MR of the Cervix and Vagina
In MR of the cervix and vagina, high-resolution images in multiple planes are obtained along the length of the vagina. The vagina is distended with a T2 bright gel to permit evaluation of the vaginal wall, including the fornix, as well as the cervix or the vaginal cuff if the patient is post hysterectomy. The entire pelvis is imaged to permit detailed evaluation of the parametrium, adnexa, bladder, urethra, pelvic vessels and lymph nodes.
Imaging is usually performed with intravenous contrast. In patients with known pelvic malignancy, dynamic post gadolinium imaging may be critical to differentiate recurrent or residual tumor from post-radiation or post-surgical fibrosis. It may also be helpful for detecting pelvic metastatic disease.
In cases of suspected colovaginal or vaginovesicular fistula, this technique provides an alternative to fluoroscopic techniques and is more sensitive for detection of associated complications such as abscess.
Patient Selection and Indications
- Known cervical cancer, both pre- and post-therapy.
- Abnormal pelvic exam or suspected vaginal or cervical mass.
- Post-hysterectomy vaginal bleeding.
- Suspected vaginal fistula.
Furthermore, MRI of the cervix and vagina can diagnose pathology such as Bartholin’s gland cysts or Gartner’s duct cysts. Finally, in patients with a known lesion or pathology, MR of the cervix and vagina may assist in surgical or radiation therapy planning.
Standard MRI precautions should be employed. The exam should not be performed if the patient is menstruating or if the patient might be pregnant. Ideal timing with respect to the menstrual cycle is similar to that for hysterosalpingogram. No other patient preparation is necessary prior to arrival at the imaging center.
The vagina is distended with a T2 bright gel to permit evaluation of the vaginal wall, including the fornix, as well as the cervix or the vaginal cuff if the patient is post hysterectomy. Oblique imaging planes are generated to evaluate cervix integrity.
Gadolinium is given to assess vascularity, the presence of fibrotic tissue, and to help exclude tumor. In patients allergic to gadolinium or in those with renal failure who are at risk for NSF, a non–contrast version of the study can be performed.
The majority of the test is performed with the patient free breathing, but breath holds of short duration may be required depending on the patient’s body habitus and degree of pelvic motion with normal respiration.
Reporting and Outcomes
By using high magnetic field strengths up to 3-Tesla as well as specialty MRI coils, Wellstar can offer higher resolution images without prolonging scan times. By obtaining detailed patient histories before each examination, we can select the most specialized protocol to address the clinical question. Quantum radiology’s strong relationship with referring clinicians from obstetricians and gynecologists, to oncologist, urologists, and colorectal surgeons enables us to cater to their specific concerns, correlate imaging findings with surgical pathology, and continually improve our performance.
MRI provides soft-tissue contrast superior to competing modalities. It provides an extremely sensitive depiction of fluid and edema. The addition of Gadolinium increases detection of subtle inflammation and small masses, and allows assessment of multiple vascular phases.
As other portions of the pelvis are imaged during MR of the cervix and vagina, pathology in other organs may often be detected incidentally. A comprehensive report detailing findings is provided to the referring clinician. If urgent findings are encountered, these are relayed in real time by telephone. A copy of the examination and report is furnished to the patient upon request. The exam may also be reviewed directly with the radiologist in the radiology department at a Wellstar facility.