Imaging the Female Pelvis: When Should MRI be Considered?

Jennifer Hubert, MD; Diane Bergin, MD


Appl Radiol. 2008;37(1):9-24. 

In This Article


Ultrasound remains the frst line of imaging for the female pelvis, with high diagnostic accuracy rates for uterine and ovarian abnormalities. MRI should be considered for the evaluation of adnexal pathology when sonographic characteristics are not defnitive to determine whether an adnexal mass is ovarian in origin and to determine the likelihood of malignancy. MRI has an established role in the pre- and post-procedural assessment for uterine artery embolization, diagnosis of adenomyosis, staging of known endometrial and cervical carcinoma, evaluation of suspected müllerian ductal anomalies, and presurgical workup for pelvic floor prolapse. Other indications not discussed here include assessment of the pregnant patient with acute pelvic pain and of fetal anatomy. In most cases, fetal anatomy is well evaluated by ultrasound, but MRI can play a role in problem solving. For the acute pelvis and when there is a concern for acute appendicitis, the role of MRI has yet to be established. Beyond the period of organogenesis, CT may be considered. Within the period of organogenesis, however, MRI is a safe alternative, and limited studies to date have shown promising results.


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