Magnetic resonance imaging in the diagnosis of secondary vaginal tumor involvement

Objective: to estimate the capabilities of magnetic resonance imaging (MRI) in revealing and estimating the extent of secondary vaginal involvement.

Material and methods. Thirty patients with secondary vaginal tumor involvement underwent contrast-enhanced MRI. Examinations were made using a 1.5 T MRI. The protocol encompassed T2- and T1-weighted, diffusion-weighted, and dynamic contrastenhanced MRIs. To smooth out vaginal wall rigosity, the examination was made using an intracavitary MR-compatible applicator.

Results. Vaginal metastatic involvement was detected in 30 patients with sustained malignancies at various sites. The largest group consisted of 16 (53.3%) patients with uterine corpus metastases. Secondary vaginal involvement was observed in 11 36.7%) patients with cervix uteri cancer, in 2 (6.7%) patients with progressive ovarian cancer, and in 1 (3.3%) patients with rectal cancer. With a significant tumor volume giving rise to thickening of the vaginal wall or its impaired slice differentiation, the portion of an inhomogeneously increased MR signal portion during T2-weighted MRI, which intensively accumulated the paramagnetic in an arterial and venous phase of dynamic contrast-enhanced MRI, was detected. There were no T2-weighted images of a hypointense muscular layer and paravaginal fat streaks during an invasive process. In our investigation, vaginal metastatic tumors which were enclosed by the mucous membrane and evident as shallow erosion, as shown by the data of clinical and   рistological examinations, had no specific MRI signs in any of the pulse patterns, which is likely to be associated with the resolution of this technique.

Conclusion. The proposed protocol of comprehensive magnetic resonance imaging makes it possible to clearly localize a tumor process into the vagina and to determine the volume and pattern of involvement in most patients, including whose who have a history of antitumor treatment.

1. Bokhman Ya.V. Guide gynecological oncology. St. Petersburg: Meditsina; 2002 (in Russian).

2. Rubtsova N.A., Novikova E.G., Sinitsyn V.E. The role of diffusionweighted magnetic resonance imaging in the diagnosis of recurrent tumors of the uterus. Radiologiya– praktika. 2012; 4: 41–54 (in Russian).

3. Lopez C., Balogun M., Ganesan R. et al. MRI of vaginal conditions. Clin. Radiol. 2005; 60: 648–62.

4. Taylor M.B., Dugar N., Davidson S.E. et al. Magnetic resonance imaging of primary vaginal carcinoma. Clin. Radiol. 2007; 62 (6): 549–55.

5. Di Donato V., Bellati F., Fischetti M. et al. Vaginal cancer. Crit. Rev. Oncol. Hematol. 2012; 81 (3): 286–95.

6. Blecharz P., Reinfuss M., Jakubowicz J. et al. Effectiveness of radiotherapy in patients with primary invasive vaginal carcinoma. Eur. J. Gynaecol. Oncol. 2013; 34 (5): 436–41.

7. Rubtsova N.A., Novikova E.G. Errors of magnetic resonance imaging in the diagnosis of cervical cancer and endometrial. Luchevaya diagnostika i terapiya. 2013; 3: 71–6 (in Russian).

8. Rubtsova N.A. Magnetic resonance imaging in the diagnosis, planning and evaluation of the effectiveness of treatment of cervical and endometrial cancer. Dr. med. sci. dis. Moscow; 2013 (in Russian).

9. Chang Y.C.F., Hricak H., Thurnher S. et al. Vagina: evaluation with MR imaging. Part 2. Neoplasms. Radiology. 1988; 169: 175–9.

10. Parikh F.H., Barton D.P., Ind T.E. et al. MR imaging features of vaginal malignancies. Radiographics. 2008; 28 (1): 49–63.

11. Thoeny H.C., Ross B.D. Predicting and monitoring сancer treatment response with DW-MRI. J. Magn.Reson. Imaging. 2010; 32 (1): 2–16.

12. Papaioannou G., Koussidis G., Michala L. Magnetic resonance imaging visualization of a vaginal septum. J. Fertil. Steril. 2011; 96 (5): 1193–4.

13. FIGO Committee on Gynecologic Oncology, Staging classifications and clinical practice guidelines for gynecologic cancer. Int. J. Gynecol. Obst. 2000; 70: 207–312.

14. Yagci G., Cetiner S., Dede M. et al. True vaginal metastasis of rectal cancer. Indian. J. Surg. 2005; 67:270–2.

15. Marchal F., Leroux A., Hoffstetter S. et al. Vaginal metastasis revealing colon adenocarcinoma. Int. J. Colorectal. Dis. 2006; 21: 861–2.

16. Filatova E.I. Primary cancer of the vagina. Diagnosis and therapeutic tactics. Prakticheskaya onkologiya. 2006; 7 (4): 228–35 (in Russian).

17. Turkevich G.V. Radiation treatment of primary and metastatic cancer of the vagina. Prakticheskaya onkologiya. 2006; 4: 236–45 (in Russian).

18. ESMO Gynecological Cancer Guidelines. 2014. http://www.esmo.org/clinicalguidelines.

19. Kazumova A.A. Ultrasound diagnosis of tumors of the vagina and vulva: PhD med. sci. dis. Obninsk; 2010 (in Russian).