Title: Role of MRI in Evaluation of Uterine and Adnexal Pathologies
Authors: Dr Vanshika Kohli, Dr P S Mishrikotkar, Dr Asmita Suryawanshi
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.150
Abstract
Introduction: Uterine and adnexal masses are one of the common causes of gynecological consultations. These masses may be due to physiological and benign conditions or may suggest presence of more sinister pathologies such as uterine or adnexal malignancies. The multi-planar capabilities along with superior contrast resolution has made magnetic resonance imaging (MRI) an excellent modality of choice for proper depiction of female uterine and adnexal anatomy. It has got superior sensitivity and specificity in the diagnosis of uterine and adnexal pathologies as compared to any other available imaging technique. There for we conducted this prospective study to analyze the role of MRI in evaluation of uterine and adnexal pathologies
Materials and Methods: This was a prospective observational study in which 75 female patients who came to the radiology department with uterine and adnexal pathologies were included on the basis of a predefined inclusion and exclusion criteria. Institutional ethical committee approved the study and informed consent was obtained from all the participants. All patients underwent MRI imaging examinations were performed on a PHILIPS MULTIVA 1.5T. Imaging was performed using a pelvic coil with the patient in supine position. Gadodiamide 10 ml was administered as and when required. Collected data was compiled in MS Excel sheet 2007 for analysis of this data SPSS version 20th software shall be used. Qualitative data was represented in form of frequency and percentile. Quantitative data was represented in the form of mean, standard deviation, etc. P value less than 0.05 was taken as statistically significant.
Results: A total 75 women were included in this study. The mean age of the studied cases was found to be 38.73 +/- 18.62 years. The common presenting complaints were found to be post-menopausal bleeding (32%) followed by abdominal pain (24%) and menstrual irregularities (18.7%). The most common etiology of the mass was found to be neoplastic (29.3%) followed by congenital abnormalities (25.3%). 25 (33.3%) patients were found to have malignant neoplastic lesions. The Anatomical distribution of mass lesions showed that the common locations were uterus (60%), cervix (17.3%) or adnexa (18.7%). The most common abnormalities diagnosed were carcinoma cervix (20.97%), bicornuate (11.29%) and hypoplastic uterus (11.29%). Amongst the patients having adnexal pathologies the most common lesion was found to be complex ovarian cyst (35.7%) and the most common congenital anomaly was found to be bicornuate uterus which was seen in 7/21 (33.33%) patients. Majority of the adnexal pathologies were either cysto-solid (7/13) or cystic (5/13) whereas all vaginal and cervical lesions were solid on imaging characteristics. Contrast enhancement was seen in all 46 patients in whom contrast was given and heterogeneous contrast enhancement was seen in majority (69.6%) of the patients. Out of 13 patients having carcinoma cervix 7 patients had stage II (A or B) cancer whereas amongst 5 patients with ovarian carcinoma 4 (80%) patients had stage 1A cancer. There were 2 patients with endometrial carcinoma and both of them had stage IB cancer. Out of 51 samples sent for histopathology correlation of HPE with MR diagnosis was seen in 49 (96%) patients.
Conclusion: MRI is found to be an excellent imaging technique for the diagnosis of uterine and adnexal pathologies. It has got a high sensitivity and specificity for the diagnosis of congenital as well as benign and malignant pathologies of uterus and adnexa.
Keywords: Uterine and adnexal pathologies, Magnetic resonance imaging, contrast enhancement, Staging.
