Role of Magnetic Resonance Imaging in The Evaluation of Female Genital Tract Pathologies: A Prospective Cross-Sectional Study With Histopathological

Abstract

Background

Female genital tract disorders encompass a broad spectrum of congenital, benign, inflammatory, and malignant conditions that frequently present with overlapping clinical manifestations. Although ultrasonography remains the initial imaging modality, Magnetic Resonance Imaging (MRI) offers superior soft-tissue contrast, multiplanar capability, and excellent lesion characterization, making it the preferred imaging modality for comprehensive pelvic evaluation.

Objective

To evaluate the role of magnetic resonance imaging in the diagnosis and characterization of female genital tract pathologies and to compare MRI findings with histopathological diagnosis or clinical follow-up whenever available.

Materials and Methods

A prospective cross-sectional study was conducted in the Department of Radiodiagnosis, VMKV MCH Salem Tamilnadu. One hundred female patients referred for MRI evaluation of suspected gynecological diseases were included. Pelvic MRI was performed using a 1.5-Tesla Siemens MRI system with standard pelvic imaging protocol, including T1-weighted, T2-weighted, diffusion-weighted imaging (DWI), ADC mapping, susceptibility-weighted imaging (SWI), and contrast-enhanced sequences following intravenous gadolinium administration. MRI findings were correlated with histopathological diagnosis whenever available and with clinical diagnosis and treatment response in remaining cases.

Results

Among 100 patients, the highest proportion belonged to the 31–40 years age group (30%). Cervical carcinoma was the most common pathology (16%), followed by endometrial carcinoma (13%), uterine fibroids (12%), ovarian carcinoma (11%), ovarian cystic lesions (10%), adenomyosis (7%), congenital anomalies (7%), miscellaneous lesions (7%), endometriosis (5%), uterine polyps (4%), while MRI findings were normal in 11% of patients.

Lower abdominal pain (44.3%) was the commonest presenting complaint followed by abnormal uterine bleeding (28.4%), anorexia (22.1%), weight loss (22.1%), pregnancy failure (17.6%) and vaginal discharge (9.6%).

Among uterine fibroids, intramural fibroids constituted 50% of cases. Of the ovarian lesions, 75% were benign whereas 25% were malignant. Among malignant female genital tract neoplasms, cervical carcinoma accounted for 40%, endometrial carcinoma for 32.5%, and ovarian carcinoma for 27.5%.

MRI demonstrated excellent lesion characterization, precise anatomical localization, accurate staging of malignant lesions, and superior assessment of lesion extent and tissue characterization.

Conclusion

MRI is an excellent comprehensive imaging modality for evaluating female genital tract diseases owing to its superior soft tissue contrast, multiplanar capability, and high diagnostic accuracy. It provides reliable differentiation between benign and malignant lesions, accurately evaluates congenital anomalies, facilitates staging of gynecological malignancies, and significantly contributes to treatment planning.