Imaging of the Female Pelvis through the Life Cycle

Abstract

The appearance of the normal reproductive tract on radiologic images changes dramatically over the female patient's life span, reflecting the influence of hormones on these organs. In female children and adolescents, the appearance of the reproductive tract reflects the stage of sexual maturation. In women of reproductive age, physiologic changes such as those occurring in the corpus luteum are routinely imaged and must be distinguished from pathologic conditions. In the postmenopausal years, as reproductive hormone levels diminish, the endometrium and ovaries undergo progressive involution. Imaging findings that might be considered physiologic in younger women may represent pathologic or even neoplastic changes in postmenopausal women. Although postpartum imaging is typically performed in symptomatic patients, including those with greater than expected vaginal bleeding, suspected obstetric trauma, thromboembolic disease, or infectious complications, clinicians who interpret these radiologic results should be familiar with expected findings in asymptomatic patients after childbirth. Familiarity with the spectrum of ultrasonographic, computed tomographic, and magnetic resonance imaging appearances of the normal female reproductive tract from birth through the postmenopausal years will ultimately help clinicians avoid misinterpreting these normal physiologic changes as pathologic conditions.

ACR Appropriateness Criteria® Infertility

“…10 During infertility evaluation, TVS can be used to monitor follicle development, 11 perform antral follicle counts, 12 assess for polycystic ovaries, 13 and look for evidence of endometriosis. It also is readily available, relatively low in cost, and without ionizing radiation.…”

“…This technique does not involve exposure to ionizing radiation nor potential allergic reaction to iodine based contrast agents. 10 MRI provides accurate assessment of uterine contour anomalies potentially contributing to infertility such as congenital uterine anomalies, 23Y28 adenomyosis, 29 and leiomyomas. In the interim some providers utilize agitated saline to assess tubal patency, the accuracy of which is less validated.…”

Transient uterine contractions as a potential pathology mimic on premenopausal pelvic MRI and the role of routine repeat T2 sagittal images to improve observer confidence

“…MRI of the female pelvis has an increasingly important and validated role in the evaluation of underlying gynaecologic pathology. Superior soft tissue contrast and multiplanar capability provide MRI with greater sensitivity than traditional first‐line ultrasound for several key conditions including endometriosis, adenomyosis, fibroid workup and ovarian lesion characterisation . There is also a high degree of concordance between 3D U/S and MRI with regards to uterine cavity morphology .…”

“…These endometrial contractions are detectable on MRI, particularly pelvic sagittal T2 weighted images. During contractions, blood is squeezed out of a contracted area and results in demonstrable lower T2 signal to the region compared with adjacent myometrium . The contractions are, however, transient (3–5 contractions per minute) and have a tendency to resolve or appear over the course of a MRI examination …”

“…During contractions, blood is squeezed out of a contracted area and results in demonstrable lower T2 signal to the region compared with adjacent myometrium. 9 The contractions are, however, transient (3-5 contractions per minute 6 ) and have a tendency to resolve or appear over the course of a MRI examination. 13,14 Adenomyosis and submucosal leiomyomas are evident on MRI as low T2 signal lesions centred at the junctional zone and/or submucosal cavity respectively.…”