Pelvic MRI is a modern non-invasive diagnostic technique that allows you to obtain three-dimensional images of the pelvic organs by registering radio waves emitted by the nuclei of hydrogen atoms under the influence of a magnetic field. Pelvic MRI is used in both women and men. In women, the uterus, ovaries, fallopian tubes and vagina are examined, in men – the prostate gland, vas deferens and seminal vesicles, in both sexes – the lower part of the ureters, bladder, rectum and pelvic tissue.
Pelvic MRI is a complementary and clarifying method. It is used at the final stage, after overview and contrast radiography, ultrasound of the pelvic organs and other studies. Allows you to get the most complete and reliable information about the state of organs and tissues, to clarify the size, localization, structure and prevalence of pathological foci. An MRI of the pelvis is prescribed to clarify the diagnosis, during differential diagnosis, when determining the plan of conservative therapeutic measures or deciding on an operation. In addition, it is used to track the dynamics of the process during treatment and to detect relapses in the long term.
Pelvic MRI in women
Native pelvic MRI in women is used to study the shape, size and disposition of the uterus, vagina, ovaries, fallopian tubes, bladder, rectum, lymph nodes and large blood vessels of this area, as well as to assess the condition of parametral, paravaginal, pararectal and paravesical fiber. Indications are difficulties in the process of diagnosis after standard instrumental and laboratory tests with suspected neoplasms, anomalies of the female genital organs and urinary system, widespread endometriosis and adhesions.
Contrast MRI of the pelvis is used when it is impossible to clarify the diagnosis and make a differential diagnosis based on the information obtained during native MRI. In addition, the procedure is carried out if necessary to determine the number and exact boundaries of pathological foci at the stage of planning surgery, for a more accurate assessment of the condition of lymph nodes, as well as to determine the effectiveness of surgical treatment, radiotherapy and chemotherapy.
Pelvic MRI in men
Pelvic MRI in men allows you to assess the location and structural features of the prostate gland, vas deferens, testicles, penis, bladder, ureters and rectum, assess the condition of the pelvic fiber, detect pathological foci, determine their localization, structure and prevalence. Pelvic MRI is used in case of diagnostic difficulties with injuries, malformations, inflammatory processes, volumetric formations and concretions of the bladder.
MRI of the prostate is performed if inflammatory diseases and oncological lesions are suspected. MR spectroscopy of the prostate is usually performed simultaneously with MRI, the purpose of the study is to identify metabolic disorders characteristic of prostate cancer. MRI urography is used for narrowing and dilation of the urinary tract caused by inflammation, tumor, scar deformity or the presence of concretions.
The list of absolute contraindications to native MRI includes ferromagnetic implants available to the patient, hemostatic vascular clips, implanted electronic devices, Ilizarov apparatus, body weight over 120-130 kg and waist size over 120-140 cm. Tattoos with the use of metal-containing paints can also become an obstacle to MRI. MRI with contrast is not prescribed for individual intolerance to the contrast agent and chronic renal failure.
A relative contraindication to native pelvic MRI is the first half of pregnancy. The procedure is carried out only if there are vital indications, in other cases, the study is transferred to the second half of pregnancy or the postpartum period or replaced with other studies. It is undesirable to prescribe an MRI in the presence of claustrophobia, since staying in the confined space of the camera can provoke a panic attack. The solution to the problem may be the use of an open MRI machine or immersing the patient in a drug-induced sleep for the duration of the study.
Certain difficulties during pelvic MRI occur in patients with hyperkinesis, impaired consciousness and mental disorders that prevent the preservation of immobility and the implementation of specialist instructions. In such cases, medication sleep is also used or MRI is replaced with other methods. The lactation period is a relative contraindication to contrast MRI. The study is allowed if the patient refrains from breastfeeding for two days after it is carried out.
Within 2-3 days before the study, it is recommended to exclude from the diet foods that contribute to increased gas formation (foods with a large amount of coarse fiber, flour, milk, carbonated drinks). On the eve of an MRI of the pelvis, it is necessary to take a laxative or put a cleansing enema. Activated charcoal can be used to reduce the amount of gas in the intestine. 60-30 minutes before the start of the MRI, you need to take an antispasmodic (for example, no-shpu). The study is carried out on an empty stomach. The optimal time for pelvic MRI in women is 6-14 days of the menstrual cycle. If necessary, the procedure is prescribed in the second half of the cycle. During menstruation, the technique is not used. You need to have the results of other studies and extracts from medical records (if available) on hand.
Methodology of conducting
Before the procedure begins, the patient is asked to remove all metal objects: clothes with metal elements, dentures, jewelry, watches, etc. Then the patient is placed on a table, after which the table is moved inside the tomograph. During the MR scan of the pelvic organs, it is necessary to remain motionless. If unpleasant sensations occur, you should inform the doctor about it through the built-in microphone. After the procedure is completed, the patient is informed when it is possible to come for a conclusion, or the conclusion is passed to the attending physician.
Among the advantages of MRI over other studies (radiography, endoscopy) are non-invasiveness, minimal amount of unpleasant sensations during the procedure, the ability to obtain detailed information about the state of all anatomical structures, including the outer surface of hollow organs, lymph nodes and surrounding tissue, as well as the absence of ionizing radiation.
Ultrasound of the pelvic organs and MRI allow us to obtain similar data on the state of the anatomical structures of this area. The distinctive features of both methods are painlessness, non-invasiveness, high information content and absence of radiation exposure. At the same time, ultrasound is widely used at the initial stages of diagnosis, and MRI is prescribed selectively when it is necessary to supplement and clarify the data obtained during ultrasound. The advantages of pelvic MRI are the absence of restrictions in the form of echographic “windows”, wider diagnostic possibilities in the examination of patients with pelvic floor muscle failure, as well as the possibility of conducting a full-fledged study in girls. Despite its high informative value, MRI cannot be considered as a technique capable of replacing other diagnostic procedures.