Skip to main content

Female Genital Tract

  • Chapter
  • First Online:
Pediatric Body MRI

Abstract

Transabdominal ultrasound remains the first-line imaging modality of the pediatric female pelvis. However, magnetic resonance imaging (MR imaging) is increasingly important in the investigation and characterization of suspected abnormalities. The superior soft tissue contrast resolution of MR imaging provides excellent evaluation of ovarian and uterine anatomy. MR imaging may be particularly useful in nonsexually active girls in whom transvaginal ultrasound is generally contraindicated. This chapter discusses MR imaging applications to evaluate normal anatomy and development as well as congenital and acquired disorders of the pediatric female genital tract.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ratner E, Staib L, Cross S, Raji R, Schwartz P, McCarthy S. The clinical impact of gynecologic MRI. AJR Am J Radiol. 2015;204(3):674–80.

    Google Scholar 

  2. Tsiflikas I, Obermayr F, Werner S, Teufel M, Fuchs J, Schafer J. Functional magnetic resonance urography in infants: feasibility of a feed-and-sleep technique. Pediatr Radiol. 2019;49(3):351–7.

    Article  PubMed  Google Scholar 

  3. Ahmad R, Hu HH, Krishnamurthy R, Krishnamurthy R. Reducing sedation for pediatric body MRI using accelerated and abbreviated imaging protocols. Pediatr Radiol. 2018;48(1):37–49.

    Article  PubMed  Google Scholar 

  4. Baughman S, Richardson R, Podberesky D, Dalrymple N, Yerkes E. 3-Dimensional magnetic resonance genitography: a different look at cloacal malformation. J Urol. 2007;178(4. Pt 2):1675–8.

    Article  PubMed  Google Scholar 

  5. Podberesky DJ, Towbin AJ, Eltomey MA, Levitt MA. Magnetic resonance imaging of anorectal malformations. Magn Reson Imaging Clin N Am. 2013;21(4):791–812.

    Article  PubMed  Google Scholar 

  6. Cox M, Gould SW, Podberesky DJ, Epelman M. Magnetic resonance imaging of acquired disorders of the pediatric female pelvis other than neoplasm. Pediatr Radiol. 2016;46(6):806–17.

    Article  PubMed  Google Scholar 

  7. Son JK, Ali S, Khouri NA, Lee EY. MR imaging evaluation of pediatric genital disorders: MR technologic overview and interpretation. Magn Reson Imaging Clin N Am. 2019;27(3):201–321.

    Google Scholar 

  8. Chavhan GB, AlSabban Z, Babyn PS. Diffusion-weighted imaging in pediatric body MR imaging: principles, technique and emerging applications. Radiographics. 2014;34(3):E73–88.

    Article  PubMed  Google Scholar 

  9. Iraha Y, Okada M, Iraha R, Azama K, Yamashiro T, Tsubakimoto M, et al. CT and MR imaging of gynecologic emergencies. Radiographics. 2017;37(5):1569–86.

    Article  PubMed  Google Scholar 

  10. Takeuchi M, Matsuzaki K, Harada M. Susceptibility-weighted MRI of extra-ovarian endometriosis: preliminary results. Abdom Imaging. 2015;40(7):2512–6.

    Article  PubMed  Google Scholar 

  11. Cimsit C, Yoldemir T, Guclu M, Akpinar IN. Susceptibility-weighted magnetic resonance imaging for the evaluation of deep infiltrating endometriosis: preliminary results. Acta Radiol. 2015;57(7):878–85.

    Article  PubMed  Google Scholar 

  12. DelGrande F, Santini F, Herzka DA. Fat-suppression techniques for 3-T imaging of the musculoskeletal system. Radiographics. 2014;34(1):217–33.

    Article  Google Scholar 

  13. Jaimes C, Kirsch JE, Gee MS. Fast, free-breathing and motion-minimized techniques for pediatric body magnetic resonance imaging. Pediatr Radiol. 2018;48(9):1197–208.

    Article  PubMed  Google Scholar 

  14. Chavhan GB, Parra DA, Oudjhane K, Miller SF, Babyn PS, Salle JLP. Imaging of ambiguous genitalia: classification and diagnostic approach. Radiographics. 2008;28:1891–904.

    Article  PubMed  Google Scholar 

  15. Gould SW, Servaes S, Lee EY, Lipsich J, Loya VMT, Epelman MS. Female genital tract. In: Lee EY, editor. Pediatric radiology practical imaging evaluation of infants and children. Philadelphia: Wolters Kluwer; 2018. p. 973–1010.

    Google Scholar 

  16. Li Y, Phelps A, Zapala MA, MacKenzie JD, MacKenzie TC, Courtier J. Magnetic resonance imaging of Mullerian duct anomalies in children. Pediatr Radiol. 2016;46(6):796–805.

    Article  PubMed  Google Scholar 

  17. Behr SC, Courtier JL, Qayyum A. Imaging of Mullerian duct anomalies. Radiographics. 2012;32(6):E233–50.

    Article  PubMed  Google Scholar 

  18. Servaes S, Victoria T, Lovrenski J, Epelman MS. Contemporary pediatric gynecologic imaging. Semin Ultrasound CT MRI. 2010;31(2):116–40.

    Article  Google Scholar 

  19. Epelman M, Dinan D, Gee MS, Servaes S, Lee EY, Darge K. Müllerian duct and related anomalies in children and adolescents. Radiol Clin N Am. 2013;21(4):773–89.

    Google Scholar 

  20. Furey EA, Bailey AA, Twickler DM. Fetal MR imaging of gastrointestinal abnormalities. Radiographics. 2016;36(3):904–17.

    Article  PubMed  Google Scholar 

  21. Podberesky DJ, Towbin AJ, Eltorney MA, Levitt MA. Magnetic resonance imaging of anorectal malformations. Magn Reson Imaging Clin N Am. 2013;21(4):791–812.

    Article  PubMed  Google Scholar 

  22. Sintim-Damoa A, Majmudar AS, Cohen HL, Parvey LS. Pediatric ovarian torsion: spectrum of imaging findings. Radiographics. 2017;37(6):1892–908.

    Article  PubMed  Google Scholar 

  23. Langer JE, Oliver ER, Lev-Toaff AS, Coleman BG. Imaging of the female pelvis through the life cycle. Radiographics. 2012;32(6):1575–97.

    Article  PubMed  Google Scholar 

  24. Chung EM, Biko DM, Schroeder JW, Cube R, Conran RM. From the radiologic pathology archives: precocious puberty: radiologic-pathologic correlation. Radiographics. 2012;32(7):2071–99.

    Article  PubMed  Google Scholar 

  25. Rezvani M, Shaaban AM. Fallopian tube disease in the nonpregnant patient. Radiographics. 2011;31(2):527–48.

    Article  PubMed  Google Scholar 

  26. Walker DK, Salibian RA, Salibian AD, Belen KM, Palmer SL. Overlooked diseases of the vagina: a directed anatomic-pathologic approach for imaging assessment. Radiographics. 2011;31(6):1583–98.

    Article  PubMed  Google Scholar 

  27. Siegelman ES, Outwater EK, Banner MP, Ramchandani P, Anderson TL, Schnall MD. High-resolution MR imaging of the vagina. Radiographics. 1997;17(5):1183–203.

    Article  CAS  PubMed  Google Scholar 

  28. The American Fertility. Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies, and intrauterine adhesions. Fertil Steril. 1988;49(6):944–55.

    Article  Google Scholar 

  29. Matos J, Orazi C, Sertorio F, Magnano G, Toma P, Granata C. Imaging of diseases of the vagina and external genitalia in children. Pediatr Radiol. 2019;49(6):827–34.

    Article  PubMed  Google Scholar 

  30. Schmahmann S, Haller JO. Neonatal ovarian cysts: pathogenesis, diagnosis, and management. Pediatr Radiol. 1997;27(2):101–5.

    Article  CAS  PubMed  Google Scholar 

  31. Trinh TW, Kennedy AM. Fetal ovarian cysts: review of imaging spectrum, differential diagnosis, management, and outcome. Radiographics. 2015;35(2):621–35.

    Article  PubMed  Google Scholar 

  32. Enriquez G, Duran C, Toran N, Piqueras J, Gratacos E, Aso C, et al. Conservative versus surgical treatment for complex neonatal ovarian cysts: outcomes study. AJR Am J Radiol. 2004;185(2):501–8.

    Google Scholar 

  33. Kessler A, Nagar H, Graif M, Ben-Sira L, Miller E, Fisher D, et al. Percutaneous drainage as the treatment of choice for neonatal ovarian cysts. Pediatr Radiol. 2006;36(9):954–8.

    Article  PubMed  Google Scholar 

  34. Laing FC, Allison SJ. US of the ovary and adnexa: to worry or not to worry. Radiographics. 2012;32(6):1621–39.

    Article  PubMed  Google Scholar 

  35. Lam CZ, Chavhan GB. Magnetic resonance imaging of pediatric adnexal masses and mimics. Pediatr Radiol. 2018;48(9):1291–306.

    Article  PubMed  Google Scholar 

  36. Ackerman S, Irshad A, Lewis M, Anis M. Ovarian cystic lesions a current approach to diagnosis and management. Radiol Clin N Am. 2013;51(6):1067–85.

    Article  PubMed  Google Scholar 

  37. Choe J, Wortman JR, Sodickson AD, Khurana B, Uyeda JW. Imaging of acute conditions of the perineum. Radiographics. 2018;38(4):1111–30.

    Article  PubMed  Google Scholar 

  38. Hosseinzadeh K, Heller MT, Houshmand G. Imaging of the female perineum in adults. Radiographics. 2012;32(4):E129–68.

    Article  PubMed  Google Scholar 

  39. Chauvin NA, Epelman M, Victoria T, Johnson AM. Complex genitourinary abnormalities on fetal MRI: imaging findings and approach to diagnosis. AJR Am J Radiol. 2012;199(2):W222–31.

    Google Scholar 

  40. Dannull KA, Browne LP, Meyers MZ. The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI. Pediatr Radiol. 2019;49(3):387–98.

    Article  PubMed  Google Scholar 

  41. Dohke M, Watanabe Y, Okumura A, Amoh Y, Hayashi T, Yoshizako T, et al. Comprehensive MR imaging of acute gynecologic diseases. Radiographics. 2000;20(6):1551–66.

    Article  CAS  PubMed  Google Scholar 

  42. Czeyda-Pommersheim F, Kalb B, Costello J, Liau J, Meshksar A, Tiwari HA, et al. MRI in pelvic inflammatory disease: a pictorial review. Abdom Radiol. 2017;42(3):935–50.

    Article  Google Scholar 

  43. Uyeda JW, Gans BS, Sodickson A. Imaging of acute and emergent genitourinary conditions: what the radiologist needs to know. AJR Am J Radiol. 2015;204:W631–W9.

    Google Scholar 

  44. Kim SH, Kim SH, Yang DM, Kim KA. Unusual causes of tubo-ovarian abscesses: CT and MR imaging findings. Radiographics. 2004;24(6):1575–89.

    Article  PubMed  Google Scholar 

  45. Vyas RC, Sides C, Klein DJ, Reddy SY, Santos MC. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess. Pediatr Radiol. 2008;38(9):1006–8.

    Article  PubMed  Google Scholar 

  46. Towbin AJ, Sullivan J, Denson LA, Wallihan DB, Podberesky DJ. CT and MR enterography in children and adolescents with inflammatory bowel disease. Radiographics. 2013;33(7):1843–60.

    Article  PubMed  Google Scholar 

  47. Marro A, Allen LM, Kives SL, Moineddin R, Chavhan GB. Simulated impact of pelvic MRI in treatment planning for pediatric adnexal masses. Pediatr Radiol. 2016;46(9):1249–57.

    Article  PubMed  Google Scholar 

  48. Anthony EY, Caserta MP, Singh J, Chen MYM. Adnexal masses in female pediatric patients. AJR Am J Radiol. 2012;198(5):W426–31.

    Google Scholar 

  49. Epelman M, Chikwava KR, Chauvin N, Servaes S. Imaging of pediatric ovarian neoplasms. Pediatr Radiol. 2011;41(9):1085–99.

    Article  PubMed  Google Scholar 

  50. Taskinen S, Urtane A, Fagerholm R, Lohi J, Taskinen M. Metachronous benign ovarian tumors are not uncommon in children. J Pediatr Surg. 2014;49(4):543–5.

    Article  PubMed  Google Scholar 

  51. Heo SH, Kim JW, Shin SS, Jeong SI, Lim HS, Choi YD, et al. Review of ovarian tumors in children and adolescents: radiologic-pathologic correlation. Radiographics. 2014;34(7):2039–55.

    Article  PubMed  Google Scholar 

  52. Park E-A, Cho JY, Lee MW, Kim SH, Seong CK, Kim SH. MR features of fluid-fluid levels in ovarian masses. Eur Radiol. 2007;17:3247–54.

    Article  PubMed  Google Scholar 

  53. Vaysse C, Delsol M, Carfagna L, Bouali O, Combelles S, Lemasson F, et al. Ovarian germ cell tumors in children. Management, survival and ovarian prognosis. A report of 75 cases. J Pediatr Surg. 2010;45(7):1484–90.

    Article  PubMed  Google Scholar 

  54. Tanaka YO, Tsunoda H, Kitagawa Y, Ueno T, Yoshikawa H, Saida Y. Functioning ovarian tumors: direct and indirect findings at MR imaging. Radiographics. 2004;24(Suppl 1):S147–66.

    Article  PubMed  Google Scholar 

  55. Pai D, Coletti MC, Elkins M, Ladino-Torres M, Caoili E. Diffuse uterine leiomyomtosis in a child. Pediatr Radiol. 2012;42(1):124–8.

    Article  PubMed  Google Scholar 

  56. Moyle PL, Kataoka MY, Nakai A, Takahata A, Reinhold C, Sala E. Nonovarian cystic lesions of the pelvis. Radiographics. 2010;30(4):921–38.

    Article  PubMed  Google Scholar 

  57. Agrons GA, Wagner BJ, Lonergan GJ, Dickey GE, Kaufman MS. From the archives of the AFIP. Genitourinary rhabdomyosarcoma in children: radiologic-pathologic correlation. Radiographics. 1997;17(4):919–37.

    Article  CAS  PubMed  Google Scholar 

  58. Dehner LP, Jarzembowski JA, Hill DA. Embryonal rhabdomyosarcoma of the uterine cervix: a report of 14 cases and a discussion of its unusual clinicopathological associations. Mod Pathol. 2012;25(4):602–14.

    Article  PubMed  Google Scholar 

  59. Parikh JH, Barton DPJ, Ind TEJ, Sohaib SA. MR imaging features of vaginal malignancies. Radiographics. 2008;28(1):49–63.. quiz 322

    Article  PubMed  Google Scholar 

  60. Garel L, Dubois J, Grignon A, Filiatrault D, Vliet GV. US of the pediatric female pelvis: a clinical perspective. Radiographics. 2001;21(6):1393–407.

    Article  CAS  PubMed  Google Scholar 

  61. Niemi TA, Norton LW. Vaginal injuries in patients with pelvic fractures. J Trauma. 1985;25(6):547–51.

    Article  CAS  PubMed  Google Scholar 

  62. Goldman HB, Idom CB, Dmochowski RR. Traumatic injuries of the female external genitalia and their association with urological injuries. J Urol. 1998;159(3):956–9.

    Article  CAS  PubMed  Google Scholar 

  63. Laufer MR, Makai G. Evaluation and management of female lower genital tract trauma. In: Post TW, editor. UpToDate. Waltham: UpToDate Inc. https://www.uptodate.com. Accessed 13 Aug 2019.

  64. Stricker T, Navratil F, Sennhauser FH. Vaginal foreign bodies. J Paediatr Child Health. 2004;40(4):205–7.

    Article  CAS  PubMed  Google Scholar 

  65. Kanso HN, Hachem K, Aoun NJ, Haddad-Zebouni S, Klein-Tomb L, Atallah D, et al. Variable MR findings in ovarian functional hemorrhagic cysts. J Magn Reson Imaging. 2006;24(2):356–61.

    Article  PubMed  Google Scholar 

  66. Lee NK, Kim S, Kim KH, Suh DS, Kim TU, Han GJ, et al. Diffusion-weighted magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts in the ovary. Acta Radiol. 2016;57(8):998–1005.

    Article  PubMed  Google Scholar 

  67. Brown M, Park AS, Shayya RF, Wolfson T, Su HI, Chang RJ. Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary syndrome and age-matched controls. J Magn Reson Imaging. 2013;38(3):689–93.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Bremer AA. Polycystic ovary syndrome in the pediatric population. Metab Syndr Relat Disord. 2010;8(5):375–94.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Rosenfeld RL. The polycystic ovary morphology-polycystic ovary syndrome spectrum. J Pediatr Adolesc Gynecol. 2015;28(6):412–9.

    Article  Google Scholar 

  70. Lakhani K, Seifalian AM, Atiomo WU, Hardiman P. Polycystic ovaries. Br J Radiol. 2002;75(889):9–16. Review

    Article  CAS  PubMed  Google Scholar 

  71. ESHRE/ R. ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–7. Review

    Article  Google Scholar 

  72. Fondin M, Rachas A, Huynh V, Franchi-Abella S, Teglas J-P, Duranteau L, et al. Polycystic ovary syndrome in adolescents: which MR imaging-based diagnostic criteria? Radiology. 2017;285(3):961–70.

    Article  PubMed  Google Scholar 

  73. Rosenfeld RL. The diagnosis of polycystic ovary syndrome in adolescents. Pediatrics. 2015;136(6):1154–65.

    Article  Google Scholar 

  74. Siegelman ES, Oliver ER. MR imaging of endometriosis: ten imaging pearls. Radiographics. 2012;32(6):1675–91.

    Article  PubMed  Google Scholar 

  75. Corwin MT, Gerscovich EO, Lamba R, Wilson MD. Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology. 2014;271(1):126–32.

    Article  PubMed  Google Scholar 

  76. Jensen JR, Charles C, Coddington I. Evolving spectrum: the pathogenesis of endometriosis. Clin Obstet Gynecol. 2010;53(2):379–88.

    Article  PubMed  Google Scholar 

  77. Glastonbury CM. The shading sign. Radiology. 2002;224(1):199–201.

    Article  PubMed  Google Scholar 

  78. Outwater E, Schiebler ML, Owen RS, Schnall MD. Characterization of hemorrhagic adnexal lesions with MR imaging: blinded reader study. Radiology. 1993;186(2):489–94.

    Article  CAS  PubMed  Google Scholar 

  79. Antonio Coutinho J, Bittencourt LK, Pires CE, Junqueira F, Lima CM, Coutinho E, et al. MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics. 2011;31(2):549–67.

    Article  PubMed  Google Scholar 

  80. Brosens I, Gordts S, Habiba M, Benagiano G. Uterine cystic adenomyosis: a disease of younger women. J Pediatr Adolesc Gynecol. 2015;28(6):420–6.

    Article  PubMed  Google Scholar 

  81. Byun JY, Kim SE, Choi BG. Diffuse and focal adenomyosis: MR imaging findings. Radiographics. 1999;19(Spec No):S161–S170.

    Article  PubMed  Google Scholar 

  82. Takeuchi M, Matsuzaki K. Adenomyosis: usual and unusual imaging manifestations, pitfalls, and problem-solving MR imaging techniques. Radiographics. 2011;31(1):99–115.

    Article  PubMed  Google Scholar 

  83. Ho ML, Raptis C, Hulett R. Adenomyotic cyst of the uterus in an adolescent. Pediatr Radiol. 2008;38(11):1239–42.

    Article  PubMed  Google Scholar 

  84. Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol. 2010;150(1):8–12.

    Article  PubMed  Google Scholar 

  85. Oltmann SC, Fischer A, Barber R. Cannot exclude torsion--a 15 year review. J Pediatr Surg. 2009;44(6):1212–6.

    Article  PubMed  Google Scholar 

  86. Rha SE, Byun JY, Jung SE. CT and MR findings of adnexal torsion. Radiographics. 2002;22(2):283–94.

    Article  PubMed  Google Scholar 

  87. Servaes S, Zurakowski D, Laufer MR. Sonographic findings of ovarian torsion in children. Pediatr Radiol. 2007;37(5):446–51.

    Article  PubMed  Google Scholar 

  88. Beranger-Gibert S, Sakly H, Ballester M, Rockall A, Bornes M, Bazot M, et al. Diagnostic value of MR imaging in the diagnosis of adnexal torsion. Radiology. 2015;279(2):461–70.

    Article  PubMed  Google Scholar 

  89. Duigenan S, Olivia E, Lee SI. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Radiol. 2012;198(2):W122–31.

    Google Scholar 

  90. Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT and MRI. Emerg Radiol. 2014;21(2):179–87.

    Article  PubMed  Google Scholar 

  91. Piper HG, Oltmann SC, Xu L, Adusumilli S, Fischer AC. Ovarian torsion: diagnosis of inclusion mandates earlier intervention. J Pediatr Surg. 2012;47(11):2071–6.

    Article  PubMed  Google Scholar 

  92. Cohen SB, Oelsner G, Seidman DS, Admon D, Mashiach S, Goldenberg M. Laparoscopic detorsion allows sparing of the twisted ischemic adnexa. J Am Assoc Gynecol Laparasc. 1999;6(2):139–43.

    Article  CAS  Google Scholar 

  93. Selim MF, Haggag MS, Hassan MA. Detorsion or adnexectomy for adnexal torsion and MRI for assessment for necrosis. J Gynecol Surg. 2015;31(6):336–41.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Monica Epelman .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gould, S.W., Calle Toro, J.S., Back, S.J., Podberesky, D.J., Epelman, M. (2020). Female Genital Tract. In: Lee, E., Liszewski, M., Gee, M., Daltro, P., Restrepo, R. (eds) Pediatric Body MRI. Springer, Cham. https://doi.org/10.1007/978-3-030-31989-2_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-31989-2_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-31988-5

  • Online ISBN: 978-3-030-31989-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics