Imaging the Female Pelvis: When Should MRI be Considered?

Jennifer Hubert, MD; Diane Bergin, MD

Disclosures

Appl Radiol. 2008;37(1):9-24. 

In This Article

Fallopian Tube Abnormalities

Abnormalities of the fallopian tube commonly present as adnexal masses and generally result from salpingitis, endometriosis, or peritubal adhesions.[8] Although readily identifed with ultrasound, MRI is useful in cases of dense scarring and in the identifcation of the adjacent ovary. With a large simple hydrosalpinx, the relatively large feld of view utilized in MRI (as compared with ultrasound) facilitates easy recognition of its tubular morphology, which differentiates it from a potential ovarian cystic mass. When hydrosalpinx is complicated by pyosalpinx, the T2 signal intensity may exhibit shading or hypointense areas from the high protein content, similar to that of an endometrioma. When complicated by a tubo-ovarian abscess, inflammatory changes are seen in the surrounding tissue. The associated inflammatory changes and the abscess wall exhibit intense enhancement with contrast administration (Figure 3).

Pelvic inflammatory disease. (A) Axial T2-weighted (T2W) fast spin-echo (FSE), (B) sagittal T2W FSE fat-suppressed, and (C) postcontrast axial T1-weighted 3-dimensional gradient-recalled echo images show an enhancing, thick-walled loculated collection (arrowheads) in the left hemipelvis and cul-de-sac consistent with tubo-ovarian abscess. There is an enhancing fibroid (arrow in C) anterior to this.

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