive than laparoscopy. Strong cooperation between radiologists and surgeons is highly recommended.
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Affiliation(s)
- G Pompili
- Servizio di Radiologia Diagnostica e Interventistica, Università di Milano, Ospedale San Paolo, Milano, Italy.
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Barnhart K, Kulp JL, Rosen M, Shera DM. A randomized trial to determine the distribution of four topical gel formulations in the human vagina. Contraception 2009; 79:297-303. [DOI: 10.1016/j.contraception.2008.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 11/03/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022]
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Saks EK, Vakili B, Steinberg AC. Primary amenorrhea with an abdominal mass at the umbilicus. J Pediatr Adolesc Gynecol 2009; 22:e1-3. [PMID: 19232288 DOI: 10.1016/j.jpag.2008.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 07/09/2008] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transverse vaginal septum is a rare cause of primary amenorrhea. It has a reported incidence of 1:2,100-1:72,000 and a variety of clinical presentations. CASE A 16-year-old patient presented with primary amenorrhea and a large abdominal mass that was palpated on clinical exam and confirmed on MRI imaging. A diagnosis of transverse vaginal septum was ultimately made and the patient underwent a successful surgical excision of the septum and vaginal reconstruction. CONCLUSION The presentation, etiology, diagnosis, and surgical treatment of a transverse vaginal septum are discussed.
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Affiliation(s)
- Emily K Saks
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Affiliation(s)
- Amos A. Akinbiyi
- Department of Obstetrics and Gynecology, Regina General Hospital, College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Ian Suchet
- Department of Clinical Medical Imaging, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
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35
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Parikh JH, Barton DPJ, Ind TEJ, Sohaib SA. MR imaging features of vaginal malignancies. Radiographics 2008; 28:49-63; quiz 322. [PMID: 18203930 DOI: 10.1148/rg.281075065] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary vaginal malignancies are rare, accounting for only 1%-2% of all gynecologic malignancies. Squamous cell carcinoma makes up about 85% of primary vaginal malignancies. This tumor characteristically arises from the posterior wall of the upper third of the vagina. The main patterns of disease are an ulcerating or fungating mass or an annular constricting lesion. At magnetic resonance (MR) imaging, squamous cell carcinoma has intermediate signal intensity on T2-weighted images and low signal intensity on T1-weighted images. The tumors that account for the remaining 15% of primary vaginal malignancies are adenocarcinoma, melanoma, and sarcomas. The signal intensity characteristics on MR images correlate with the histologic subtypes and reflect the MR imaging appearances of these histologic subtypes elsewhere in the body. Secondary malignancy of the vagina is far more frequent than primary vaginal malignancy. Most vaginal metastases occur by means of direct local spread from the cervix, uterus, or rectum. The MR imaging appearances of these metastases reflect the MR imaging appearances of the primary tumor.
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Affiliation(s)
- Jyoti H Parikh
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom
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36
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Magnetic resonance imaging of vaginal and vulval pathology. Eur Radiol 2008; 18:1269-80. [DOI: 10.1007/s00330-008-0865-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 11/30/2007] [Accepted: 01/09/2008] [Indexed: 12/12/2022]
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37
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Hauth EA, Kimmig R, Forsting M. Verwendung der Magnetresonanztomographie in der Diagnostik von Neoplasien der Vulva und Vagina. ACTA ACUST UNITED AC 2007; 47:226-35. [PMID: 17914269 DOI: 10.1159/000107264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 01/11/2007] [Indexed: 11/19/2022]
Abstract
Magnetic resonance imaging (MRI) is widely accepted as an established method in the diagnostic imaging of diseases of the female pelvis. This review article describes the role of MRI in the diagnosis of neoplasms of the vulva and the vagina. MRI is useful in the pretherapeutic staging of vulval and vaginal neoplasms in order to assess tumor size, local tumor extent and presence of lymph node metastases. Further indications for MRI are the diagnosis of posttherapeutic changes and tumor recurrence.
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Affiliation(s)
- E A Hauth
- Institut fur diagnostische und interventionelle Radiologie und Neuroradiologie, Universitatsklinikum Essen, Essen, Deutschland
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38
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Orazi C, Lucchetti MC, Schingo PMS, Marchetti P, Ferro F. Herlyn-Werner-Wunderlich syndrome: uterus didelphys, blind hemivagina and ipsilateral renal agenesis. Sonographic and MR findings in 11 cases. Pediatr Radiol 2007; 37:657-65. [PMID: 17503029 DOI: 10.1007/s00247-007-0497-y] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 03/05/2007] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare entity, sometimes referred to as Herlyn-Werner-Wunderlich syndrome (HWW). It usually presents after menarche with progressive pelvic pain, sometimes with regular menses, and a palpable mass due to hemihaematocolpos. The diagnosis is generally made only if the suspicion of this genitourinary syndrome is raised. OBJECTIVE To highlight the imaging diagnostic clues in this rare condition. MATERIALS AND METHODS We report on 11 adolescents with this condition. RESULTS Sonography mostly allowed the correct diagnosis by showing uterovaginal duplication, haematocolpos or haematometrocolpos, and the absence of the ipsilateral kidney. MRI provided more detailed information regarding uterine morphology, the continuity with each vaginal channel (obstructed and nonobstructed), and the bloody nature of the contents. CONCLUSION Early and accurate diagnosis of this syndrome is important so that adequate and prompt surgical therapy (excision of the vaginal septum) can provide relief of pain and prevent further complications. It is also advisable to look for an obstructed Müllerian system whenever a multicystic dysplastic kidney or the absence of a kidney is discovered in a fetus, or girl postnatally.
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Affiliation(s)
- Cinzia Orazi
- Department of Diagnostic Imaging, I.R.C.C.S. Bambino Gesù Pediatric Hospital, Rome, Italy
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39
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40
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Barnhart KT, Pretorius ES, Shera DM, Shabbout M, Shaunik A. The optimal analysis of MRI data to quantify the distribution of a microbicide. Contraception 2006; 73:82-7. [PMID: 16371301 DOI: 10.1016/j.contraception.2005.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Accepted: 07/01/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to systematically review the use of MRI for the evaluation of deployment characteristics of vaginal microbicides and to understand the relationship of gel spread with potential influencing factors. METHODS Data from four clinical trials that used MRI to assess the deployment of a vaginal gel were combined. A linear mixed model best represented the spread of gel over time. Significant covariates that influence vaginal gel spread are baseline dimensions of the vagina, time from insertion, gel type, ambulation and volume of gel. RESULTS These data demonstrate that MRI has outstanding intraperson validity and reproducibility. Therefore, paired design, using linear modeling adjusting for significant covariates, is the most efficient study design for comparison of products or volumes. Division of the vagina into two distinct anatomical regions best explains difference in gel spread, i.e., upper area (above the pelvic diaphragm) and lower area (below pelvic diaphragm). CONCLUSION We conclude that the concept of spread from the cervix to the introits, in one dimension, is inadequate to explain spread of gel due to the complex shape of the vagina.
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Affiliation(s)
- Kurt T Barnhart
- Penn Fertility Care, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, 19104, USA.
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41
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Barnhart KT, Pretorius ES, Shaunik A, Timbers K, Nasution M, Mauck C. Vaginal distribution of two volumes of the novel microbicide gel cellulose sulfate (2.5 and 3.5 mL). Contraception 2005; 72:65-70. [PMID: 15964295 DOI: 10.1016/j.contraception.2005.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Revised: 01/24/2005] [Accepted: 02/08/2005] [Indexed: 11/20/2022]
Abstract
This was a blinded crossover study to determine the in vivo distribution of 2.5 and 3.5 mL of 6% cellulose sulfate gel. This potential vaginal microbicide was mixed with dilute gadolinium chelate and inserted into the vagina. Magnetic resonance imaging was performed at baseline and repeated after 5, 20, 35 and 50 min with subjects either resting or ambulating between data acquisitions. Use of 2.5 mL with no ambulation gave low linear spread (53.1% of vaginal length) and surface contact (61.7%) at 50 min. Using 3.5 mL of gel with ambulation improved linear spread (84.5%) and surface contact (85.9%) of the gel in the same time interval without significant leakage. Most linear spreading took place in the first 5 min after insertion, although lateral spreading continued to increase with time especially when ambulation took place. Leakage and gel was not a significant problem at either volume.
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Affiliation(s)
- Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
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42
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Devine C, Szklaruk J, Tamm EP. Magnetic resonance imaging in the characterization of pelvic masses. Semin Ultrasound CT MR 2005; 26:172-204. [PMID: 15987066 DOI: 10.1053/j.sult.2005.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Female pelvic masses most commonly arise from the reproductive tract, although masses may arise from other structures in the pelvis, such as the gastrointestinal or urinary tracts. The evaluation of a pelvic mass often begins with the physical exam and proceeds to ultrasound, computed tomography, or magnetic resonance imaging. Each of these modalities has a role in the work-up of pelvic masses and each modality has inherent advantages and disadvantages. The focus of this article is to demonstrate the imaging features and role of MRI, in contrast to CT, for detecting, characterizing, and staging pelvic masses. The differential diagnosis for pelvic masses is extremely broad. Clinical history, precise anatomical localization, and MR imaging characterization can significantly narrow the differential diagnosis. With recent advances in therapeutic strategies, a non-invasive, preoperative diagnosis is highly desirable to suggest prognosis and to tailor the treatment approach.
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Affiliation(s)
- Catherine Devine
- Diagnostic Radiology, Department of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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López C, Balogun M, Ganesan R, Olliff JF. MRI of vaginal conditions. Clin Radiol 2005; 60:648-62. [PMID: 16038691 DOI: 10.1016/j.crad.2005.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 02/03/2005] [Accepted: 02/08/2005] [Indexed: 11/28/2022]
Abstract
Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, transverse vaginal septum), benign (Bartholin's cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, post-surgical appearances with the formation of a neovagina and adhesions) or malignant, usually due to extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies.
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Affiliation(s)
- C López
- Department of Radiology, Birmingham Women's Hospital, Birmingham, UK.
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Botsis D, Deligeoroglou E, Christopoulos P, Aravantinos L, Papagianni V, Creatsas G. Ultrasound imaging to evaluate Creatsas vaginoplasty. Int J Gynaecol Obstet 2005; 89:31-4. [PMID: 15777895 DOI: 10.1016/j.ijgo.2004.12.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 12/27/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present a new imaging technique for the evaluation of the functional effectiveness of Creatsas vaginoplasty. METHOD Eighteen women with Mayer-Rokitansky-Kuster-Hauser syndrome underwent a transabdominal and transperineal ultrasound examination 4 weeks and 6 months after the surgical creation of a neovagina, and then yearly, with a condom filled with water as a distending and imaging medium. The functional length and width of the neovagina and its axis deviation were assessed, as well as the postoperative quality of the women's sexual life. RESULTS A functional vagina 10 to 12 cm in length and 4 to 5 cm in width was observed; its axis deviation, which was similar to the anatomic deviation, was easily determined; and 94.5% of the women reported a satisfactory while 5.5% reported an adequate sexual life. CONCLUSION This new imaging technique is a simple and effective alternative for the evaluation of the postoperative effectiveness of colpopoiesis.
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Affiliation(s)
- D Botsis
- Second Department of Obstetrics and Gynecology, University of Athens, Medical School, Aretaieion Hospital, Athens, Greece
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Kuligowska E, Deeds L, Lu K. Pelvic Pain: Overlooked and Underdiagnosed Gynecologic Conditions. Radiographics 2005; 25:3-20. [PMID: 15653583 DOI: 10.1148/rg.251045511] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic pelvic pain is a common, disabling problem among women. Although chronic pelvic pain can be produced by many conditions, some gynecologic causes are frequently overlooked and underdiagnosed, resulting in inappropriate referral and inadequate treatment. The gynecologic conditions most often unrecognized are endometriosis, adenomyosis, pelvic congestion, and less common congenital and acquired abnormalities. Transvaginal ultrasonography (US) is helpful for assessing endometriotic cysts but has a limited role in the diagnosis of adhesions or peritoneal implants. The classic magnetic resonance (MR) imaging features diagnostic of endometrioma are a cystic mass with high signal intensity on T1-weighted images and loss of signal intensity on T2-weighted images. When transvaginal US findings are suggestive of adenomyosis, MR imaging is used as the definitive imaging modality for diagnosis. High-resolution transvaginal US and MR imaging can help establish the diagnosis of adenomyosis with a high degree of accuracy, since the imaging appearance closely correlates with the histopathologic characteristics. Pelvic varices can be identified by using transvaginal US with color Doppler and Doppler spectral analysis. Three-dimensional T1 gradient-echo sequences performed after the intravenous administration of gadolinium are the most effective MR imaging sequence for demonstrating pelvic varices. Blood flow in pelvic varices appears with high signal intensity. Recent advances in radiologic imaging and therapeutic procedures make it possible to diagnose accurately the conditions producing chronic pelvic pain in most women and to guide effective treatment.
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Affiliation(s)
- Ewa Kuligowska
- Department of Radiology, Boston University School of Medicine, 88 E Newton Ave, Boston, MA 02118, USA.
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Barnhart KT, Pretorius ES, Timbers K, Shera D, Shabbout M, Malamud D. In vivo distribution of a vaginal gel: MRI evaluation of the effects of gel volume, time and simulated intercourse. Contraception 2004; 70:498-505. [PMID: 15541413 DOI: 10.1016/j.contraception.2004.06.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Revised: 06/17/2004] [Accepted: 06/24/2004] [Indexed: 10/26/2022]
Abstract
A microbicide is designed to coat the vaginal epithelium and prevent transmission of HIV. Complete coverage is desired for optimal protection. In vivo factors affecting coverage have not yet been studied. This randomized crossover trial evaluates the effect of gel volume and patient activity upon vaginal epithelial coating. Gynol II gel was mixed with a magnetic resonance imaging (MRI) contrast agent. Ten women self-inserted, on separate visits, 3 or 5 mL of gel and underwent serial MRI scanning both before and after simulated intercourse. Gel spread was dependent upon time and volume. There was modest spread during the first hour and greater spread 6 h after insertion. Five milliliters of gel resulted in statistically significantly greater coverage immediately following insertion, within the first 30 min and at 6 h after insertion. Simulated intercourse greatly enhances gel spread. After simulated intercourse, the distribution of the gel at each volume was similar. Less leakage of gel was reported with the smaller volume.
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Affiliation(s)
- Kurt Thomas Barnhart
- Center for Reproductive Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
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Abstract
Bartholin gland cysts account for 2% of all gynecologic visits per year. The treatment of Bartholin gland cysts has evolved from a complicated, bloody procedure requiring general anesthesia to, most recently, a simple puncture of the cyst and placement of a drain performed in the office. Although treatments for Bartholin gland cysts seem simple on the surface, recurrent cysts as well as diagnosing simple cysts versus abscesses versus malignant tumors can complicate treatment for this common problem. This article exams a history of the treatment of Bartholin gland cysts, including the use of the traditional treatments of excision, fistulization, marsupialization, as well as cauterization with carbon dioxide laser and silver nitrate. Modern variations are discussed, including the use of hydrodissection for excision, as well as the application of magnetic resonance imaging use in devising treatment for recurrent cysts.
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Affiliation(s)
- David A Marzano
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Abstract
Uterovaginal anomalies are associated with a high incidence of decreased fertility and multiple obstetric problems. These anomalies are caused by alterations in development or fusion of the müllerian ducts. Uterovaginal anomalies are classified into three types: dysgenesis, vertical or lateral fusion defects, and unusual configurations. Systematic analysis of magnetic resonance (MR) images allows accurate morphologic demonstration and classification of uterovaginal anomalies, thereby indicating the appropriate treatment. The following parameters are recorded in MR images: uterine size, external fundal contour, intercornual distance, zonal anatomy, and presence of uterine or vaginal septa. Associated pelvic lesions or renal anomalies are to be reported. MR imaging allows diagnosis of obstructive uterovaginal anomalies; determining the site of obstruction is imperative for planning the proper surgical approach. MR imaging techniques, including planes, sequences, and the application of more recent advances, are discussed. Pelvic phase-array coils and endovaginal coils provide detailed images and can be problem-solving tools in complex anomalies. MR imaging findings associated with a variety of uterovaginal anomalies are shown. The author suggests a five-step approach for diagnosing uterovaginal anomalies with MR imaging.
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Affiliation(s)
- Sahar N Saleem
- Radio-diagnosis Department, Cairo University Faculty of Medicine, Kasr Al-Ainy Hospital, 4 St 49 Mokattam, Cairo 11451, Egypt.
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Suh DD, Yang CC, Cao Y, Garland PA, Maravilla KR. Magnetic resonance imaging anatomy of the female genitalia in premenopausal and postmenopausal women. J Urol 2003; 170:138-44. [PMID: 12796666 DOI: 10.1097/01.ju.0000071880.15741.5f] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We used contrast enhanced magnetic resonance imaging (MRI) of the female genital organs to describe normal anatomy and differences between premenopausal and postmenopausal women. MATERIALS AND METHODS A total of 12 healthy premenopausal and 9 healthy postmenopausal women underwent MRI. A 1.5 Tesla system with phased array coils anterior and posterior to the pelvis was used to produce T1-weighted images before and after intravenous administration of MS-325 (Epix Medical, Cambridge, Massachusetts), a new gadolinium based blood pool contrast agent. Select structural dimensions were measured for reference. RESULTS The clitoris and vestibular bulbs were well delineated on T1-weighted post-contrast images. The clitoral unit formed a brightly enhancing, wishbone-shaped structure lying just anterior to the inverted V of the bulbs, which surrounded the urethra and vagina. The urethral complex had a target-like appearance with layers that were discernible on T1 post-contrast images. The urethra, vagina and rectum formed a distinct complex within uniformly enhancing soft tissue. The vagina was well visualized in premenopausal subjects but without distinguishable mucosal rugae or clearly separate layers in postmenopausal subjects. Postmenopausal subjects were also observed to have smaller labia minora width, vestibular bulb width, vaginal width and wall thickness, and cervical diameter. Pelvic and genital structures were not well visualized on T1 noncontrast images. CONCLUSIONS To our knowledge we describe detailed female genital anatomy for the first time using MRI with MS-325 contrast medium. The clitoris, vestibular bulbs, labia majora and minora, urethra, vagina, cervix and rectum are well visualized on T1 post-contrast images. The observed genital anatomy on MRI was consistent with descriptions in current anatomical texts. Differences in the female genitalia between premenopausal and postmenopausal women were discernible on MRI. These data are important for future studies using MRI for evaluating anatomical anomalies, postoperative changes and female sexual function.
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Affiliation(s)
- Donald D Suh
- Department of Urology, University of Washington, Box 356510, 1959 NW Pacific Street, Seattle, WA 98195-6510, USA
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Pretorius ES, Timbers K, Malamud D, Barnhart K. Magnetic resonance imaging to determine the distribution of a vaginal gel: before, during, and after both simulated and real intercourse. Contraception 2002; 66:443-51. [PMID: 12499038 DOI: 10.1016/s0010-7824(02)00412-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To provide effective contraception and protection against sexually transmitted disease, vaginal gels should maximally cover the cervical os and the vaginal epithelium before, during and after intercourse. To non-invasively monitor the intravaginal distribution of an applied intravaginal gel, we performed high-resolution magnetic resonance imaging (MRI) of the female pelvis before, during and after both real and simulated sexual intercourse. We sought to determine whether simulated intercourse with a plastic phallus could be used as a surrogate for real intercourse for such experiments. Dilute gadolinium chelate solution was mixed with Gynol-II gel and introduced intravaginally to volunteer female human subjects using a conventional applicator. MRI was performed at 1.5 Tesla with a surface coil. Imaging of the female pelvis was performed: (1) immediately after insertion of the gel; (2) during real intercourse with a male partner (2 subjects) or simulated intercourse with a plastic phallus (4 subjects); and (3) after completion of real or simulated intercourse. Subjects were studied after application of both 3 mL and 5 mL of vaginal gel. Measurements of gel thickness covering the vaginal mucosa were made digitally using electronic calipers. The bolus of gel is initially located in the upper vaginal canal, superior to the urogenital diaphragm. Both real and simulated intercourse dramatically increases the spread of gel to the lower vagina. The cervix appears to be adequately covered with gel both before and after intercourse. Increasing the volume of the gel increases initial vaginal mucosal coverage but also increases leakage from the introitus. No statistically significant differences in vaginal mucosal coverage were found between patients having undergone real vs. simulated intercourse, or on post-intercourse scans of 3 mL versus 5 mL. MRI is a sensitive, reproducible means of tracking the spread of intravaginal medications.
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Affiliation(s)
- E Scott Pretorius
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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