Pitfalls of MRI

• Following biopsy differentiation of tumour from inflammation and haemorrhage is often difficult, particularly if the primary tumour is small.

• The introitus is difficult to assess on MRI, as it is often asymmetrical and the superficial perineal structures are of similar signal to tumour on T2-weighted images. Fortunately, superficial tumour extent is usually apparent clinically. Dynamic T1-weighted Gd-DTPA enhanced fat saturated sequences may be of value in the perineum and vulva, with enhancing tumour seen well against the saturated vulval fat.

• Following radiotherapy it is often difficult to discriminate between a sterile tumour residuum and recurrent tumour. Inert post treatment residuum is fibrotic and typically of low signal, whereas tumour is more commonly of intermediate to high signal on T2W1. However, there is overlap in the appearances and both may show Gd-DTPA enhancement. Consequently, biopsy is often required to diagnose recurrence. Alternatively, enlargement of a mass on serial examinations is almost invariably due to recurrence.

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