Skip to main content
SpringerLink
Log in

CT and MRI of Benign and Malignant Conditions of the Vagina

  • Chapter
Lower Genitourinary Radiology

  • 234 Accesses

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.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
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

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Cooper R. Vaginography: a presentation of new cases and subject review. Radiology 1982; 143: 421–425

    PubMed  CAS  Google Scholar 

  2. Coe FD. Vaginography. AJR 1963; 90: 721–722

    CAS  Google Scholar 

  3. Katzen P, Trachtman B. Diagnosis of vaginal ectopic ureter by vaginogram.J Urol 1954; 72: 808–811

    PubMed  CAS  Google Scholar 

  4. Schulman CC. The single ectopic ureter. Eur Urol 1976; 1: 64–69

    Google Scholar 

  5. Wolfson JJ. Vaginography for demonstration of uretero-vaginal, vesicovaginal and rectovaginal fistulas, with case reports. Radiology 1964; 83: 438–441

    PubMed  CAS  Google Scholar 

  6. Graham D, Nelson MW. Combined perineal-abdominal sonography in the evaluation of vaginal atresia. J Clin Ultrasound 1986; 14: 735–738

    Article  PubMed  CAS  Google Scholar 

  7. Little HK, Crawford DB, Meister K. Hematocolpos: diagnosis made by ultrasound. J Clin Ultrasound 1978; 6: 341–342

    Article  PubMed  CAS  Google Scholar 

  8. Scanlan KA, Pozniak MA, Fagerhulm M. Shapiro S. Value of transperineal sonography in the assessment of vaginal atresia. AJR 1990;154:545

    Google Scholar 

  9. McCarthy S, Taylor KJW. Sonography of vaginal masses. AJR 1983; 140: 1005–1008

    PubMed  CAS  Google Scholar 

  10. Williams PL, Warwick R, Dyson M, Bannister LH. Grays Anatomy, 37th ed. Edinburgh, Churchill Livingstone, 1989

    Google Scholar 

  11. Moore KL. Clinically Oriented Anatomy, 3rd ed., Baltimore, Williams & Wilkins, 1992

    Google Scholar 

  12. Hafez ESE, Kenemans P. Atlas of Human Reproduction by Scanning Electron Microscopy. Lancaster, MCP Press, 1982

    Google Scholar 

  13. 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

    Google Scholar 

  14. Anderson MC. The vagina. In: Anderson MC (ed) Systemic Pathology, Female Reproductive System, Vol 6, 3rd ed. Edinburgh, Churchill Livingstone, 1991

    Google Scholar 

  15. Cunha GR. The dual origin of vaginal epithelium. Am J Anat 1975;143:387

    Google Scholar 

  16. Lee JKT, Marx MV. Pelvis. In: Lee JKT, Sagel SS, Stanley RJ (eds) Computed Body Tomography with MRI Correlation. New York, Raven, 1989: 853

    Google Scholar 

  17. Constant O, Cooke J, Parsons CA. Reformatted computed tomography of the female pelvis: normal anatomy. Br J Obstet Gynaecol 1989; 96: 1047–1053

    Article  PubMed  CAS  Google Scholar 

  18. Hricak H. MRI of the female pelvis: a review. AJR 1986; 146: 1115–1122

    PubMed  CAS  Google Scholar 

  19. Hricak H, Chang YCF, Thurnher S. Vagina: evaluation with MR imaging. I. Normal anatomy and congenital anomalies. Radiology 1988; 169: 169–174

    PubMed  CAS  Google Scholar 

  20. 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

    PubMed  CAS  Google Scholar 

  21. 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

    PubMed  CAS  Google Scholar 

  22. Buttram VC, Gibbons WE. Müllerian anomalies: a proposed classification (an analysis of 144 cases). Fertil Steril 1979; 32: 40–46

    PubMed  Google Scholar 

  23. Vainright JR, Fulp CJ, Schiebler ML. MR imaging of vagnal agenesis with hematocolpos: case report. J Comput Assist Tomogr 1988; 12: 891–893

    Article  PubMed  Google Scholar 

  24. Bates WG, Wiser WL. A technique for uterine conservation in adolescents with vaginal agenesis and a functional uterus. Obstet Gynecol 1985; 66: 290–294

    PubMed  CAS  Google Scholar 

  25. Fedele L, Dorta M, Brioschi D, et al. Magnetic resonance imaging in Mayer-Rokitansky Küster-Hauser syndrome. Obstet Gynecol 1990; 76: 593–596

    PubMed  CAS  Google Scholar 

  26. Doyle MB. Magnetic resonance imaging on müllerian fusion defects. J Reprod Med 1992; 37: 33–38

    PubMed  CAS  Google Scholar 

  27. Carrington BM, Hricak H, Nuruddin RN, et al. Müllerian duct anomalies: MRI imaging evaluation. Radiology 1991; 176: 715

    Google Scholar 

  28. Hugosson C, Jorulf H, Bakri Y. MRI in distal vaginal atresia. Pediatr Radiol 1991; 21: 281–283

    Article  PubMed  CAS  Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. Togashi K, Nishimura K, Itoh K, et al. Vaginal agenesis: classification by MR imaging. Radiology 1987; 162: 675–677

    PubMed  CAS  Google Scholar 

  31. 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

    Google Scholar 

  32. Grumback MM, VanWyk JJ. Disorders of sex differentiation. In: Williams RH (ed) Textbook of Endocrinology, 5th ed. Philadelphia, Saunders, 1974: 423–501

    Google Scholar 

  33. 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

    Article  CAS  Google Scholar 

  34. Hudson CN, Chir M. Acquired fistulae between the intestine and the vagina. Ann R Coll Surg Engl 1970; 46: 20–39

    PubMed  CAS  Google Scholar 

  35. Lang IM, Wilson BPM. Case report: an unusual association of a rectovaginal fistula with the currarino triad. Clin Radiol 1994; 49: 281–283

    Article  PubMed  CAS  Google Scholar 

  36. Rosenshein NB, Genadry RR, Woodruff JD. Anatomic classification of rectovaginal septal defects. Am J Obstet Gynecol 1980; 137: 439–442

    CAS  Google Scholar 

  37. Kuhlman JE, Fishman EK. CT evaluation of enterovaginal and vesicovaginal fistulas. Comput Assist Tomogr 1990; 14: 390–394

    Article  CAS  Google Scholar 

  38. Hadar H, Kornreic HL, Heifetz M, et al. Air in vagina: indicator of intrapelvic pathology on CT. Acta Radiol 1991; 32: 170–173

    Article  PubMed  CAS  Google Scholar 

  39. Outwater E, Schiebler ML. Pelvic fistulas: findings on MR images. AJR 1993; 160: 327–330

    PubMed  CAS  Google Scholar 

  40. Brown CE. Mixed epithelial tumor of the vagina. Am J Clin Pathol 1953; 23: 237–240

    PubMed  CAS  Google Scholar 

  41. Kraus FT. Female genitalia. In: Kissane JM (ed) Anderson’s Pathology, Vol 2, 9th ed. St. Louis, Mosby, 1990: 1637–1642

    Google Scholar 

  42. Tavassoli FA, Norris HJ. Smooth muscle tumors of the vagina. Obstet Gynecol 1979; 53: 689–693

    PubMed  CAS  Google Scholar 

  43. Chabrel CN, Beilby JOW. Vaginal rhabdomyoma. Histopathology 1980; 4: 645–651

    Article  PubMed  CAS  Google Scholar 

  44. 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

    PubMed  CAS  Google Scholar 

  45. Terada S, Suzuki N, Tomimatsu N, Akasofu K. Vaginal schwannoma. Arch Gynecol Obstet 1992; 251: 203–206

    Article  PubMed  CAS  Google Scholar 

  46. O’Neal MF, Amparo EG. MR demonstration of extensive pelvic involvement in vulvar hemangiomas. J Comput Assist Tomogr 1988; 12: 219–221

    Article  PubMed  Google Scholar 

  47. 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

    PubMed  CAS  Google Scholar 

  48. 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

    Article  PubMed  CAS  Google Scholar 

  49. Togashi K, Nishimura K, Kimora K., et al. Endometrial cyst: diagnosis with MR imaging. Radiology 1991; 180: 73

    PubMed  CAS  Google Scholar 

  50. Arrive L, Hricak H, Martin MC. Pelvic endometriosis: MR imaging. Radiology 1989;171:687

    Google Scholar 

  51. Hall DA, Hann LE. Gynecologic radiology: benign disorders. In: Taveras JM, Ferrucci JT (eds) Radiology: Diagnosis-Imaging-Intervention. Philadelphia, Lippincott, 1995; 87: 1–16

    Google Scholar 

  52. Wade-Evans T. The aetiology and pathology of cancer of the vagina. Clin Obstet Gynaecol 1976; 3: 229–241

    PubMed  CAS  Google Scholar 

  53. Benedet JL, Murphy KJ, Fairey RN, Boyes DA. Primary invasive carcinoma of the vagina. Obstet Gynecol 1983; 62: 715–719

    PubMed  CAS  Google Scholar 

  54. Pride GL, Schultz AE, Chuprevich TW, Buchler DA. Primary invasive squamous carcinoma of the vagina. Obstet Gynecol 1979; 53: 218–225

    PubMed  CAS  Google Scholar 

  55. Chang YCF, Hricak H, Thurnher S, Lacey CG. Vagina: evaluation with MR imaging. 2. Neoplasms. Radiology 1988; 169: 175–179

    PubMed  CAS  Google Scholar 

  56. 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

    Article  PubMed  CAS  Google Scholar 

  57. Troiano RN, Smith R. Malignant gynecologic disease: applications of magnetic resonance imaging. Top Magn Reson Imaging 1995; 7: 44–53

    Article  PubMed  CAS  Google Scholar 

  58. Chen NJ. Vagina invasion by cervical carcinoma. Acta Med Okayuma 1984; 38: 305–313

    CAS  Google Scholar 

  59. Walsh JW, Amendola MA, Hall DJ, et al. Recurrent carcinoma of the cervix: CT diagnosis. AJR 1981; 136: 117–122

    PubMed  CAS  Google Scholar 

  60. Herbst AL. Clear cell adenocarcinoma and the current status of DES-exposed females. Cancer 1990; 48: 484–488

    Article  Google Scholar 

  61. 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

    Article  PubMed  CAS  Google Scholar 

  62. Conctant BO, Blake P. Primary malignant melanoma of the vagina. Br J Radiol 1989; 62: 623–624

    Article  Google Scholar 

  63. Moon WK, Kim SH, Hand MC. MR findings of malignant melanoma of the vagina. Clin Radiol 1993; 48: 326–328

    Article  PubMed  CAS  Google Scholar 

  64. 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

    PubMed  CAS  Google Scholar 

  65. McNicholas MMJ, Fennelly JJ, Macerlaine DP. Imaging of primary vaginal lymphoma. Clin Radiol 1994; 49: 130–132

    Article  PubMed  CAS  Google Scholar 

  66. 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

    Article  PubMed  CAS  Google Scholar 

  67. 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

    Article  PubMed  CAS  Google Scholar 

  68. Jones HW III. In: Novak’s Textbook of Gynecology. Malignancies of the Vulva and Vagina. Baltimore, Williams & Wilkins, 1988: 617

    Google Scholar 

  69. 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

    Google Scholar 

  70. Willing SJ, Purcell SH, Koch SR, Tobin GR. Vaginal reconstruction with rectus abdominis myocutaneous flap: CT findings. AJR 1990; 156: 1001–1004

    Google Scholar 

  71. Epstein DM, Arger PH, LaRossa D, et al. CT evaluation of gracilis myocutaneous vaginal reconstruction after pelvic exenteration. AJR 1987; 148: 1143–1146

    PubMed  CAS  Google Scholar 

  72. Brown JJ, Guitierrez ED, Lee JKT. MR appearance of the normal and abnormal vagina after hysterectomy. AJR 1992; 158: 95–99

    PubMed  CAS  Google Scholar 

  73. 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

    Google Scholar 

  74. Glazer HS, Lee JKT, Levitt RG, et al. Radiation fibrosis: differentiation from recurrent tumor by MR imaging. Radiology 1985; 156: 721–726

    PubMed  CAS  Google Scholar 

  75. Walsh JW, Amendola MA, Hall DJ, et al. Recurrent carcinoma of the cervix: CT diagnosis. AJR 1981; 136: 117–122

    PubMed  CAS  Google Scholar 

  76. Sugimura K, Carrington BM, Quirey JM, Hricak H. Postirradiation changes in the pelvis: assessment with MR imaging. Radiology 1990;175: 805–813

    Google Scholar 

  77. 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

    Google Scholar 

  78. 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

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Kostaki G. Bis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas G. Vrachliotis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Shirkhoda
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Wayne State University School of Medicine, Detroit, MI, 48202, USA

    Syed Zafar H. Jafri M.D. (Clinical Associate Professor, Chief) (Clinical Associate Professor, Chief)

  2. Section of Uroradiology, William Beaumont Hospital, Royal Oak, MI, 48073, USA

    Syed Zafar H. Jafri M.D. (Clinical Associate Professor, Chief) (Clinical Associate Professor, Chief)

  3. University of Michigan Medical School, Ann Arbor, MI, 48109, USA

    Ananias C. Diokno M.D. (Clinical Professor of Urology, Chief) (Clinical Professor of Urology, Chief)

  4. Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA

    Ananias C. Diokno M.D. (Clinical Professor of Urology, Chief) (Clinical Professor of Urology, Chief)

  5. Body MRI Section Department of Radiology, University of Miami School of Medicine, Miami, FL, 33101, USA

    Marco A. Amendola M.D. (Professor of Radiology and Radiation Oncology, Chief) (Professor of Radiology and Radiation Oncology, Chief)

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer Science+Business Media New York

About this chapter

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-1648-3_24

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7230-4

  • Online ISBN: 978-1-4612-1648-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation