Magnetic Resonance Imaging of the Vagina and Pelvic Organs in Women who Underwent Antitumor Treatment for Female Genital Cancer

Objective. To clarify MRI semiotics of non-neoplastic changes in the vagina in women undergoing treatment for cancer of the female genital organs.

Materials and methods. 141 patients with suspected tumor vaginal involvement were included in the study. In all the patients, the diagnosis was confirmed morphologically. According to the study, a tumor lesion of the vagina was established in 96 (68.1%) patients, with primary vaginal cancer detected in only 11 (11%) of the examined, the largest number of cases was a secondary organ damage – 85 (89%). The basis for differential diagnosis was the results of a comprehensive MR-study of 45 (31.9%) patients who did not receive data for the new formation, but determined the posttherapeutic changes in the small pelvis. MR-studies were performed on a Toshiba Vantage Atlas, 1.5T. A multiparametric MRI protocol was used for the study of pelvic organs, including T2WI with and without suppression of fat tissue signal, T1WI, diffusion-weighted images, T1WI with dynamic contrast enhancement. For the purpose of moderate expansion of the physiological folding of the vagina, we used an MP-compatible plastic applicator.

Results. In the course of monitoring changes in the form of fibrosis of the dome of the vaginal stump were determined in 51.9% of observations, fibrous thickening of the vaginal walls with a narrowing of its lumen – in 18.5% of observations, prolonged edema of the vaginal tissues with a moderate change in anatomo-topographic relationships – in 73.3% of observations. In 12 (26.6%) patients with clinically pronounced fibrosis of the vaginal walls, strictures of different localization, accompanied by dyspareunia, dryness and increased bleeding of the vaginal tissues, even the possibility of examination was significantly limited, and MRI was practically the only complete differential diagnostic method.

Conclusion. Knowledge of the anatomy of the operated vagina made it possible to correctly interpret the revealed changes in the vagina, to perform a detailed differentiation between the unchanged tissues of the dome of the vaginal stump and its tumor lesion.

1. Vinogradova L.V. Diagnosis and prevention of vaginal tumors. Rossiyskiy meditsinskiy zhurnal. 2005; 1: 28–30. (In Russian)

2. Berezovskaya T.P., Spitsyn A.F., Mikhailova E.V., Valkova V.N. Magnetic resonance characterization of post-radial changes in the pelvic area in women. Magnetic resonance in medicine and biology: Abstracts of the international conference. Kazan, 1997. 95 p. (In Russian)

3. Shavladze Z.N., Berezovskaya T.P., Proshin A.A. Magnetic resonance image of radioinduced changes in the pelvic region after radiation therapy of malignant tumors. Medical Visualization . 2007; 5: 76–90. (In Russian)

4. Kaprin A.D., Galkin V.N., Ivanov S.A., Solodky V.A., Titova V.A. Brachyterpia in the treatment of vaginal cancer. Biomedical Photonics . 2016; 5 (1): 22–26. (In Russian)

5. Sugemura K., Carrington B.M., Quivey J.M., Hricak H. Postirradiation changes in the pelvis: assessment with MR imaging. Radiology . 1990; 175 (6): 805–813.

6. Fletcher B.D., Hanna S.L., Kun L.E. Changes in MR signal intensity and contrast enhancement of therapeutically irradiated soft tissue. Magn. Reson. Imaging . 1990; 8: 771–777.

7. Kudrevatykh E.V., Ter-Harutyunyants S.A., Mershina E.A., Sinitsyn V.E. Magnetic resonance imaging in diagnosis and evaluation of combined and chemoradiation treatment of cervical cancer. Kubanskiy nauchniy meditsinskiy vestnik. 2010; 6: 65–69. (In Russian)

8. Rubtsova N.A., Novikova E.G., Sinitsin V.E. The role of diffusion-weighted magnetic resonance imaging in the diagnosis of recurrent tumors of the uterus. RadiologiyaPraktika . 2012; 4: 41–54. (In Russian)

9. Rubtsova N.A. Magnetic resonance imaging in the diagnosis, planning and evaluation of the effectiveness of treatment of cervical and endometrial cancer: Diss. ... doct. of med. sci. Moscow, 2013. 216 p. (In Russian)

10. Blomlie V., Roftstad E.K., Tvera K., Lien H.H. Noncritical soft tissues of female pelvis: serial MR imaging before, during and after radiation therapy. Radiology . 1996; 199 (2): 461–468.

11. Richardson M.L., ZinkBrody G.C., Patten R.M., Koh W.J, Conrad E.U. MR characterization of postirradiation soft tissue edema. Skeletal. Radiol. 1996; 25: 537–543.

12. Devine C., Szklaruk J., Tamm E.P. Magnetic Resonance Imaging in the Characterization of Pelvic Masses. Seminars in Ultrasound. CT and MRI . 2005; 26: 172–204.

13. Hosseinzadeh K., Heller M.T., Houshmand G. Imaging of the Female Perineumin Adults. RadioGraphics . 2012; 32 (4): 129–168.

14. Hricak H., Chang Y.C., Thurnher S. Vagina: evaluation with MR imaging. Part I. Normal anatomy and congenital anomalies. Radiology . 1988; 169: 169–174.

15. Parikh J.H., Barton D.P.J., Ind T.E.J., Aslam Sohaib S. MR Imaging Features of Vaginal Malignancies. RadioGraphics . 2008; 28 (1): 49–63.

16. Young P., Daniel B., Sommer G., Kim B, Herfkens R. Intravaginal gel for staging of female pelvic cancerspreliminary report of safety, distention, and gel-mucosal contrast during magnetic resonance examination. J. Comput. Assist. Tomogr . 2012; 36 (2): 253–256.