Widespread use of MRI in gynecology: a myth or reality?

Abstract

It has been 15 years since magnetic resonance imaging (MRI) has been introduced into clinical practice. MRI of the central nervous system (CNS) and musculoskeletal system is flourishing. In the field of gynecology, the medical literature is flooded with evidence and support for the excellence of MRI and its superiority over other imaging modalities. Furthermore, the scientific data are complemented by cost-effectiveness studies to a much greater extent than that of CNS. National surveys, however, show that MRI of the female pelvis accounts for less than 4% of the MRI load nationwide. What are the reasons for this discrepancy between evidence and practice and how can it be corrected?1. Training and expertise: The vicious cycle of a paucity of clinical cases leads to lack of expertise. Therefore, only a few centers offer training. 2. Cost: There is a misconception about the high cost of MRI without the realization that a tailored, streamlined approach to the problem with a half-hour MR study may be all that is needed to obtain a specific diagnosis. Disease-driven protocols need to be developed including plane of section, type of sequence, and indications for the use of contrast media. 3. MRI in relation to ultrasound (US) or computed tomography (CT): MRI is not in competition with US. It is a valuable problem-solving approach often obviating surgery and guiding therapeutic decisions. In the evaluation of cancer of the vagina, cervix, or uterus, MRI should be used instead of, and not in addition to, CT. 4. Education: Referring physicians and third-party payors need to be informed and presented with evidence about not only the medical usefulness but also cost effectiveness of MRI. A more costly but practical approach that results in a precise diagnosis and eliminates a succession of less costly, inconclusive diagnostic examinations is cost effectiveness. Basic approach to imaging the female pelvisEssential imaging protocols for the female pelvis include axial T1-and T2-weighted images and sagittal T2-weighted images. Coronal images are not routinely needed but may add important information in selected cases. T2-weighted sequences (preferably fast spin-echo [FSE] T2-weighted images) are essential for the demonstration of normal anatomy and pathology. SE T1-weighted sequences are used to evaluate pelvic lymph nodes and to provide characterization of pathology involving the uterus and adnexa. If an adnexal lesion demonstrating high signal intensity on a T1-weighted sequence is identified, fat-saturation T1 imaging should be performed to differentiate between fat and blood. Contrast enhancement with gadolinium chelates is reserved primarily for the evaluation of ovarian and endometrial pathology. Flow-sensitive sequences, such as the gradient recalled echo technique, are sometimes needed to distinguish pelvic lymph nodes from vessels or to assess vascular patency. Respiratory compensation is used with all conventional SE sequences to reduce breathing artifact. Major clinical indications and MRI findingsMRI is currently u...

Magnetic resonance imaging of the cervix

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