Gynecologic applications of MRI

Gynecologic anatomy is consistently depicted with MRI. Abnormal developmental anatomy is also well assessed. In cases of complete or partial vaginal agenesis where ultrasound is equivocal, MRI can be definitive. The various subtypes of uterine anomalies are well delineated with MRI. MRI is the optimal technique in the therapeutic evaluation of leiomyomas, because the number, size, location, and degeneration can be documented. It is particularly useful in the identification of the ovaries in the presence of an enlarged leiomyomatous uterus. Adenomyosis, an often neglected diagnosis, is distinguishable from leiomyomas. In the setting of an equivocal ultrasound, MRI is useful in discerning whether a mass is ovarian or uterine in origin. Endometriosis, a disease routinely diagnosed and staged by laparoscopy, does have a typical MR appearance and therefore can usually be differentiated from other adnexal masses. Dermoids are readily diagnosed with MRI. Other adnexal masses do not have a specific MR appearance and morphologic criteria as used with ultrasound or CT must be relied upon in suggesting whether or not the mass is benign or malignant. MRI is the procedure of choice in the staging of cervical and endometrial cancer.