As for other pelvic tumours, imaging is best performed with a phased array surface coil utilising turbo spin echo sequences. Thin section T2 -weighted sequences in the transaxial and sagittal planes are most useful in the evaluation of local tumour extent. Transaxial images must include the entire vagina down to the vulva, this usually requires an additional image series. Off-axis imaging, perpendicular to the vagina, may be helpful to assess invasion of the bladder or rectum. Tampons may obscure detail of the vaginal mucosa and should not be used. Tl- weighted images are acquired in the transaxial plane through the entire pelvis to include the upper pelvic lymph node groups. An additional coronal Tl -weighted sequence to cover the entire abdomen is helpful in assessing for upper retroperitoneal lymph node metastases and hydronephrosis.
Intravenous contrast agents are not routinely used, but dynamic Tl-weighted Gd-DTPA enhanced fat saturated sequences may be of value in delineating tumour extent, with tumour typically showing early enhancement. Delayed sequences, obtained after filling of the bladder with Gd-DTPA, can demonstrate small fistulae from the bladder.
Another interesting technique is MR vaginography, using saline or other positive contrast material, injected via a Foley catheter to distend the vagina. T2-weighted sequences are then performed in the standard planes. This technique has been used to determine vaginal extent of cervical carcinomas and could also be of use in primary vaginal carcinoma.
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