Abstract
Transabdominal US remains the primary screening imaging modality of the pediatric female pelvis. However, MRI has become an invaluable adjunct to US in recent years. MRI offers superb soft-tissue contrast resolution that allows for detailed evaluation, particularly of the ovaries and their associated pathology. MRI can yield diagnostic information that is similar to or even better than that of US, especially in nonsexually active girls in whom transvaginal US would be contraindicated. MRI is generally a second-line examination and is preferred over CT because it does not involve the use of ionizing radiation. MRI might be underutilized in this population, particularly in differentiating surgical from nonsurgical conditions. This article reviews the relevant anatomy and discusses imaging of acquired conditions that involve the pediatric female genital tract, illustrating associated pathology with case examples.
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References
Ratner ES, Staib LH, Cross SN et al (2015) The clinical impact of gynecologic MRI. AJR Am J Roentgenol 204:674–680
Nalaboff KM, Pellerito JS, Ben-Levi E (2001) Imaging the endometrium: disease and normal variants. Radiographics 21:1409–1424
Takeuchi M, Matsuzaki K, Harada M (2015) Susceptibility-weighted MRI of extra-ovarian endometriosis: preliminary results. Abdom Imaging 40:2512–2516
Cimsit C, Yoldemir T, Guclu M, Akpinar IN (2015) Susceptibility-weighted magnetic resonance imaging for the evaluation of deep infiltrating endometriosis: preliminary results. Acta Radiol. doi: 10.1177/0284185115602147
Del Grande F, Santini F, Herzka DA et al (2014) Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 34:217–233
Servaes S, Victoria T, Lovrenski J et al (2010) Contemporary pediatric gynecologic imaging. Semin Ultrasound CT MR 31:116–140
Anthony EY, Caserta MP, Singh J et al (2012) Adnexal masses in female pediatric patients. AJR Am J Roentgenol 198:W426–W431
Langer JE, Oliver ER, Lev-Toaff AS et al (2012) Imaging of the female pelvis through the life cycle. Radiographics 32:1575–1597
Stranzinger E, Strouse PJ (2008) Ultrasound of the pediatric female pelvis. Semin Ultrasound CT MR 29:98–113
Garel L, Dubois J, Grignon A et al (2001) US of the pediatric female pelvis: a clinical perspective. Radiographics 21:1393–1407
Ratani RS, Cohen HL, Fiore E (2004) Pediatric gynecologic ultrasound. Ultrasound Q 20:127–139
McCarthy SM, Stark DD, Filly RA et al (1985) Obstetrical magnetic resonance imaging: maternal anatomy. Radiology 154:421–425
Scoutt LM, McCauley TR, Flynn SD et al (1993) Zonal anatomy of the cervix: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 186:159–162
Rezvani M, Shabaan AM (2011) Fallopian tube disease in the nonpregnant patient. Radiographics 31:527–548
Brown M, Park AS, Shayya RF et al (2013) Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary syndrome and age-matched controls. J Magn Reson Imaging 38:689–693
Kenigsberg LE, Agarwal C, Sin S et al (2015) Clinical utility of magnetic resonance imaging and ultrasonography for diagnosis of polycystic ovary syndrome in adolescent girls. Fertil Steril 104:1302–1309
Bremer AA (2010) Polycystic ovary syndrome in the pediatric population. Metab Syndr Relat Disord 8:375–394
Lakhani K, Seifalian AM, Atiomo WU et al (2002) Polycystic ovaries. Br J Radiol 75:9–16
Tanaka YO, Tsunoda H, Kitagawa Y et al (2004) Functioning ovarian tumors: direct and indirect findings at MR imaging. Radiographics 24:S147–S166
Pfeifer SM, Kives S (2009) Polycystic ovary syndrome in the adolescent. Obstet Gynecol Clin N Am 36:129–152
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long‐term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47
Rosenfield RL (2015) The diagnosis of polycystic ovary syndrome in adolescents. Pediatrics 136:1154–1165
Rosenfield RL (2015) The polycystic ovary morphology-polycystic ovary syndrome spectrum. J Pediatr Adolesc Gynecol 28:412–419
Witchel SF, Oberfield S, Rosenfield RL et al (2015) The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr. doi: 10.1159/000375530
Huchon C, Fauconnier A (2010) Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol 150:8–12
Cass DL (2005) Ovarian torsion. Semin Pediatr Surg 14:86–92
Servaes S, Zurakowski D, Laufer MR et al (2007) Sonographic findings of ovarian torsion in children. Pediatr Radiol 37:446–451
Oltmann SC, Fischer A, Barber R et al (2009) Cannot exclude torsion — a 15-year review. J Pediatr Surg 44:1212–1216
Piper HG, Oltmann SC, Xu L et al (2012) Ovarian torsion: diagnosis of inclusion mandates earlier intervention. J Pediatr Surg 47:2071–2076
Cohen SB, Oelsner G, Seidman DS et al (1999) Laparoscopic detorsion allows sparing of the twisted ischemic adnexa. J Am Assoc Gynecol Laparosc 6:139–143
Rha SE, Byun JY, Jung SE et al (2002) CT and MR imaging features of adnexal torsion. Radiographics 22:283–294
Lourenco AP, Swenson D, Tubbs RJ et al (2014) Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol 21:179–187
Duigenan S, Oliva E, Lee SI (2012) Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol 198:W122–W131
Bottomley C, Bourne T (2009) Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol 23:711–724
Kanso HN, Hachem K, Aoun NJ et al (2006) Variable MR findings in ovarian functional hemorrhagic cysts. J Magn Reson Imaging 24:356–361
Lee NK, Kim S, Kim KH et al (2015) Diffusion-weighted magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts in the ovary. Acta Radiol. doi: 10.1177/0284185115609805
Balaban M, Idilman IS, Toprak H et al (2015) The utility of diffusion-weighted magnetic resonance imaging in differentiation of endometriomas from hemorrhagic ovarian cysts. Clin Imaging 39:830–833
Centers for Disease Control and Prevention (2010) Sexually transmitted disease surveillance 2009. U.S. Department of Health and Human Services, Atlanta
Washington AE, Sweet RL, Shafer MA (1985) Pelvic inflammatory disease and its sequelae in adolescents. J Adolesc Health Care 6:298–310
Tukeva TA, Aronen HJ, Karjalainen PT et al (1999) MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 210:209–216
Dohke M, Watanabe Y, Okumura A et al (2000) Comprehensive MR imaging of acute gynecologic diseases. Radiographics 20:1551–1566
Kim SH, Kim SH, Yang DM et al (2004) Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics 24:1575–1589
Pearl RH, Hale DA, Molloy M et al (1995) Pediatric appendectomy. J Pediatr Surg 30:173–178
Vyas RC, Sides C, Klein DJ et al (2008) The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess. Pediatr Radiol 38:1006–1008
Towbin AJ, Sullivan J, Denson LA et al (2013) CT and MR enterography in children and adolescents with inflammatory bowel disease. Radiographics 33:1843–1860
Schwartz DA, Loftus EV Jr, Tremaine WJ et al (2002) The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 122:875–880
Tolan DJ, Greenhalgh R, Zealley IA et al (2010) MR enterographic manifestations of small bowel Crohn disease. Radiographics 30:367–384
Schmidt S, Chevallier P, Bessoud B et al (2007) Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions. Eur Radiol 17:2957–2963
Howard FM (1993) The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surv 48:357–387
Takeuchi M, Matsuzaki K (2011) Adenomyosis: usual and unusual imaging manifestations, pitfalls, and problem-solving MR imaging techniques. Radiographics 31:99–115
Byun JY, Kim SE, Choi BG et al. (1999) Diffuse and focal adenomyosis: MR imaging findings. Radiographics 19 Spec No: S161–170
Ho ML, Raptis C, Hulett R et al (2008) Adenomyotic cyst of the uterus in an adolescent. Pediatr Radiol 38:1239–1242
Laufer MR, Goitein L, Bush M et al (1997) Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol 10:199–202
Kunz G, Beil D, Huppert P et al (2005) Adenomyosis in endometriosis — prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 20:2309–2316
Siegelman ES, Oliver ER (2012) MR imaging of endometriosis: ten imaging pearls. Radiographics 32:1675–1691
Jensen JR, Coddington CC 3rd (2010) Evolving spectrum: the pathogenesis of endometriosis. Clin Obstet Gynecol 53:379–388
Corwin MT, Gerscovich EO, Lamba R et al (2014) Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology 271:126–132
Glastonbury CM (2002) The shading sign. Radiology 224:199–201
Coutinho A Jr, Bittencourt LK, Pires CE et al (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 31:549–567
Moyle PL, Kataoka MY, Nakai A et al (2010) Nonovarian cystic lesions of the pelvis. Radiographics 30:921–938
Wood SC (2015) Clinical manifestations and therapeutic management of vulvar cellulitis and abscess: methicillin-resistant Staphylococcus aureus, necrotizing fasciitis, Bartholin abscess, Crohn disease of the vulva, hidradenitis suppurativa. Clin Obstet Gynecol 58:503–511
Stricker T, Navratil F, Sennhauser FH (2004) Vaginal foreign bodies. J Paediatr Child Health 40:205–207
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Cox, M., Gould, S.W., Podberesky, D.J. et al. Magnetic resonance imaging of acquired disorders of the pediatric female pelvis other than neoplasm. Pediatr Radiol 46, 806–817 (2016). https://doi.org/10.1007/s00247-016-3595-x
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DOI: https://doi.org/10.1007/s00247-016-3595-x