 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