Jalal Jalal Shokouhi-MD Radiologist, Jam e jam and koorosh medical imaging center General secretary of Iranian society of radiology - President of Iranian radiologic cooperative Hasan Joorabchi-MD OB & GY, Tabriz medical university, Iran Mohammad Hossein Herischi – MD Orthopedist, Baku, Republic Azerbayjan Shahyar Pashaie – PhD Anatomist, Tehran, Iran Dariush Etemadi –MD Radiologist, Koorosh medical imaging center, Tehran, Iran Women's imaging Pelvic pain MRI in chronic pelvic pain (C.P.P.)
1/3 of women pelvic pain in lifetime Most common complain Most difficult to diagnosis and manage 60% (three of five) never find out the cause of their pelvic pain
Women seek help from: Gynecologists Urologists Family practitioners
Pelvic masses
PET/CT technique & imaging issues
Low midline pelvic mass Prolapsing LeiomyomaMucinous Rectal Cancer
Anorectal Mass Prolapsing rectal cancerRectum duplication cyst
Chronic pelvic pain: Any pelvic pain lasting more than six months 1 woman of five women (20% incidence) It is a non specific pain (acute pain may indicate a specific injury) Cause: change in nervous system, tissues or muscles
Sacral teratoma
Sacral Masses Anterior Meningocele Sacrococcygeal chordoma
Signs and symptoms: 1. Severe and steady pain (dull to sharp, mild to severe) 2. Pain that comes and goes (intermittent) 3. Sharp pains or cramping 4. Dull aching 5. Limited physical activity 6. Pressure or heaviness deep within pelvis 7. Painful intercourse 8. Pain when urination and bowel movement 9. Severe cramping during periods 10. Depression and hopelessness and addiction
Accurate diagnosis: Pelvic exam Cultures of excretions Pelvic ultrasound and sonohisterography (TA, TV,TR) Laparascopy X-ray, X-ray CT, CT PET MRI (most accurate)
Causes (Gynecologic) : 1.Endometriosis (asymptomatic, marked pain, possible infertility) 2.Pelvic congestion syndrome 3.Adenomyosis 4.Chronic pelvic inflammatory disease *sexually transmitted organism *pelvic surgery *appendix perforation pain, bleeding, fever, chills if acute 5.Ovarian remnant 6.Fibroids 7.Irritable bowel syndrome 8.Interstitial cystitis (painful bladder syndrome) 9.Vaginal fistula 10.Vesicovaginal fistula 11.Uterovaginal fistula 12.Urethrovaginal fistula 13.Rectovaginal fistula 14.Tumors (benign and malignant) 15.Neuropathic pain 16.Diverticulitis 17.Pelvic floor pain (painful urination, constipation, painful intercourse) 18.Fibromyalgia connective tissue disease, pain and depression Non-gynecologic Bone and joint diseases Muscular Neurogenic
Hemangioma, Pelvis
Hemangiopericytoma Liposarcoma
Pelvic congestion syndrome
Lymphadenopathy
CYSTIC ADENOMYOSIS
ADENOMYOSIS
Cervical cancer
URETHRAL ANATOMY & IMAGING ISSUE
Vaginal fistula
Pelvic MRI: Non-invasive 3 Dimensional (x-y-z) Accurate Gives vital information Uncover, covered conditions Elegant imaging technology Diagnosis and staging Can diagnose pelvic floor lesions T1 - T2 - T1,F.S - T1,GD - 3D,GRE - T1 dynamic - MR lymphangiography MR PET
MUCINOUS CYSTADENOMA
PELVIC FLOOD DESCENT
MR TECHNIQUE & ANATOMY
Interventional treatments: Acupuncture Biofeed back and relaxation therapies Nerve stimulation devices Local anesthesia injection in tender areas Help women who have become dependent on narcotics Fibroid embolization