MRI | Uterus

The Common Vein

Introduction

Indications

Uterine masses

Pelvic pain or vaginal bleeding

Congenital abnormalities

Technique

Cor T2 SSFSE add kidneys

T1 SE or GRE +/- Fat suppression

T2 axial sagittal coronal

Uterine axis

Pre and post gad T1 SPGR FS

Results

Uniform T1 poor tissue contrast

Best seen on T2

endometrium bright

Junctional zone is dark

Myometrium intermediate

T1 with Gadolinium

Pear Shape in both the Sagital and Coronal Planes

The uterus is pear shaped as depicted in this overlay sagital (a,b) and coronal (c,d) T 1weighted enhanced MRI study

STIR

The Uterus in the Sagittal Plane

The sagittal STIR sequence from an MRI study shows the normal appearance of the uterus in a 34 year old female. The pear shaped form is exemplified together with the 3 parts of the uterus. The inner endometrium of intermediate signal, the junctional zone of low signal consisting of compacted smooth muscle with low water content, and the surrounding myometrium of smooth muscle with a higher water content.

Axial Plane Coronal Projection

The axial STIR sequence from an MRI study shows the normal appearance of the uterus in a 34 year old female. Because the uterus is anteverted it lies flat so that in this instance the coronal plane of the uterus is demonstrated. The pear shaped form is exemplified together with the 3 parts of the uterus. The inner endometrium of intermediate signal, the junctional zone of low signal consisting of compacted smooth muscle with low water content, and the surrounding myometrium of smooth muscle with a higher water content. Two high signal cuysts are seen in the right ovary

Thickened Junctional Zone

This T2 weighted MRI of a 41 year old female shows thickened junctional zone of the uterus measuring up to 12 mms characteristic of adenomyosis

Adenomyosis

Thickened Junctional Zone

Enlarged Uterus

This T2 weighted MRI of a 41 year old female shows thickened junctional zone (light maroon) of the uterus measuring up to 12 mms characteristic of adenomyosis

Deformity of the Endometrial CAvity Caused by an Intramural Fibroid

In this sagittal view of the T1 weighted contrast enhanced study of the the uterus of a 46 year old female. The uterus roughly retains its pear shaped structure but the shape of the endometrial cavity is distinctly abnormal as if there is something pushing on it from above. This patient has a diffusely enhancing isointense leiomyoma that impinges on the endometrial cavity.

Large Intramural Fibroid Deforming the Stripe

T2 Weighted Image

In this sagittal view of the T2 weighted MRI of the uterus of a 46 year old female an almost 6cms slightly hyperintense fibroid is seen pushing on the endometrial cavity from above. This patient has a large fibroid aka leiomyoma that impinges on the endometrial cavity.

Fibroid Impingement on the Endometrium

In this sagittal view of a T2 weighted MRI of the uterus of a 42 year old female with multiple fibroids two of which impinge on the endometrial cavity (the larger (light green) from posterior and the smaller (dark green) from anterior resulting in a sigmoid shaped cavity (yellow). In addition incidentally noted Nabothian cysts (orange) are seen within the cervix.

Congenital Anomalies

Two Hemiuteri, Two Cervices and One Vagina

MRI T2 Weighted with FAt Saturation

The MRI is from a 24F year old female with uterus didelphys The T2 weighted study in axial projection reveals 2 uterine corpuses (a) 2 cervices (b), vaginal septum in the upper 1/3 (c) but single distal vagina (d)

Two Hemiuteri, Two Cervices and One Vagina

MRI T2 Weighted

References

Hamm, B Rosemarie Forstner, R, Beinder E MRI and CT of the female pelvis

Hricak, H, Carrington BM. MRI of the pelvis: a text atlas