Federica Curti, Roberta Ninkova, Valentina Miceli, Marco Gennarini, Angelica Cupertino, Carlo Catalano, Lucia Manganaro
Magnetic resonance imaging (MRI) is a non invasive exam which can replace the diagnostic role of laparoscopy in the assessment of chronic pelvic pain (CPP).
Chronic pelvic pain (CPP) is cyclic or noncyclic pain that lasts six months or longer, related to pelvic structures and can significantly affect quality of life. Gynaecological conditions are the most common causes of CPP ,such as endometriosis, adenomyosis, pelvic congestion syndrome, chronic pelvic inflammatory disease (PID), and pelvic adhesions. Laparoscopy is an invasive examination, that is used as a diagnostic tool in women with CPP. However up to 40% of laparoscopies do not identify any pathologies. MRI is an innovative examination characterized by multiplanar sequences, high contrast resolution and a wide field of view (FOV) with multiple directions, which can provide detailed images of pelvic structures. In particular the MRI protocol requires acquisition on sagittal, coronal and axial plane of multiparametric images weighted on T2 (T2WI) , T1(T1WI) also with suppression of adipose tissue signal (T1FS-WI) and diffusion weighted (DWI) sequences; optional can be the use of contrast medium. These sequences can evaluate the presence of superficial or deep endometriosis (extensive pelvic adhesions and ureteral involvement), adenomyosis (focal or diffuse thickening of the junctional zone (ZG), PID (presence of fluid collections, lymphadenopathy),vascular anomalies and pelvic adhesions.
deep infiltrating endometriosis complicated by adhesions in the posterior compartment and adenomyosisdee
Diffuse adenomyosis : diffuse thickening of the junctional zone
Diffuse adenomyosis associated with focal area of adenomyosis on the posterior wall.
Pelvic congestion syndrome
The aim is to make radiologists familiar with gynaecological causes of CPP and their MRI features.