Abstract
Imaging the vagina has evolved from a semiinvasive radiographic evaluation utilizing iodinated contrast vaginography to a noninvasive evaluation using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Vaginography1 employs the use of water-soluble iodinated radiographic contrast and a Foley or barium enema catheter equipped with a balloon to tamponade the introitus. Although it is a useful technique for evaluating patients with congenital vaginal abnormalities,2 vaginal ectopic ureter,3,4 and fistulas to the vagina,1,5 vaginography is not reliable for evaluating masslesions, as the vaginal wall and paravaginal tissues are not imaged. Ultrasonography has been used with limitations for assessing congenital abnormalities6,8 and mass lesions9 of the vagina; however, US techniques are limited by their operator dependence, poor field of view, presence of bowel gas, and obese body habitus. Advantages of CT include its ability to evaluate the pelvis with a larger field of view, but it is suboptimal owing to its insufficient soft tissue contrast resolution and single plane of image acquisition. The limitations of vaginography, CT, and US are overcome with MRI because of its multiplanar capabilities, exquisite soft tissue and spatial resolution, and ability to accurately evaluate the anatomic relations of vaginal pathology to subjacent structures. In this chapter normal anatomy and embryology are discussed followed by a review of the benign and malignant conditions of the vagina imaged using CT and MRI.
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References
Cooper R. Vaginography: a presentation of new cases and subject review. Radiology 1982; 143: 421–425
Coe FD. Vaginography. AJR 1963; 90: 721–722
Katzen P, Trachtman B. Diagnosis of vaginal ectopic ureter by vaginogram.J Urol 1954; 72: 808–811
Schulman CC. The single ectopic ureter. Eur Urol 1976; 1: 64–69
Wolfson JJ. Vaginography for demonstration of uretero-vaginal, vesicovaginal and rectovaginal fistulas, with case reports. Radiology 1964; 83: 438–441
Graham D, Nelson MW. Combined perineal-abdominal sonography in the evaluation of vaginal atresia. J Clin Ultrasound 1986; 14: 735–738
Little HK, Crawford DB, Meister K. Hematocolpos: diagnosis made by ultrasound. J Clin Ultrasound 1978; 6: 341–342
Scanlan KA, Pozniak MA, Fagerhulm M. Shapiro S. Value of transperineal sonography in the assessment of vaginal atresia. AJR 1990;154:545
McCarthy S, Taylor KJW. Sonography of vaginal masses. AJR 1983; 140: 1005–1008
Williams PL, Warwick R, Dyson M, Bannister LH. Grays Anatomy, 37th ed. Edinburgh, Churchill Livingstone, 1989
Moore KL. Clinically Oriented Anatomy, 3rd ed., Baltimore, Williams & Wilkins, 1992
Hafez ESE, Kenemans P. Atlas of Human Reproduction by Scanning Electron Microscopy. Lancaster, MCP Press, 1982
Carrington BN, Hricak H. The uterus and vagina. In: Hricak H, Carrington BN, (eds) MRI of the Pelvis, a Text Atlas. Edinburgh, Martin Dunitz, 1991: 93–184
Anderson MC. The vagina. In: Anderson MC (ed) Systemic Pathology, Female Reproductive System, Vol 6, 3rd ed. Edinburgh, Churchill Livingstone, 1991
Cunha GR. The dual origin of vaginal epithelium. Am J Anat 1975;143:387
Lee JKT, Marx MV. Pelvis. In: Lee JKT, Sagel SS, Stanley RJ (eds) Computed Body Tomography with MRI Correlation. New York, Raven, 1989: 853
Constant O, Cooke J, Parsons CA. Reformatted computed tomography of the female pelvis: normal anatomy. Br J Obstet Gynaecol 1989; 96: 1047–1053
Hricak H. MRI of the female pelvis: a review. AJR 1986; 146: 1115–1122
Hricak H, Chang YCF, Thurnher S. Vagina: evaluation with MR imaging. I. Normal anatomy and congenital anomalies. Radiology 1988; 169: 169–174
Smith RC, Reinhold C, Lange RC, et al. Fast spin-echo MR imaging of the female pelvis. I. Use of a whole volume coil. Radiology 1992; 184: 665–667
Smith RC, Reinhold C, McCauley TR, et al. Multicoil high-resolution fast spin-echo MR imaging of the female pelvis. Radiology 1992; 184: 671–675
Buttram VC, Gibbons WE. Müllerian anomalies: a proposed classification (an analysis of 144 cases). Fertil Steril 1979; 32: 40–46
Vainright JR, Fulp CJ, Schiebler ML. MR imaging of vagnal agenesis with hematocolpos: case report. J Comput Assist Tomogr 1988; 12: 891–893
Bates WG, Wiser WL. A technique for uterine conservation in adolescents with vaginal agenesis and a functional uterus. Obstet Gynecol 1985; 66: 290–294
Fedele L, Dorta M, Brioschi D, et al. Magnetic resonance imaging in Mayer-Rokitansky Küster-Hauser syndrome. Obstet Gynecol 1990; 76: 593–596
Doyle MB. Magnetic resonance imaging on müllerian fusion defects. J Reprod Med 1992; 37: 33–38
Carrington BM, Hricak H, Nuruddin RN, et al. Müllerian duct anomalies: MRI imaging evaluation. Radiology 1991; 176: 715
Hugosson C, Jorulf H, Bakri Y. MRI in distal vaginal atresia. Pediatr Radiol 1991; 21: 281–283
Barach B, Falces E, Benzian SR. Magnetic resonance imaging for diagnosis and preoperative planning in agenesis of the distal vagina. Ann Plast Surg 1987; 19: 192–194
Togashi K, Nishimura K, Itoh K, et al. Vaginal agenesis: classification by MR imaging. Radiology 1987; 162: 675–677
Lawrence R, Shapiro MD. Disorders of female sex differentiation. In: Blaustein A (ed) Pathology of the Female Genital Tract, 2nd ed., New York, Springer, 1982: 420–450
Grumback MM, VanWyk JJ. Disorders of sex differentiation. In: Williams RH (ed) Textbook of Endocrinology, 5th ed. Philadelphia, Saunders, 1974: 423–501
Moulopoulos LA, Varma DGK, Charnsangavej C, Wallace S. Magnetic resonance imaging and computed tomography appearance of asymptomatic paravaginal cysts. Clin Imag 1993; 17: 126–132
Hudson CN, Chir M. Acquired fistulae between the intestine and the vagina. Ann R Coll Surg Engl 1970; 46: 20–39
Lang IM, Wilson BPM. Case report: an unusual association of a rectovaginal fistula with the currarino triad. Clin Radiol 1994; 49: 281–283
Rosenshein NB, Genadry RR, Woodruff JD. Anatomic classification of rectovaginal septal defects. Am J Obstet Gynecol 1980; 137: 439–442
Kuhlman JE, Fishman EK. CT evaluation of enterovaginal and vesicovaginal fistulas. Comput Assist Tomogr 1990; 14: 390–394
Hadar H, Kornreic HL, Heifetz M, et al. Air in vagina: indicator of intrapelvic pathology on CT. Acta Radiol 1991; 32: 170–173
Outwater E, Schiebler ML. Pelvic fistulas: findings on MR images. AJR 1993; 160: 327–330
Brown CE. Mixed epithelial tumor of the vagina. Am J Clin Pathol 1953; 23: 237–240
Kraus FT. Female genitalia. In: Kissane JM (ed) Anderson’s Pathology, Vol 2, 9th ed. St. Louis, Mosby, 1990: 1637–1642
Tavassoli FA, Norris HJ. Smooth muscle tumors of the vagina. Obstet Gynecol 1979; 53: 689–693
Chabrel CN, Beilby JOW. Vaginal rhabdomyoma. Histopathology 1980; 4: 645–651
Dekel A, Avidan D, Bar-Ziv J, et al. Neurofibroma of the vagina presenting with urinary retention: review of the literature and report of a case. Obstet Gynecol Surv 1988; 43: 325–327
Terada S, Suzuki N, Tomimatsu N, Akasofu K. Vaginal schwannoma. Arch Gynecol Obstet 1992; 251: 203–206
O’Neal MF, Amparo EG. MR demonstration of extensive pelvic involvement in vulvar hemangiomas. J Comput Assist Tomogr 1988; 12: 219–221
Nguyen BD, Georges NP, Hamper UM, Zerhouni EA. Primary cervical vaginal endometriosis: sonographic findings with MR imaging correlation. J Ultrasound Med 1994; 13: 809–811
Ascher SM, Agrawal R, Bis KG, et al. Endometriosis: appearance and detection with conventional, fat suppressed and contrast enhanced fat suppressed spin-echo techniques. J Magn Reson Imaging 1995; 5: 251–257
Togashi K, Nishimura K, Kimora K., et al. Endometrial cyst: diagnosis with MR imaging. Radiology 1991; 180: 73
Arrive L, Hricak H, Martin MC. Pelvic endometriosis: MR imaging. Radiology 1989;171:687
Hall DA, Hann LE. Gynecologic radiology: benign disorders. In: Taveras JM, Ferrucci JT (eds) Radiology: Diagnosis-Imaging-Intervention. Philadelphia, Lippincott, 1995; 87: 1–16
Wade-Evans T. The aetiology and pathology of cancer of the vagina. Clin Obstet Gynaecol 1976; 3: 229–241
Benedet JL, Murphy KJ, Fairey RN, Boyes DA. Primary invasive carcinoma of the vagina. Obstet Gynecol 1983; 62: 715–719
Pride GL, Schultz AE, Chuprevich TW, Buchler DA. Primary invasive squamous carcinoma of the vagina. Obstet Gynecol 1979; 53: 218–225
Chang YCF, Hricak H, Thurnher S, Lacey CG. Vagina: evaluation with MR imaging. 2. Neoplasms. Radiology 1988; 169: 175–179
Hata K, Makihari K, Moriyama M, et al. Preoperative diagnostic imaging of vaginal carcinoma by transvaginal color Doppler and magnetic resonance imaging. Gynecol Obstet Invest 1991; 32: 126–128
Troiano RN, Smith R. Malignant gynecologic disease: applications of magnetic resonance imaging. Top Magn Reson Imaging 1995; 7: 44–53
Chen NJ. Vagina invasion by cervical carcinoma. Acta Med Okayuma 1984; 38: 305–313
Walsh JW, Amendola MA, Hall DJ, et al. Recurrent carcinoma of the cervix: CT diagnosis. AJR 1981; 136: 117–122
Herbst AL. Clear cell adenocarcinoma and the current status of DES-exposed females. Cancer 1990; 48: 484–488
Gilles R, Michael G, Chancelier MD, Masselot J. Case report: clear cell adenosarcoma of the vagina: MR features. Br J Radiol 1993; 66: 168–170
Conctant BO, Blake P. Primary malignant melanoma of the vagina. Br J Radiol 1989; 62: 623–624
Moon WK, Kim SH, Hand MC. MR findings of malignant melanoma of the vagina. Clin Radiol 1993; 48: 326–328
Chorlton I, Karnei RF, King FM, Norris HJ. Primary malignant reticular endothelial disease involving the vagina, cervix and corpus uteri. Obstet Gynecol 1974; 44: 735–748
McNicholas MMJ, Fennelly JJ, Macerlaine DP. Imaging of primary vaginal lymphoma. Clin Radiol 1994; 49: 130–132
Imai A, Furui T, Yokoyama Y, et al. Case report: endodermal sinus tumor of the vagina in an infant: magnetic resonance imaging evaluation. Gynecol Oncol 1993; 48: 402–405
Chen SJ, Li WY, Tsai WY. Endodermal sinus (yolk sac) tumor of the vagina and cervix in an infant. Pediatr Radiol 1993; 23: 57–58
Jones HW III. In: Novak’s Textbook of Gynecology. Malignancies of the Vulva and Vagina. Baltimore, Williams & Wilkins, 1988: 617
Carrington BM, Bis KG, Hricak H. Postsurgical and postradiation changes in the pelvis. In: Higgins CB, Hricak H, Helms CA (eds) Magnetic Resonance Imaging of the Body, 2nd ed. New York, Raven, 1992: 1003–1013
Willing SJ, Purcell SH, Koch SR, Tobin GR. Vaginal reconstruction with rectus abdominis myocutaneous flap: CT findings. AJR 1990; 156: 1001–1004
Epstein DM, Arger PH, LaRossa D, et al. CT evaluation of gracilis myocutaneous vaginal reconstruction after pelvic exenteration. AJR 1987; 148: 1143–1146
Brown JJ, Guitierrez ED, Lee JKT. MR appearance of the normal and abnormal vagina after hysterectomy. AJR 1992; 158: 95–99
Erner F, Kressel HY, Mintz MC, et al. Tumor recurrence versus fibrosis in the female pelvis: differentiation with MR at 1.5 T. Radiology 1988; 166: 333–340
Glazer HS, Lee JKT, Levitt RG, et al. Radiation fibrosis: differentiation from recurrent tumor by MR imaging. Radiology 1985; 156: 721–726
Walsh JW, Amendola MA, Hall DJ, et al. Recurrent carcinoma of the cervix: CT diagnosis. AJR 1981; 136: 117–122
Sugimura K, Carrington BM, Quirey JM, Hricak H. Postirradiation changes in the pelvis: assessment with MR imaging. Radiology 1990;175: 805–813
Hricak H, Swift P, Campos Z, et al. The value of unenhanced and contrast-enhanced MR imaging in irradiated cervix uteri. Radiology 1993; 189:381-388
Martinez A, Edmundson GK, Cox RS, et al. Combination of external beam irradiation and multiple-site perineal applicator (MUPIT) for treatment of locally advanced or recurrent prostatic, anorectal and gynecologic malignancies. Int J Radiat Oncol Biol Phys 1985; 11: 391–398
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Bis, K.G., Vrachliotis, T.G., Shirkhoda, A. (1998). CT and MRI of Benign and Malignant Conditions of the Vagina. In: Jafri, S.Z.H., Diokno, A.C., Amendola, M.A. (eds) Lower Genitourinary Radiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1648-3_24
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DOI: https://doi.org/10.1007/978-1-4612-1648-3_24
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