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Zulfiqar M, Shetty A, Yano M, McGettigan M, Itani M, Naeem M, Ratts VS, Siegel CL. Imaging of the Vagina: Spectrum of Disease with Emphasis on MRI Appearance. Radiographics 2021; 41:1549-1568. [PMID: 34297630 DOI: 10.1148/rg.2021210018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The vagina is a median fibromuscular structure of the female reproductive system that extends from the vulva inferiorly to the uterine cervix superiorly. As most vaginal lesions are detected at gynecologic examination, imaging performed for nongynecologic indications can frequently cause concomitant vaginal pathologic conditions to be overlooked. The vagina is often underevaluated at routinely performed pelvic transvaginal US because of a narrow scan area and probe positioning. MRI has progressively become the imaging method of choice for vaginal pathologic conditions, as it provides excellent soft-tissue detail with unparalleled delineation of the complex pelvic floor anatomy and helps establish a diagnosis for most vaginal diseases. It is important that radiologists use a focused approach toward understanding and correctly recognizing different vaginal entities that may otherwise go unnoticed. In this case-based review, the authors discuss the key imaging features of wide-ranging vaginal pathologic conditions, with emphasis on appearance at MRI. Knowledge of vaginal anatomy and embryology is helpful in evaluating congenital anomalies at imaging. Often seen incidentally, vaginal inflammation can cause diagnostic confusion. Because of its central location in the pelvis, the vagina can form fistulas to the urinary bladder, colon, rectum, or anus. Vaginal masses can be neoplastic and nonneoplastic and include a myriad of benign and malignant conditions, some of which have characteristic imaging features. Therapeutic and nontherapeutic vaginal foreign bodies include pessaries, vaginal mesh, and packing that can be seen with or without associated complications. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Anup Shetty
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Motoyo Yano
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Melissa McGettigan
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Muhammad Naeem
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Valerie S Ratts
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Cary Lynn Siegel
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
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Bianchini L, Santinha J, Loução N, Figueiredo M, Botta F, Origgi D, Cremonesi M, Cassano E, Papanikolaou N, Lascialfari A. A multicenter study on radiomic features from T 2 -weighted images of a customized MR pelvic phantom setting the basis for robust radiomic models in clinics. Magn Reson Med 2020; 85:1713-1726. [PMID: 32970859 DOI: 10.1002/mrm.28521] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the repeatability and reproducibility of radiomic features extracted from MR images and provide a workflow to identify robust features. METHODS T2 -weighted images of a pelvic phantom were acquired on three scanners of two manufacturers and two magnetic field strengths. The repeatability and reproducibility of features were assessed by the intraclass correlation coefficient and the concordance correlation coefficient, respectively, and by the within-subject coefficient of variation, considering repeated acquisitions with and without phantom repositioning, and with different scanner and acquisition parameters. The features showing intraclass correlation coefficient or concordance correlation coefficient >0.9 were selected, and their dependence on shape information (Spearman's ρ > 0.8) analyzed. They were classified for their ability to distinguish textures, after shuffling voxel intensities of images. RESULTS From 944 two-dimensional features, 79.9% to 96.4% showed excellent repeatability in fixed position across all scanners. A much lower range (11.2% to 85.4%) was obtained after phantom repositioning. Three-dimensional extraction did not improve repeatability performance. Excellent reproducibility between scanners was observed in 4.6% to 15.6% of the features, at fixed imaging parameters. In addition, 82.4% to 94.9% of the features showed excellent agreement when extracted from images acquired with echo times 5 ms apart, but decreased with increasing echo-time intervals, and 90.7% of the features exhibited excellent reproducibility for changes in pulse repetition time. Of nonshape features, 2.0% was identified as providing only shape information. CONCLUSION We showed that radiomic features are affected by MRI protocols and propose a general workflow to identify repeatable, reproducible, and informative radiomic features to ensure robustness of clinical studies.
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Affiliation(s)
- Linda Bianchini
- Department of Physics, Università degli Studi di Milano and INSTM RU, Milan, Italy
| | - João Santinha
- Computational Clinical Imaging Group, Center for the Unknown (CCU), Champalimaud Foundation, Lisbon, Portugal.,Instituto de Telecomunicações, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | | | - Mário Figueiredo
- Instituto de Telecomunicações, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Francesca Botta
- Medical Physics Unit, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - Daniela Origgi
- Medical Physics Unit, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - Marta Cremonesi
- Radiation Research Unit, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Center for the Unknown (CCU), Champalimaud Foundation, Lisbon, Portugal
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Pereira P, Melo Abreu E, Cunha TM, Rolim I. Transperineal aggressive angiomyxoma. BMJ Case Rep 2017; 2017:bcr-2016-217705. [PMID: 28400400 DOI: 10.1136/bcr-2016-217705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old woman with a history of total hysterectomy with adnexal preservation for uterine leiomyomas presented to our hospital with a right gluteal palpable mass, which she first noticed 6 months before and had progressively enlarged since then.Radiological studies revealed a 14 cm lesion with translevator growth that displaced rather than invaded adjacent structures, with a peculiar whorled pattern on T2-weighted MRI, which enhanced following gadolinium administration. CT-guided biopsy was performed, and in conjunction with imaging features the diagnosis of an aggressive angiomyxoma was assumed and confirmed following surgical excision.
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Affiliation(s)
- Pedro Pereira
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Elisa Melo Abreu
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Inês Rolim
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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