Imaging of the female pelvis in the evaluation of developmental anomalies

doi:10.1017/CBO9780511527036.011

10 - Imaging of the female pelvis in the evaluation of developmental anomalies

from Part II - Management of developmental abnormalities of the genital tract

Published online by Cambridge University Press: 04 May 2010

Christopher Schelvan ,

Margaret A. Hall-Craggs and

Edited by

Jane MacDougall and

Christopher Schelvan: Affiliation:
UCH Hospital Trusts, London
Margaret A. Hall-Craggs: Affiliation:
UCH Hospital Trusts, London
Rose de Bruyn: Affiliation:
Great Ormond Street Hospital for Children, London
Adam H. Balen: Affiliation:
Leeds Teaching Hospitals, University Trust
Sarah M. Creighton: Affiliation:
University College London Hospitals
Melanie C. Davies: Affiliation:
University College London
Jane MacDougall: Affiliation:
Addenbrooke's Hospital, Cambridge
Richard Stanhope: Affiliation:
Great Ormond Street Hospital

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Summary

Introduction

The use of imaging for the evaluation of developmental anomalies of the female pelvis has rapidly expanded since the 1980s mainly because of the development and availability of imaging technology, particularly high-resolution ultrasound with Doppler, spiral computed tomography (CT) and magnetic resonance imaging (MRI). Imaging is now used in virtually every case to confirm diagnosis or to show the anatomy of the structural abnormalities of the genital tract and other related disorders. Imaging is used extensively for planning the surgical management of the primary condition and any associated complications.

The most commonly used imaging modalities are fluoroscopy (usually with contrast agents), ultrasound and MRI. Each technique has particular advantages and disadvantages, and knowledge of these is important for the appropriate choice of imaging technique. A major consideration when imaging children is the use and dose of ionizing radiation, particularly as many patients are likely to need multiple investigations during the course of their lifetime.

Imaging modalities

Fluoroscopy

Genitograms and micturating cystourethrography are the traditional fluoroscopic methods for evaluating children with disorders of sexual differentiation. All perineal orifices are examined with the catheter inserted only a short distance into the orifice. Contrast is injected gently under direct fluoroscopic screening to allow visualization of the morphology of the urogenital sinus. The important features that are noted include the presence or absence of a vagina, its relationship to the urethra and the level of the external sphincter (which has important surgical implications), and the recognition of a male or female type urethral configuration (Aaronson, 1992).

Information

Type: Chapter
Information: Paediatric and Adolescent Gynaecology
A Multidisciplinary Approach
, pp. 104 - 119

DOI: https://doi.org/10.1017/CBO9780511527036.011 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2004

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References

Aaronson I A (1992). Sexual differentiation, intersexuality. In Clinical Pediatric Urology, 3rd edn, Kelalis P P, King L R, Belman A B, eds., pp. 977–1014. Saunders, Philadelphia, PA

Adams, J, Polson, D W, Abulwahid, N et al. (1985). Multifollicular ovaries: clinical, endocrine features and response to pulsatile gonadatrophin releasing hormone. Lancet ⅱ, 1375–1379CrossRef Google Scholar

Berkovitz, G D, Lee, P A, Brown, T R, Migeon, C J (1984). Etiological evaluation of male pseudohermaphroditism in infancy and childhood. Am J Dis Child 138, 755–759Google Scholar

Carrington, B, Hricak, H, Nuruddin, R N et al. (1990). Mullerian duct anomalies: MR imaging evaluation. Radiology 176, 715-720CrossRef Google Scholar PubMed

Cohen, H L, Ticc, H M, Mandel, F S (1990). Ovarian volumes measures by ultrasound: bigger than we think. Radiology 177, 18CrossRef Google Scholar PubMed

Cohen, H L, Shapiro, M A, Mandel, F S, Shapiro, M L (1993). Normal ovaries in neonates and infants; A sonographic study of 77 patients from 1 day to 24 months old. Am J Roentgenol 160, 583–586CrossRef Google Scholar PubMed

Bruyn, R (1997). Ultrasonagraphy of the normal female pelvis in childhood and adolescence. Imaging 8, 1–9Google Scholar

Demas, B E, Hricak, H, Jaffe, R B (1986). Uterine MR imaging: effects of hormonal stimulation. Radiology 159, 123–126CrossRef Google Scholar PubMed

Doyle, M B (1992). Magnetic resonance imaging in mullerian fusion defects. J Reprod Med 37, 33–38Google Scholar PubMed

Faure C, Garel L (1981). Radiology in intersex states. In Pediatric and Adolescent Endocrinology, Vol. 8, The Intersex Child, Josso N, ed., pp. 40–50. Karger, Basel

Fritzsche, P J, Hricak, H, Kogan, B A, Winkler, M L, Tanagho, E A (1987). Undescended testis: value of MR imaging. Radiology 164, 169–173CrossRef Google Scholar PubMed

Gambino, J, Caldwell, B, Dietrich, R, Walot, I, Kangarloo, H (1992). Congenital disorders of sexual differentiation: MR findings. Am J Roentgenol 158, 363–367CrossRef Google Scholar PubMed

Garel, L, Dubois, J, Grignon, A, Filiatrault, D, Vliet, G, (2001). US of the pediatric female pelvis: a clinical perspective. Radiographics 21, 1393–1407CrossRef Google Scholar PubMed

Golan, A, Langer, R, Bukovsky, I, Capsi, E (1989). Congenital anomalies of the Mullerian system. Fertil Steril 51, 747–755Google Scholar PubMed

Hadjiathanasiou, C G, Brauner, R, Lortat-Jacob, B et al. (1994). True hermaphroditism: genetic variants, clinical management. J Pediatr 125, 738–744CrossRef Google Scholar PubMed

Haynor, D R, Mack, L A, Soules, M R, Shuman, W P, Montana, M A, Moss, A A (1986). Changing appearance of the normal uterus during the menstrual cycle: MR studies. Radiology 161, 459–462CrossRef Google Scholar PubMed

Horowitz, H, Glassberg, K I (1992). Ambiguous genitalia: diagnosis evaluation and treatment. UrolRadiology 14, 306–318Google Scholar

Hricak, H, Alpers, C, Crooks, L E, Sheldon, P E (1983). Magnetic resonance imaging of the female pelvis: initial experience. Am J Roentgenol 141, 1119–1128CrossRef Google Scholar PubMed

Hurst B S, Schlaff W D (1993). Congenital anomalies of the uterus and their treatment. In Congenital Malformations of the Female Reproductive Tract, Verkauf B S, ed., pp. 91–115. Appleton & Lange, Norwalk, CT

Izquierdo, G, Glassberg, K I (1993). Gender assignment and gender identity in patients with ambiguous genitalia. Urology 42, 232–242CrossRef Google Scholar PubMed

Josso, N, Fortier Beaulieu, M, Faure, C (1969). Genitography in intersexual states. Acta Endocrinol165–180Google Scholar PubMed

Kutteh, W H, Santos-Ramos, R, Ermel, L D (1995). Accuracy of ultrasonic detection of the uterus in normal newborn infants: implications for infants with ambiguous genitalia. Ultrasound Obstet Gynecol 5, 109–113CrossRef Google Scholar PubMed

Lee, J K, Gersell, D J, Balfe, D M, Worthington, J L, Picus, D, Gapp, G (1985). The uterus: in vitro MR anatomic correlation of normal and abnormal specimens. Radiology 157, 175–179CrossRef Google Scholar PubMed

Levitt, M A, Stein, D M, Peña, A (1998). Gynaecological concerns in the treatment of teenagers with cloaca. J Pediatr Surg 33, 188–193CrossRef Google Scholar

Lyons, E A, Gratton, D, Harrington, C (1992). Transvaginal sonography of normal pelvic anatomy. Radiol Clin North Am 30, 663–675Google Scholar PubMed

McCarthy, S, Tauber, C, Gore, J (1986). Female pelvic anatomy: MR assessment of variations during the menstrual cycle, with use of oral contraceptives. Radiology 160, 119–123CrossRef Google Scholar PubMed

McGillivray, B C (1992). Genetic aspects of ambiguous genitalia. Paediatr Clin North Am 39, 307–317CrossRef Google Scholar PubMed

Minto, C L, Hollings, N, Hall-Craggs, M A, Creighton, S (2001). Magnetic resonance imaging of complex Mullerian anomalies. Br J Obstet Gynaecol 108, 791–797Google Scholar PubMed

Nahum, G G (1998). Uterine anomalies: how common are they and what is the distribution amongs subtypes?J Reprod Med 43, 877–887Google Scholar

Nussbaum Blask, A R, Saunders, R C, Gearhart, J P (1991). Obstructed uterovaginal anomalies: demonstration with sonography. Part 1 Neonates and infants. Radiology 179, 79–83CrossRef Google Scholar

Outwater, E K, Mitchell, D G (1996). Normal ovaries and functional cysts: MR appearance. Radiology 201, 751–755CrossRef Google Scholar

Page, J (1994). The newborn with ambiguous genitalia. Neonat Netw 13, 15–21Google Scholar PubMed

Pellerito, J S, McCarthy, S M, Doyle, M B, Glickman, M G, Cherney, A H (1992). Diagnosis of uterine anomalies: relative accuracy of MR imaging endovaginal sonography and hysterosalpingography. Radiology 183, 795–800CrossRef Google Scholar PubMed

Peters, H, Himelstein-Braw, R, Faber, M (1976). The normal development of the ovary in childhood. Acta Endocrinol 82, 617–630Google Scholar PubMed

Rouanet de Lavit, J P, Maubon, A J, Thurmond, A S (2000). MR hysterography performed with saline injection and fluid attenuated inversion recovery sequences: initial experience. Am J Roentgenol 175, 774–776CrossRef Google Scholar PubMed

Salardi, S, Forsini, L, Cacciari, E et al. (1985). Pelvic ultrasonography in premenarchal girls: relation to puberty and sex hormone concentrations. Arch Dis Child 60, 120–125CrossRef Google Scholar

Secaf, E, Hricak, H, Gooding, C A et al. (1994). Role of MRI in the evaluation of ambiguous genitalia. Pediatr Radiol 24, 231–235CrossRef Google Scholar PubMed

Seigel, M J (1991). Paediatric gynaecological sonography. Radiology 179, 593–600CrossRef Google Scholar

Tello, R, Tempany, C M, Chai, J, Ainslie, M, Adams, D F (1997). MR hysterography using axial long TR imaging with three-dimensional projections of the uterus. Comput Med Imaging Graph 21, 117–123CrossRef Google Scholar

Togashi, K, Nakai, A, Sugimura, K (2001). Anatomy and physiology of the female pelvis: MR imaging revisited. J Magn Reson Med 13, 842–849Google Scholar PubMed

Wiesner, W, Ruehm, S G, Bongartz, G, Kaim, A, Reese, E, Geyter, C (2001). Three-dimensional dynamic MR hysterosalpingography: a preliminary report. Eur Radiol 11, 1439–44CrossRef Google Scholar PubMed

Williams, D M, Patterson, M N, Hughes, I A (1993). Androgen insensitivity syndrome. Arch Dis Child 68, 343–344CrossRef Google Scholar PubMed

Wright, N, Smith, C, Rickwood, A M K, Carty, H M L (1995). Imaging children with ambiguous genitalia and intersex states. Clin Radio 50, 823–829CrossRef Google Scholar PubMed

Yoder, I C, Hall, D A (1991). Hysterosalpingography in the 1990s. Am J Roentgenol 157, 675–683CrossRef Google Scholar PubMed

Yordam, N, Alikasifoglu, A, Kandemir, N, Caglar, M, Balci, S (2001). True hermaphroditism: clinical features, genetic variants and gonadal histology. J Pediatr Endocrinol Metab 14, 421–427CrossRef Google Scholar PubMed

Zanetti, E, Ferrari, L R, Rossi, G (1978). Classification and radiographic features of uterine malformations: hysterosalpingographic study. Br J Radiol 51, 161–170CrossRef Google Scholar PubMed

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