Transvaginal Sonography (TVS) is often the initial imaging exam used when evaluating the female genital tract. However, if the TVS is suboptimal or non-diagnostic, or if additional information is needed, magnetic resonance imaging (MRI) should be considered. MRI is advantageous because of its multiplanar capability, high spatial and contrast resolution and lack of ionizing radiation. For the evaluation of a possible pelvic abnormalities, MRI is able to address the following clinical questions: (1) where is it? (e.g., uterine or ovarian); (2) what is it? (neoplastic or non-neoplas-tic, malignant or benign, congenital or acquired); and (3) how does the information impact patient management (e.g., selection of appropriate candidates for different therapies and patient monitoring following treatment).

MRI Technique

Pelvic MRI is best performed on high field strength systems (> 1.5 T) using a torso phased-array body coil. This set-up affords the greatest signal-to-noise ratios and spatial resolution. Patient preparation is negligible. In our practice, patients are asked to fast for 4-6 hours prior to the exam in order to limit bowel peristalsis. Patients are also asked to void immediately before imaging to increase their comfort during the course of the exam.

A bare bones examination includes orthogonal T2-weighted (W) fast spin echo sequences (FSE), axial T1-W sequences, with and without fat suppression, and when indicated, sagittal dynamic contrast-enhanced 3D fat-suppressed T1-W sequences. Most of our sequences are performed in a breath hold (e.g., T2-W single shot FSE [SS FSE]). Breath hold sequences are advantageous because they eliminate respiratory artifacts, limit peristatic artifacts and shorten exam times, leading to greater patient satisfaction. We reserve high resolution (512 matrix), non-breath hold T2-W FSE sequences to determine tumor extent in patients with gynecologic malignancies.

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