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MR Imaging in Pelvic Inflammatory Disease: Comparison with Laparoscopy and US

¹ Departments of Radiology (T.A.T., H.J.A., P.T.K.)
² Obstetrics and Gynecology (P.M., J.P.)
³ Pathology (T.P.), Helsinki University Central Hospital and Haartman Institute, Haartmaninkatu 4, FIN-00290 Helsinki, Finland.

View larger version (184K): [in a new window]   Figure 1a. Patient 13. Images in a 15-year-old girl with salpingitis. (a) T2-weighted axial oblique MR image (5,600/132) shows the fluid-filled tube. A small amount of liquid in the tube (arrow) lying on the right ovary has high signal intensity. (b) Sagittal T2-weighted MR image (4,100/99) shows a polycystic-like ovary (arrow). (c) Laparoscopic verification shows salpingitis and enlarged ovaries. The fallopian tube (*) is edematous, especially the fimbriae (black arrow). The tube has been lifted up from the ovary (white arrow).

View larger version (195K): [in a new window]   Figure 1b. Patient 13. Images in a 15-year-old girl with salpingitis. (a) T2-weighted axial oblique MR image (5,600/132) shows the fluid-filled tube. A small amount of liquid in the tube (arrow) lying on the right ovary has high signal intensity. (b) Sagittal T2-weighted MR image (4,100/99) shows a polycystic-like ovary (arrow). (c) Laparoscopic verification shows salpingitis and enlarged ovaries. The fallopian tube (*) is edematous, especially the fimbriae (black arrow). The tube has been lifted up from the ovary (white arrow).

View larger version (96K): [in a new window]   Figure 1c. Patient 13. Images in a 15-year-old girl with salpingitis. (a) T2-weighted axial oblique MR image (5,600/132) shows the fluid-filled tube. A small amount of liquid in the tube (arrow) lying on the right ovary has high signal intensity. (b) Sagittal T2-weighted MR image (4,100/99) shows a polycystic-like ovary (arrow). (c) Laparoscopic verification shows salpingitis and enlarged ovaries. The fallopian tube (*) is edematous, especially the fimbriae (black arrow). The tube has been lifted up from the ovary (white arrow).

View larger version (187K): [in a new window]   Figure 2a. Patient 11. Images in a 35-year-old woman with a bilateral pyosalpinx. (a) T2-weighted axial oblique MR image (5,600/132) shows a bilateral pyosalpinx (arrows). The dilated tubes have high signal intensity. The walls are slightly thicker than those in salpingitis (Fig 1a) but are not irregular. (b) Sagittal STIR MR image (6,500/60/150) shows a small amount of free pelvic fluid (arrow) and layering (arrowheads) in the high-signal-intensity pyosalpinx. (c) Laparoscopic verification shows both pus-filled, dilated fallopian tubes (arrows).

View larger version (155K): [in a new window]   Figure 2b. Patient 11. Images in a 35-year-old woman with a bilateral pyosalpinx. (a) T2-weighted axial oblique MR image (5,600/132) shows a bilateral pyosalpinx (arrows). The dilated tubes have high signal intensity. The walls are slightly thicker than those in salpingitis (Fig 1a) but are not irregular. (b) Sagittal STIR MR image (6,500/60/150) shows a small amount of free pelvic fluid (arrow) and layering (arrowheads) in the high-signal-intensity pyosalpinx. (c) Laparoscopic verification shows both pus-filled, dilated fallopian tubes (arrows).

View larger version (96K): [in a new window]   Figure 2c. Patient 11. Images in a 35-year-old woman with a bilateral pyosalpinx. (a) T2-weighted axial oblique MR image (5,600/132) shows a bilateral pyosalpinx (arrows). The dilated tubes have high signal intensity. The walls are slightly thicker than those in salpingitis (Fig 1a) but are not irregular. (b) Sagittal STIR MR image (6,500/60/150) shows a small amount of free pelvic fluid (arrow) and layering (arrowheads) in the high-signal-intensity pyosalpinx. (c) Laparoscopic verification shows both pus-filled, dilated fallopian tubes (arrows).

View larger version (142K): [in a new window]   Figure 3a. Patient 25. Images in a 48-year-old woman with abscess. (a) T1-weighted axial oblique MR image (792/14) shows a low-signal-intensity abscess with thick, irregular walls (arrows). Asterisk indicates the uterus. (b) On the T2-weighted MR image (5,600/132), the abscess has high signal intensity. Typical, irregular walls (arrowheads) can be easily detected because of high-signal-intensity fluid.

View larger version (165K): [in a new window]   Figure 3b. Patient 25. Images in a 48-year-old woman with abscess. (a) T1-weighted axial oblique MR image (792/14) shows a low-signal-intensity abscess with thick, irregular walls (arrows). Asterisk indicates the uterus. (b) On the T2-weighted MR image (5,600/132), the abscess has high signal intensity. Typical, irregular walls (arrowheads) can be easily detected because of high-signal-intensity fluid.

View larger version (128K): [in a new window]   Figure 4a. Patient 15. Images in a 48-year-old woman with tubal torsion. (a) T1-weighted axial oblique MR image (792/14) shows a tubal torsion (arrows) with high signal intensity. (b) On the T2-weighted MR image (5,600/132), the tubal torsion has high signal intensity and layering (arrow). (c) US scan shows the tube (arrows). (d) Laparoscopic verification of torsion (arrow).

View larger version (127K): [in a new window]   Figure 4b. Patient 15. Images in a 48-year-old woman with tubal torsion. (a) T1-weighted axial oblique MR image (792/14) shows a tubal torsion (arrows) with high signal intensity. (b) On the T2-weighted MR image (5,600/132), the tubal torsion has high signal intensity and layering (arrow). (c) US scan shows the tube (arrows). (d) Laparoscopic verification of torsion (arrow).

View larger version (146K): [in a new window]   Figure 4c. Patient 15. Images in a 48-year-old woman with tubal torsion. (a) T1-weighted axial oblique MR image (792/14) shows a tubal torsion (arrows) with high signal intensity. (b) On the T2-weighted MR image (5,600/132), the tubal torsion has high signal intensity and layering (arrow). (c) US scan shows the tube (arrows). (d) Laparoscopic verification of torsion (arrow).

View larger version (98K): [in a new window]   Figure 4d. Patient 15. Images in a 48-year-old woman with tubal torsion. (a) T1-weighted axial oblique MR image (792/14) shows a tubal torsion (arrows) with high signal intensity. (b) On the T2-weighted MR image (5,600/132), the tubal torsion has high signal intensity and layering (arrow). (c) US scan shows the tube (arrows). (d) Laparoscopic verification of torsion (arrow).

View larger version (150K): [in a new window]   Figure 5a. Patient 19. Images in a 24-year-old woman with an endometrioma. (a) T1-weighted axial oblique MR image (792/14) shows a high-signal-intensity endometrioma (*). (b) US scan shows that the content of the endometrioma (*) is homogeneous. (c) Cytologic sample from peritoneal lavage. Cells from the endometrium are clustered in a papillary form.

View larger version (136K): [in a new window]   Figure 5b. Patient 19. Images in a 24-year-old woman with an endometrioma. (a) T1-weighted axial oblique MR image (792/14) shows a high-signal-intensity endometrioma (*). (b) US scan shows that the content of the endometrioma (*) is homogeneous. (c) Cytologic sample from peritoneal lavage. Cells from the endometrium are clustered in a papillary form.

View larger version (136K): [in a new window]   Figure 5c. Patient 19. Images in a 24-year-old woman with an endometrioma. (a) T1-weighted axial oblique MR image (792/14) shows a high-signal-intensity endometrioma (*). (b) US scan shows that the content of the endometrioma (*) is homogeneous. (c) Cytologic sample from peritoneal lavage. Cells from the endometrium are clustered in a papillary form.