Uterus and uterine tubes

The uterus is a pear-shaped muscular organ lying centrally in the pelvis between the bladder anteriorly and the rectum posteriorly. It is divided into the fundus, which lies above the level of the uterine tube orifices, the body and the isthmus, which constricts inferiorly to form the cervix. The cervix is divided into supra-vaginal and infravaginal parts. The fundus, body and isthmus of the uterus are predominantly muscular whereas the cervix is predominantly fibrous in composition. The...

P

Central pelvic and subcutaneous haematoma complicating radical hysterectomy. (a) Transaxial T1W1, (b) transaxial T2W1and (c) sagittal T2W1 in which a central haematoma (H) is seen with characteristic high signal intensity on the T1W1, and T2-weighted heterogeneous appearance with a low signal intensity rim and mixed high and intermediate signal intensity content. Compared to the central pelvic haematoma, the small subcutaneous haematoma (arrows) is of similar signal intensity....

Transaxial plane

Slices are obtained through the pelvis, from the iliac crests to the lower border of the symphysis pubis, either using the phased array or body coil (FOV 34-38cm), slice thickness ranges from 5-1 0mm. Ghosting artifact throughout the pelvis from anterior to posterior is caused by fat in the anterior abdominopelvic wall moving during respiration. This can be suppressed by changing the phase encoding direction so that it runs from side to side, i.e. right to left, or by selecting a breath-hold...

Residual And Recurrent Tumour

Residual tumour is defined as tumour which persists after initial treatment. It is diagnosed clinically by nonregression of the tumour mass and radiologically by a persisting tumour mass, incomplete restoration of organ zonal anatomy or nondevelopment of expected treatment effects. Tumour recurrence is locoregional tumour detected more than 6 months after initial therapy when there has been a documented treatment response. Recurrence can be diagnosed clinically by physical examination or rising...

Patient Evaluation Before Pelvic Clearance

MRI has a recognised role in patients being considered for pelvic clearance. Its superior contrast resolution, multiplanar imaging facility and excellent spatial resolution (with a pelvic phased array coil) permit detailed evaluation of the pelvis. Before a patient undergoes pelvic clearance, an intensive work-up is required, involving clinical and radiological assessment. This includes examination under anaesthesia when there is palpation of the tumour mass to determine its mobility within the...

Further Reading

DeVita VT, Hellman S, Rosenberg SA (Eds) (2001) Carroll PR, Lee RL, Foks ZY, etal. In Cancer Principles and Practice of Oncology, 6th Edition. Lippincott Williams and Wilkins, Philadelphia, USA, pp. 1418-1469. The leading oncology reference text provides a comprehensive review of the management ofprostate cancer. 2. Husband J, Resnick H (Eds) (1998) Jages G and Basentz J. Prostate Cancer In Imaging in Oncology. Isis Medical Media Ltd, Oxford, UK, pp. 239-257. Aimed at the clinical radiologist,...

Signal Intensity

Cervical Cancer

T2b cervical cancer with involvement of the uterovesical ligament, the anterior parametrium. Sagittal T2W1 with tumour (T) arising from the anterior lip and involving the upper third of the vagina. The tumour extends anteriorly into the uterovesical ligament, normally of high signal intensity due to its fat content. Disease abuts the posterior wall of the bladder (B) (arrows). A small volume of ascites (A) is present in the Pouch of Douglas. Sagittal T2W1 demonstrating tumour (T)...

Patterns of tumour spread

Rectal cancers arise in the mucosa, usually in a pre-existing adenomatous polyp. Tumours advance radially through the layers of the bowel wall, longitudinal spread is uncommon. Following breach of the bowel wall, spread occurs directly into the meso-rectum (see below) and then progressively into adjacent pelvic structures. Lymphatic spread occurs initially to the meso-rectal and pre-sacral nodes adjacent to the tumour, and thence along the course of the superior rectal vessels. More advanced...

T1w1 Definition

Williams AD, Cousins C, Souffer WP etal. (2001) Detection of pelvic lymph node metastases in gynaecological malignancy. A comparison of CT, MR imaging and positron emission tomography. AJR 177 343-348. Assesses the relative values ofCT, MRI and PET, with histological correlation, in the detection of pelvic lymph node metastases. 2. Vinicombe SJ, Norman AR, Nicolson V and Husband JE. (1995) Normal pelvic lymph nodes Evaluation with CT after bipedal lymphangiography. Radiology 194 349-355. Normal...

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Pelvic tumour mass involving the external iliac vessels. (a) to (c) Coronal T2W1 demonstrating compression and displacement of the external iliac vein which is seen as a fine low signal intensity band at the margin of the large pelvic tumour (T) (arrows in (a)). Distal to the mass the vein demonstrates high signal intensity due to slow flow within its lumen (V in (a), (b) and (c)). The left common and external iliac artery are also markedly displaced and compressed by the tumour...

Mri Manual Of Pelvic Cancer

Paul Hulse and Bernadette Carrington Consultant Radiologists Christie Hospital, Manchester, UK Martin Dunitz IV L_J ifrjiirrj.riwiifrfir-if 2004 Martin Dunitz, an imprint of the Taylor & Francis Group First published in the United Kingdom 2004 by Martin Dunitz, an imprint of the Taylor and Francis Group, 11 New Fetter Lane, London EC4P 4EE Tel +44 (0) 20 7583 9855 Fax +44 (0) 20 7842 2298 Email info dunitz .co.uk website http www. dunitz.co .uk This edition published in the Taylor &...

Mr Imaging Of Prostate Cancer Technique

MRI evaluation of the prostate requires optimal technique using phased array pelvic surface coils. Endo-rectal coils (ERCs) used either alone or in combination with pelvic phased array coils have been shown to improve staging accuracy by better depiction of pseudocapsular penetration. ERCs have the drawbacks of causing patient discomfort and therefore possible movement artifact, and producing near field artifact although the latest scanners have software to overcome this problem. Thin section...

Pelvic Fascia Visceral Ligaments And Peritoneal Reflections

The pelvis has a two-layered covering of fascia. The parietal fascia covers the walls and floor and is continuous superiorly with the iliacus and transversalis fascia. It is thickened over the obturator internus. The visceral fascia covers the bladder, uterus and rectum. Fascial condensations form a bilateral band running from pubis to sacrum. Around the urethra and at the bases of the prostate, bladder, rectum and uterus, these form supporting ligaments, which attach to the pelvic wall. The...

Teknik Sagital T1a Ve T2a

Sohaib S, Reznek R and Husband JES. (1997) Ovarian cancer. In Imaging in Oncology (eds Janet ES Husband and R Reznek). Isis Medical Media Ltd, Oxford, pp.277-305. A chapter summarising the imaging features of malignant ovarian diseases for all commonly utilised modalities. Also provides a summary of epidemiology and pathology. 2. Forstner R, Hricak H, Occhipinti KA etal. (1995) Ovarian cancer Staging with CT and MR Imaging. Radiology 197 619-626. Study to evaluate ovarian cancer staging and...

Cervical Cancer

Bernadette M.Carrington and Rhidian Bramley Worldwide, cervical cancer is the third most common cancer among women after breast and colorectal cancer, with a greater incidence in developing countries and in lower socioeconomic groups. In developed countries it is the third most common gynaecological malignancy with an estimated annual incidence of 10.4 per 100000 women in the UK and 8 per 100000 women in the USA. The peak incidence is between 35 and 50 years. In the last 10 years, there has...

Transcoelomic spread

Peritoneal deposits are seen as nodular or plaque-like lesions adjacent to or projecting from the peritoneal surfaces. They are high signal intensity on T2 -weighted images and enhance on post Gd-chelate T1-weighted images. Omental involvement is identified as infiltrative, nodular or cake-like soft tissue within the usually fatty omentum which is of intermediate signal intensity on T1 - and T2-weighted images and shows enhancement after administration of Gd. Serosal bowel deposits are seen as...

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(a) Transaxial T2W1 and (b) transaxial STIR image showing lobulated intermediate signal intensity tumour mass less than 2.0 cm maximum dimension extending through anal wall (arrows) vagina (V). (a) Transaxial T2W1 showing intermediate signal intensity tabulated tumour mass (arrows) between 2.0 cm and 5.0 cm maximum dimension largely filling ano-rectal lumen, (b) Transaxial T2W1 just above (a) showing circumferential spread of tumour in lower rectum (arrows).The muscle layer remains intact. (c)...

Seminal vesicles vas deferens and ejaculatory ducts

The seminal vesicles are lobulated sacks 5.0cm long with a terminal duct positioned inferiorly. They lie obliquely behind the bladder and converge towards the mid line. The superior parts of the seminal vesicles lie posterior to the ureters and above the level of the peritoneal reflection within the rectovesical space. They are therefore separated from the rectum by a double layer of peritoneum. The inferior part of each seminal vesicle lies below the peritoneal reflection and is separated from...

V

The upper vagina mimicking the outer cervical stroma. (a), (b) Off-axis transaxial T2W1 with a cervical tumour (T) seen in (a) surrounded by a low signal intensity rim (arrows) which was the vagina. More cranially in (b) the tumour can be seen to extend into the parametrium (arrowheads). The left bladder wall is irregularly thickened and of altered signal intensity due to infiltration by a large left pelvic sidewall lymph node metastasis (out of plane on this image). Figure 4.31....

Mr Imaging Cancer Of Rectal Technique

Schematic Diagram Cervical Cancer

The tumour is localised using a T2-weighted turbo (or fast) spin echo (TSE or FSE) sequence in the sagittal plane. High resolution (3.0mm) T2-weighted images are then acquired perpendicular to the tumour to allow assessment of the circumferential extent of the lesion. A pelvic phased array coil is required for images of suitable quality. Endo-rectal coils are not required and may have inherent problems (see below). Smooth muscle relaxants improve image quality, though not necessarily staging...

Endometrial Cancer

Endometrial Cancer Stage Grade Mri

In the United Kingdom, endometrial carcinoma has an incidence of 4850 new cases per year, compared to 6820 per annum for ovarian cancer and 3240 for cervical cancer. There are approximately 990 deaths per year from uterine cancer in the UK. Endometrial carcinoma is the commonest gynaecological malignancy in the USA, and the American Cancer Society estimates that 39 300 new cases and 6600 deaths will occur in 2002. The disease predominantly affects postmenopausal women, peaking in the decade...

Pelvic Clearance Exenteration

Pelvic clearance is the removal of most or all of the pelvic viscera when pelvic tumours are large and locally extensive. It is divided into three types. Anterior pelvic clearance is the removal of the bladder, urethra and male or female sex organs with the formation of a urinary diversion via an ileal conduit. Posterior pelvic clearance involves resection of the rectum and the male or female pelvic sex organs with a bowel anastomosis or formation of an end colostomy. In male patients the...

Figure 714 T4 N1 Vaginal carcinoma with rectovaginal fistula

Transaxial T2W1 showing upper vaginal tumour which presented with rectovaginal fistula. Low signal tumour (T) extends from the right lateral vagina (V) along the right utero-sacral ligament (short arrows) and is tethered to the sacrum posteriorly (arrow). Tumour extends through the right perirectal space to invade the rectum (R). Fluid and locules of gas are seen within the fistula tract (asterisk). There are bilateral enlarged external iliac lymph nodes (N). Sagittal T2W1 showing high signal...

Info

Irregular Junctional Zone Uterus

T4N1 Stage IVA endometrial cancer. (a) Sagittal and (b) and (c) oblique transaxial T2WI showing an endometrial tumour (T) replacing the cervix (arrows) and extending into the left adenexal structures in (c) (asterisk), vagina in (a) (open arrows) and invading the posterior bladder wall in (a) and (b), the proximal urethra in (a) and the rectum in (b) (black and white arrowheads). The presence of bladder and rectal involvement makes the stage of this tumour T4NI Stage IVA.There are...

Left Ischiocavernosus Muscle Tumor

Hricak H, Chang YCF and Thurnher S. 1998 Vagina Evaluation with MR imaging. Part I. Normal anatomy and congenital anomalies. Radiology 169 169-174. 2. Chang YCF, Hricak H, Thurnher S and Lacey CG. 1988 Vagina Evaluation with MR imaging. Part 2. Neoplasms. Radiology 169 175179. 3. Siegelman ES, Outwater EK, Banner MP, Ramchandani P, Anderson TL and Schnall MD. 1997 High-resolution MR imaging of the vagina. Rodiographics 17 1183-1203. Beautifully illustrated article including normal anatomy,...

Lymph Node Metastases

Since lymphatic tumour spread is common in pelvic malignancy, it is important to identify the anatomical location of all the pelvic nodal groups and to be aware of the usual pathway of lymphatic drainage for each organ involved. There are perivisceral nodes in the meso-rectal fat, parametrium, and paravesical fat. While meso-rectal lymph node metastases are often identified in rectal cancer, the other perivisceral nodes are only rarely seen. Nodal metastases are most frequently identified in...

Bone Metastases

Malignant bone infiltration occurs due to direct tumour invasion or from haematogenous spread. Direct invasion may be due to erosion by the primary tumour, as in rectal cancer involvement of the sacrum, or due to extra-capsular lymph node infiltration, as in cervical cancer. Bone metastases due to haematogenous spread can occur with any pelvic tumour, most commonly in prostate cancer and rarely in ovarian cancer. Accuracy and use of MRI in detection of bone metastases Compared to bone...

Anal Cancer

Anus Levator Muscle

Paul A.Hulse and Bernadette M.Carrington Cancers of the anal canal are rare, accounting for approximately 1.5 of gastrointestinal tract malignancies. In the United States, there were an estimated 3400 new cases in 2000. In England, there were 245 new cases in men 1.0 100000 and 377 in women 1.5 100000 in 1997. It was originally thought that anal cancer was associated with chronic irritation from haemorrhoids, fissures, fistulae and inflammatory bowel disease. However, this is now known not to...

Bladder Cancer

Mri Perivesical Fat Infiltrations

Suzanne Bonington and Jeremy A.L.Lawrance Bladder cancer is the most common malignancy of the urinary tract, and represents 4.5 of all new malignancies. The peak incidence is in the 6th and 7th decades, although there is an increasing number of patients who present under the age of 30. The male to female ratio is 4 1. The age standardised incidence rates 100000 population for males is 19.5 in the UK and 23 in the USA. For females it is 6 100000 population both in the UK and USA. There is an...

MR appearance

On T1W1. the prostate, seminal vesicles and periprostatic veins are of uniform intermediate to low signal. On T2W1, the zonal anatomy is clearly demonstrated. The central zone and transitional zone, commonly termed the central gland, have low signal compared to the high signal intensity peripheral zone. The anterior fibromuscular band has low signal on T1W1 and T2W1, and is contrasted with the relatively high signal from fat in the retropubic space. The verumontanum is often visualised on T2W1...

Sue Roach Uk Radiologist

1 Diagnosis and Staging of Pelvic Tumours the Role of MR Imaging Bernadette M Carrington Stage migration stage shift 2 Principles of oncoradiological practice in tumour diagnosis and staging 2 2 MR Imaging Techniques in Pelvic Cancer Susan M Todd amp Andrew Jones Patient motivation and support 7 Expert radiographers technologists 8 3 Anatomy of the pelvis Paul A Hulse Pelvic fascia, visceral ligaments and peritoneal reflections 15 Bernadette M Carrington amp Rhidian Bramley MR imaging of...