Intravaginal contrast-enhanced MR imaging. Diagnostic value in gynecological cancer

Purpose: To analyze the utility of the vaginal contrast medium (VCM) in the MRI of pelvis and its impact in the diagnosis of gynecology cancer. Materials and methods: We present 30 patients with gynecological cancer (cervical carcinoma, n = 26; endometrial carcinoma, n = 3 and ovarian carcinoma, n = 1) studied with pelvic MRI before and after opacification of the vagina with echographic gel. In our series, the patient's ages ranged between 26-76 years, average 52 years. Patients were divided into Group S (Staging) and Group R (Recurrent disease). In the staging group were included: 12 cervical carcinomas (FIGO stage I, n 3; IIA, n = 1; IIB n = 8) and 2 endometrial carcinomas (FIGO stage IC). In Group R were included 14 cervical, 1 endometrial and 1 ovarian carcinomas. In 11/30 cases (36,6%) VCM caused a mild discomfort. Results: Taken into account the various anatomic structures considered as landmarks for tumor staging the VCM improved their visualization in different percentages: vagina and fornix in all cases (100%), parametrium in 15 cases (50%), bladder in 16 cases (53%), and rectum in 20 cases (67%). In only 3 cases VCM conduced to a worse definition of the rectal anterior wall. Conclusion: In our work in progress the use of VCM improved the diagnostic value of the pelvic MRI in the pre and post-therapeutic work-up of patients with gynecological cancer. The VCM administration was easy, with low cost, and without complications or any considerable discomfort. However, further experience is required to quantify the VCM contribution for MRI tumor staging in cervical and endometrial carcinomas. (author)