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      Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making* Translated title: Ressonância magnética da vagina: uma visão geral para os radiologistas, com enfoque na decisão clínica

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          Abstract

          Magnetic resonance imaging is a method with high contrast resolution widely used in the assessment of pelvic gynecological diseases. However, the potential of such method to diagnose vaginal lesions is still underestimated, probably due to the scarce literature approaching the theme, the poor familiarity of radiologists with vaginal diseases, some of them relatively rare, and to the many peculiarities involved in the assessment of the vagina. Thus, the authors illustrate the role of magnetic resonance imaging in the evaluation of vaginal diseases and the main relevant findings to be considered in the clinical decision making process.

          Translated abstract

          A ressonância magnética é um método com alta resolução de contraste e por isso muito utilizada na avaliação de doenças ginecológicas pélvicas. No entanto, seu potencial para diagnóstico de lesões vaginais ainda é subestimado, provavelmente em razão da escassa literatura referente ao tema, da pouca familiaridade dos radiologistas com doenças vaginais, algumas delas relativamente raras, e das muitas peculiaridades em um exame para avaliação desta víscera oca. Desta forma, ilustraremos neste estudo o papel da ressonância magnética na avaliação das doenças vaginais e os principais achados relevantes para a conduta clínica.

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          Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions. Analysis of 42 cases.

          Giant condyloma acuminatum or Buschke-Loewenstein tumor of the anorectal and perianal regions is an uncommon entity that has not been extensively reviewed. We analyzed 42 known cases of giant condyloma acuminatum in the English literature and reviewed their behavior and management. All reported cases of giant condyloma acuminatum in the English literature were selected. The relevant clinicopathologic features of this uncommon entity were examined and discussed. These tumors are generally large with the propensity to ulcerate and infiltrate into deeper tissues. The hallmark of the disease is the high rate of recurrence (66 percent) and malignant transformation (56 percent). No distant metastases have been reported. The overall mortality was 20 percent, all occurring in patients with recurrences. Fifty percent of the patients who were initially treated with radical surgery developed recurrences. The average duration of disease was longer in patients with recurrences than in patients without recurrences (9.6 years vs. 2.8 years). The median number of recurrences was two (range, one to seven) recurrences, and the median time before first recurrence was ten months. Recurrences were treated by radical surgery in 17 patients and chemoradiotherapy +/- local excision in 5 patients. Follow-up information for the remaining five patients was not available. The cure rate in the radical surgery group was 61 percent compared with 25 percent in the chemoradiotherapy +/- local excision group. Giant condyloma acuminatum of the anorectal and perianal regions is a highly aggressive tumor with the propensity for recurrences and malignant transformation, but without metastatic potential. A high rate of recurrence is seen in patients with long duration of the disease. Salvage of patients with recurrences can be achieved successfully with radical surgery.
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            Fistulas of the genitourinary tract: a radiologic review.

            Fistulas of the genitourinary tract have diverse anatomic locations, causes, and clinical features. They can involve the upper urinary tract (kidney, ureter), the lower urinary tract (bladder, urethra), or the female reproductive tract (vagina, uterus). Causes include infection, inflammatory disease, neoplasms, congenital conditions, trauma, and iatrogenic injury. Diagnosis of genitourinary tract fistulas usually requires radiologic studies performed with fluoroscopic or cross-sectional modalities. Fistulography is the most direct means of visualizing a fistula and should be considered when feasible (eg, cutaneous fistulas). Intravenous urography and pyelography or ureterography are mainstays of investigation of the upper tract. Likewise, voiding cystourethrography and urethrography are central to study of the lower tract. Cross-sectional techniques, in particular computed tomography, are increasingly useful for diagnosis and are considered the primary test in some cases. Radiologists should be familiar with the radiologic features of genitourinary tract fistulas for accurate diagnosis and treatment planning. Management approaches depend on the type of fistula, the degree of morbidity, and the overall functional status of the patient and vary from conservative observation to aggressive surgical repair. Copyright RSNA, 2004
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              Imaging of ambiguous genitalia: classification and diagnostic approach.

              Disorders of sex development (DSDs) are congenital conditions in which the development of chromosomal, gonadal, or anatomic sex is atypical. DSDs can be classified broadly into four categories on the basis of gonadal histologic features: female pseudohermaphroditism (46,XX with two ovaries); male pseudohermaphroditism (46,XY with two testes); true hermaphroditism (ovotesticular DSD) (both ovarian and testicular tissues); and gonadal dysgenesis, either mixed (a testis and a streak gonad) or pure (bilateral streak gonads). Imaging plays an important role in demonstrating the anatomy and associated anomalies. Ultrasonography is the primary modality for demonstrating internal organs; genitography is used to assess the urethra, vagina, and any fistulas or complex tracts; and magnetic resonance imaging is used as an adjunct modality to assess for internal gonads and genitalia. Early and appropriate gender assignment is necessary for healthy physical and psychologic development of children with ambiguous genitalia. Gender assignment can be facilitated with a team approach that involves a pediatric endocrinologist, geneticist, urologist, psychiatrist, social worker, neonatologist, nurse, and radiologist, allowing timely diagnosis and proper management.
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                Author and article information

                Journal
                Radiol Bras
                Radiol Bras
                rb
                Radiologia Brasileira
                Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
                0100-3984
                1678-7099
                Jul-Aug 2015
                Jul-Aug 2015
                : 48
                : 4
                : 249-259
                Affiliations
                [1 ]MD, Resident at Service of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil.
                [2 ]Physician Assistants at Service of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil.
                [3 ]PhD, Physician Assistant at Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.
                [4 ]PhD, Head of Unit of Radiology, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil.
                [5 ]Private Docent, Associate Professor, Department of Radiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
                Author notes
                Mailing Address: Dr. Regis O. F. Bezerra. Avenida Doutor Arnaldo, 251, Cerqueira César. São Paulo, SP, Brazil, 01246-000. E-mail: regisfranca@ 123456gmail.com .
                Article
                10.1590/0100-3984.2013.1726
                4567364
                26379324
                143cfb4e-ede9-46b1-912f-8ec48b1229d0
                © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 March 2013
                : 08 May 2014
                Categories
                Iconographic Essay

                magnetic resonance imaging,vagina,tumors,congenital malformations

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