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Published in: Insights into Imaging 1/2019

Open Access 01-12-2019 | Magnetic Resonance Imaging | Educational Review

Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis—part II: uterine emergencies and pelvic inflammatory disease

Authors: Pietro Valerio Foti, Massimo Tonolini, Valeria Costanzo, Luca Mammino, Stefano Palmucci, Antonio Cianci, Giovanni Carlo Ettorre, Antonio Basile

Published in: Insights into Imaging | Issue 1/2019

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Abstract

Due to the growing use of cross-sectional imaging in emergency departments, acute gynaecologic disorders are increasingly diagnosed on urgent multidetector computed tomography (CT) studies, often requested under alternative presumptive diagnoses in reproductive-age women. If clinical conditions and state-of-the-art scanner availability permit, magnetic resonance imaging (MRI) is superior to CT due to its more in-depth characterisationof abnormal or inconclusive gynaecological findings, owing to excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation.
This pictorial review aims to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their CT and MRI appearances, in order to provide a timely and correct imaging diagnosis. Specifically, this second instalment reviews with examples and emphasis on differential diagnosis the main non-pregnancy-related uterine emergencies (including endometrial polyps, degenerated leiomyomas and uterine inversion) and the spectrum of pelvic inflammatory disease.
Literature
1.
go back to reference Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22:785–801PubMed Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22:785–801PubMed
2.
go back to reference Potter AW, Chandrasekhar CA (2008) US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics 28:1645–1659CrossRefPubMed Potter AW, Chandrasekhar CA (2008) US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics 28:1645–1659CrossRefPubMed
3.
go back to reference Swart JE, Fishman EK (2008) Gynecologic pathology on multidetector CT: a pictorial review. Emerg Radiol 15:383–389CrossRefPubMed Swart JE, Fishman EK (2008) Gynecologic pathology on multidetector CT: a pictorial review. Emerg Radiol 15:383–389CrossRefPubMed
4.
go back to reference Cano Alonso R, Borruel Nacenta S, Díez Martínez P, María NI, Ibáñez Sanz L, Zabía Galíndez E (2009) Role of multidetector CT in the management of acute female pelvic disease. Emerg Radiol 16:453–472CrossRefPubMed Cano Alonso R, Borruel Nacenta S, Díez Martínez P, María NI, Ibáñez Sanz L, Zabía Galíndez E (2009) Role of multidetector CT in the management of acute female pelvic disease. Emerg Radiol 16:453–472CrossRefPubMed
5.
go back to reference Ditkofsky NG, Singh A, Avery L, Novelline RA (2014) The role of emergency MRI in the setting of acute abdominal pain. Emerg Radiol 21:615–624PubMed Ditkofsky NG, Singh A, Avery L, Novelline RA (2014) The role of emergency MRI in the setting of acute abdominal pain. Emerg Radiol 21:615–624PubMed
6.
go back to reference Ayyala RS, Khwaja A, Anupindi SA (2017) Pelvic pain in the middle of the night: use of MRI for evaluation of pediatric female pathology in the emergent setting. Emerg Radiol 24:681–688PubMedCrossRef Ayyala RS, Khwaja A, Anupindi SA (2017) Pelvic pain in the middle of the night: use of MRI for evaluation of pediatric female pathology in the emergent setting. Emerg Radiol 24:681–688PubMedCrossRef
7.
go back to reference Pedrosa I, Zeikus EA, Levine D et al (2007) MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics 27:721–743 discussion 743-753PubMedCrossRef Pedrosa I, Zeikus EA, Levine D et al (2007) MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics 27:721–743 discussion 743-753PubMedCrossRef
8.
go back to reference Roche O, Chavan N, Aquilina J et al (2012) Radiological appearances of gynaecological emergencies. Insights Imaging 3:265–275PubMedPubMedCentral Roche O, Chavan N, Aquilina J et al (2012) Radiological appearances of gynaecological emergencies. Insights Imaging 3:265–275PubMedPubMedCentral
9.
go back to reference Iraha Y, Okada M, Iraha R et al (2017) CT and MR imaging of gynecologic emergencies. Radiographics 37:1569–1586PubMed Iraha Y, Okada M, Iraha R et al (2017) CT and MR imaging of gynecologic emergencies. Radiographics 37:1569–1586PubMed
10.
11.
go back to reference Bignardi T, Van den Bosch T, Condous G (2009) Abnormal uterine and post-menopausal bleeding in the acute gynaecology unit. Best Pract Res Clin Obstet Gynaecol 23:595–607PubMedCrossRef Bignardi T, Van den Bosch T, Condous G (2009) Abnormal uterine and post-menopausal bleeding in the acute gynaecology unit. Best Pract Res Clin Obstet Gynaecol 23:595–607PubMedCrossRef
12.
go back to reference Dueholm M, Lundorf E, Hansen ES et al (2001) Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. Fertil Steril 76:350–357PubMedCrossRef Dueholm M, Lundorf E, Hansen ES et al (2001) Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. Fertil Steril 76:350–357PubMedCrossRef
13.
go back to reference Hileeto D, Fadare O, Martel M et al (2005) Age dependent association of endometrial polyps with increased risk of cancer involvement. World J Surg Oncol 3:8PubMedPubMedCentralCrossRef Hileeto D, Fadare O, Martel M et al (2005) Age dependent association of endometrial polyps with increased risk of cancer involvement. World J Surg Oncol 3:8PubMedPubMedCentralCrossRef
14.
go back to reference Dreisler E, Stampe Sorensen S, Ibsen PH et al (2009) Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol 33:102–108PubMedCrossRef Dreisler E, Stampe Sorensen S, Ibsen PH et al (2009) Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol 33:102–108PubMedCrossRef
15.
go back to reference Nalaboff KM, Pellerito JS, Ben-Levi E (2001) Imaging the endometrium: disease and normal variants. Radiographics 21:1409–1424PubMedCrossRef Nalaboff KM, Pellerito JS, Ben-Levi E (2001) Imaging the endometrium: disease and normal variants. Radiographics 21:1409–1424PubMedCrossRef
16.
go back to reference Grasel RP, Outwater EK, Siegelman ES et al (2000) Endometrial polyps: MR imaging features and distinction from endometrial carcinoma. Radiology 214:47–52PubMedCrossRef Grasel RP, Outwater EK, Siegelman ES et al (2000) Endometrial polyps: MR imaging features and distinction from endometrial carcinoma. Radiology 214:47–52PubMedCrossRef
17.
go back to reference American Association of Gynecologic Laparoscopists (AAGL): Advancing Minimally Invasive Gynecology Worldwide (2012) AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 19:152–171CrossRef American Association of Gynecologic Laparoscopists (AAGL): Advancing Minimally Invasive Gynecology Worldwide (2012) AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 19:152–171CrossRef
18.
go back to reference Nougaret S, Horta M, Sala E et al (2019) Endometrial cancer MRI staging: updated guidelines of the European Society of Urogenital Radiology. Eur Radiol 29:792–805PubMedCrossRef Nougaret S, Horta M, Sala E et al (2019) Endometrial cancer MRI staging: updated guidelines of the European Society of Urogenital Radiology. Eur Radiol 29:792–805PubMedCrossRef
19.
go back to reference Hauth E, Libera H, Kimmig R et al (2006) MR imaging of the pelvis in the diagnosis of the endometrium in breast cancer patients in tamoxifen therapy. ROFO 178:316–323PubMedCrossRef Hauth E, Libera H, Kimmig R et al (2006) MR imaging of the pelvis in the diagnosis of the endometrium in breast cancer patients in tamoxifen therapy. ROFO 178:316–323PubMedCrossRef
20.
go back to reference Shitano F, Kido A, Kataoka M et al (2016) MR appearance of normal uterine endometrium considering menstrual cycle: differentiation with benign and malignant endometrial lesions. Acta Radiol 57:1540–1548PubMedCrossRef Shitano F, Kido A, Kataoka M et al (2016) MR appearance of normal uterine endometrium considering menstrual cycle: differentiation with benign and malignant endometrial lesions. Acta Radiol 57:1540–1548PubMedCrossRef
21.
go back to reference Murase E, Siegelman ES, Outwater EK et al (1999) Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics 19:1179–1197PubMedCrossRef Murase E, Siegelman ES, Outwater EK et al (1999) Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics 19:1179–1197PubMedCrossRef
22.
go back to reference Kido A, Togashi K, Koyama T et al (2003) Diffusely enlarged uterus: evaluation with MR imaging. Radiographics 23:1423–1439PubMedCrossRef Kido A, Togashi K, Koyama T et al (2003) Diffusely enlarged uterus: evaluation with MR imaging. Radiographics 23:1423–1439PubMedCrossRef
23.
go back to reference Kubik-Huch RA, Weston M, Nougaret S et al (2018) European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of leiomyomas. Eur Radiol 28:3125–3137PubMedPubMedCentralCrossRef Kubik-Huch RA, Weston M, Nougaret S et al (2018) European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of leiomyomas. Eur Radiol 28:3125–3137PubMedPubMedCentralCrossRef
24.
go back to reference Lakhman Y, Veeraraghavan H, Chaim J et al (2017) Differentiation of uterine leiomyosarcoma from atypical leiomyoma: diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur Radiol 27:2903–2915PubMedCrossRef Lakhman Y, Veeraraghavan H, Chaim J et al (2017) Differentiation of uterine leiomyosarcoma from atypical leiomyoma: diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur Radiol 27:2903–2915PubMedCrossRef
25.
go back to reference Tasaki A, Asatani MO, Umezu H et al (2015) Differential diagnosis of uterine smooth muscle tumors using diffusion-weighted imaging: correlations with the apparent diffusion coefficient and cell density. Abdom Imaging 40:1742–1752PubMedCrossRef Tasaki A, Asatani MO, Umezu H et al (2015) Differential diagnosis of uterine smooth muscle tumors using diffusion-weighted imaging: correlations with the apparent diffusion coefficient and cell density. Abdom Imaging 40:1742–1752PubMedCrossRef
26.
go back to reference Bulman JC, Ascher SM, Spies JB (2012) Current concepts in uterine fibroid embolisation. Radiographics 32:1735–1750PubMedCrossRef Bulman JC, Ascher SM, Spies JB (2012) Current concepts in uterine fibroid embolisation. Radiographics 32:1735–1750PubMedCrossRef
27.
go back to reference Bruno J, Sterbis K, Flick P et al (2004) Recovery after uterine artery embolisation for leiomyomas: a detailed analysis of its duration and severity. J Vasc Interv Radiol 15:801–807PubMedCrossRef Bruno J, Sterbis K, Flick P et al (2004) Recovery after uterine artery embolisation for leiomyomas: a detailed analysis of its duration and severity. J Vasc Interv Radiol 15:801–807PubMedCrossRef
28.
go back to reference Ruuskanen A, Sipola P, Hippelainen M et al (2009) Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging. Eur Radiol 19:2977–2985PubMedCrossRef Ruuskanen A, Sipola P, Hippelainen M et al (2009) Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging. Eur Radiol 19:2977–2985PubMedCrossRef
29.
go back to reference Verma SK, Gonsalves CF, Baltarowich OH et al (2010) Spectrum of imaging findings on MRI and CT after uterine artery embolisation. Abdom Imaging 35:118–128PubMedCrossRef Verma SK, Gonsalves CF, Baltarowich OH et al (2010) Spectrum of imaging findings on MRI and CT after uterine artery embolisation. Abdom Imaging 35:118–128PubMedCrossRef
30.
go back to reference Deshmukh SP, Gonsalves CF, Guglielmo FF et al (2012) Role of MR imaging of uterine leiomyomas before and after embolisation. Radiographics 32:E251–E281PubMedCrossRef Deshmukh SP, Gonsalves CF, Guglielmo FF et al (2012) Role of MR imaging of uterine leiomyomas before and after embolisation. Radiographics 32:E251–E281PubMedCrossRef
32.
go back to reference Darji P, Banker H, Gandhi V et al (2012) Postmenopausal woman with vaginal mass: do not forget to see for uterine inversion. BMJ Case Rep 2012:bcr0220125841PubMedPubMedCentral Darji P, Banker H, Gandhi V et al (2012) Postmenopausal woman with vaginal mass: do not forget to see for uterine inversion. BMJ Case Rep 2012:bcr0220125841PubMedPubMedCentral
35.
36.
go back to reference Samraj GP, Curry RW Jr (2004) Acute pelvic pain: evaluation and management. Compr Ther 30:173–184PubMedCrossRef Samraj GP, Curry RW Jr (2004) Acute pelvic pain: evaluation and management. Compr Ther 30:173–184PubMedCrossRef
37.
go back to reference Revzin MV, Mathur M, Dave HB et al (2016) Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics 36:1579–1596PubMedCrossRef Revzin MV, Mathur M, Dave HB et al (2016) Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics 36:1579–1596PubMedCrossRef
38.
go back to reference Czeyda-Pommersheim F, Kalb B, Costello J et al (2017) MRI in pelvic inflammatory disease: a pictorial review. Abdom Radiol (NY) 42:935–950CrossRef Czeyda-Pommersheim F, Kalb B, Costello J et al (2017) MRI in pelvic inflammatory disease: a pictorial review. Abdom Radiol (NY) 42:935–950CrossRef
39.
go back to reference Tukeva TA, Aronen HJ, Karjalainen PT et al (1999) MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 210:209–216PubMedCrossRef Tukeva TA, Aronen HJ, Karjalainen PT et al (1999) MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 210:209–216PubMedCrossRef
40.
go back to reference Mutter GL, Prat J (2014) Pathology of the Female Reproductive Tract, 3rd edn. London Churchill Livingstone Elsevier, London Mutter GL, Prat J (2014) Pathology of the Female Reproductive Tract, 3rd edn. London Churchill Livingstone Elsevier, London
41.
go back to reference Foti PV, Ognibene N, Spadola S et al (2016) Non-neoplastic diseases of the fallopian tube: MR imaging with emphasis on diffusion-weighted imaging. Insights Imaging 7:311–327PubMedPubMedCentralCrossRef Foti PV, Ognibene N, Spadola S et al (2016) Non-neoplastic diseases of the fallopian tube: MR imaging with emphasis on diffusion-weighted imaging. Insights Imaging 7:311–327PubMedPubMedCentralCrossRef
42.
go back to reference Moyle PL, Kataoka MY, Nakai A et al (2010) Nonovarian cystic lesions of the pelvis. Radiographics 30:921–938PubMedCrossRef Moyle PL, Kataoka MY, Nakai A et al (2010) Nonovarian cystic lesions of the pelvis. Radiographics 30:921–938PubMedCrossRef
43.
go back to reference Rezvani M, Shaaban AM (2011) Fallopian tube disease in the nonpregnant patient. Radiographics 31:527–548PubMedCrossRef Rezvani M, Shaaban AM (2011) Fallopian tube disease in the nonpregnant patient. Radiographics 31:527–548PubMedCrossRef
44.
45.
go back to reference Foti PV, Attina G, Spadola S et al (2016) MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging 7:21–41CrossRefPubMed Foti PV, Attina G, Spadola S et al (2016) MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging 7:21–41CrossRefPubMed
46.
47.
go back to reference Ma FH, Cai SQ, Qiang JW et al (2015) MRI for differentiating primary fallopian tube carcinoma from epithelial ovarian cancer. J Magn Reson Imaging 42:42–47PubMedCrossRef Ma FH, Cai SQ, Qiang JW et al (2015) MRI for differentiating primary fallopian tube carcinoma from epithelial ovarian cancer. J Magn Reson Imaging 42:42–47PubMedCrossRef
48.
go back to reference Grabowska-Derlatka L, Szeszkowski W, Sienko J et al (2018) Magnetic resonance diffusion-weighted imaging in diagnostics of primary fallopian tube carcinoma - is it useful? Pol J Radiol 83:e161–e165PubMedPubMedCentralCrossRef Grabowska-Derlatka L, Szeszkowski W, Sienko J et al (2018) Magnetic resonance diffusion-weighted imaging in diagnostics of primary fallopian tube carcinoma - is it useful? Pol J Radiol 83:e161–e165PubMedPubMedCentralCrossRef
49.
go back to reference Orlowski HL, Mellnick VM, Dahiya N et al (2016) The imaging findings of typical and atypical genital and gynecologic infections. Abdom Radiol (NY) 41:2294–2309CrossRef Orlowski HL, Mellnick VM, Dahiya N et al (2016) The imaging findings of typical and atypical genital and gynecologic infections. Abdom Radiol (NY) 41:2294–2309CrossRef
Metadata
Title
Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis—part II: uterine emergencies and pelvic inflammatory disease
Authors
Pietro Valerio Foti
Massimo Tonolini
Valeria Costanzo
Luca Mammino
Stefano Palmucci
Antonio Cianci
Giovanni Carlo Ettorre
Antonio Basile
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 1/2019
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1186/s13244-019-0807-6

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