List of Contents
MRI of the Pelvis (the Genitourinary Organs)
In our Institute for Preventive Medicine in Witten the whole-body magnetic resonance tomography provides high resolution anatomical and functional imaging of the organs, tissues and structures of the pelvis (the genitourinary organs).
In the following, we give you an exemplary overview of possible anatomical abnormalities or illnesses within this part of the body.
Genitourinary Organs of Women
The whole-body MRI is important in disease monitoring of the female genitourinary organs:
The frequently occurring myomas in the uterus can be visualised. They are benign tumors of the smooth muscles of this hollow organ. Myomas are asymptomatic in most cases.
The smallest precursors of cervical cancer can be detected. There are strong MRI signals in these areas. For further diagnosis and therapy your attending gynaecologist will initiate appropriate measures.
The endometrium – the uterine lining – dresses the uterus. There the fertilized egg nests for further development. A morbid thickening and irregular, signal-rich structure in the MRI can indicate an endometrial carcinoma. The use of an intravenous contrast agent helps to improve the quality of diagnostically conclusive images.
The ovaries which are arranged in pairs lie in the so-called small basin. Cysts (ovarian cysts) often form here. Their occurrence is cycle-dependent. Some of them are self-restrained. But rarely, these cysts have to be surgically removed. Early stages of ovarian tumors can be detected during the whole-body MRI and may be measured for further diagnosis.
In addition, in this section we look at the condition of the urinary bladder, which is responsible for the urine storage. Polyps (bulges of the bladder wall) can be visualised in the bladder. In addition, inflammations of the bladder and also bladder carcinomas (or their precursors).
The stabilizing tissue that keeps the abdominal and pelvic organs on the spot is the pelvic floor. MRI is also a useful tool for visualising changes in its musculature.
The inguinal canal in the front abdominal cavity is formed by muscle sheaths (fascia) and can have a weak spot. In this case inguinal hernias can occur. The peritoneum in this area imposes through the abdominal wall. An inguinal canal weakness can be shown very well in the whole-body MRI. If there is a weak spot, we will advise you to contact your attending physician for further diagnosis or therapy.
Genitourinary Organs of Men
Benign enlargement of the prostate gland (benign prostatic hyperplasia) is common in males from 50 years of age. Due to the enlargement of the gland, it may impair urination to a variable extent. In early stages, this can be treated with medication. In the case of very severe suffering pressure, urologists recommend a TURP (transurethral prostate resection = removal of the prostate as part of a minimally invasive surgery).
Tumor-induced changes in the prostate tissue and the nearby lymph nodes can also be detected with the help of diffusion-weighted and high-resolution sequences in the MRI. In many cases, taking biopsy samples can be avoided. In addition to the regular measurement of the PSA value, your urologist will work together with other specialists to initiate a suitable therapy concept for you.
In addition, the MRI provides information about the state of the seminal vesicles which are situated in pairs underneath the bladder floor (no semen is produced here, but only accompanying seminal fluid). Changes in their tissue structure, such as those caused by bleeding, can be visualised.
Furthermore, we provide information about the urinary bladder. At this point, however, we would like to mention a special muscular thickening of the bladder wall. It occurs when muscle mass is built up because the constriction of the urethra due to the enlarged prostate. In this case a higher pressure is required to drain the urine.
Testicles and epididymis are visualised in the MRI with regard to their blood circulation as well as monitoring signs of inflammatory processes. Contrast media administration is useful here. They usually show a homogeneous and signal-rich structure in the MRI. MRI images also provide evidence of testicular tumors detected at an early stage.
Lymph Node Diseases
The medical term lymph means clear water. The almost transparent lymph, which supplies cells with nutrients, drains tissues and transports metabolic degradation products, cell and foreign objects (bacteria and viruses), runs in the lymph pathways, which are similar to a whole-body road network. The lymph nodes form the crossing points of the lymph pathways. These have an important function in the body’s immune defense: if pathogens enter the body, their surface is analyzed and the information is passed on to the immune cells in order to attack the bacteria or viruses and destroy them. This is the reason why lymph nodes can swell in an immune reaction. After the infection has subsided, they resume their normal size.
It is very important that the earliest stages of benign or malignant lymphoma can be diagnosed. If these are caused by a malignant tumor, they are also referred to as malignant lymphomas (Hodgkin’s and Non-Hodgkin’s lymphomas). However, metastases-induced enlargements of the lymph nodes can also appear because of other tumors.
In addition, the questionable structural changes of the lymph nodes occur through lymphadenitis. This is an inflammation of the lymph nodes, which can be caused by viruses or bacteria. The MRI images offer detection of acute or chronic disease patterns or the direct infection of the nodes by special pathogens.
Free fluid in the area of the pelvis and the genitourinary organs is often an indirect sign of various diseases.
The peritoneum consists of two layers, one of which lines the abdomen from the inside and the second encloses a part of the internal organs. The peritoneum produces liquid and can also absorb it. The movement of the internal organs against each other can be carried out smoothly due to the peritoneum.
However, a pancreatic tumor can lead to the release of an abnormal amount of liquid which we can visualise in the abdominal or pelvic area (ascites).
Furthermore, liver cirrhosis or heart failure (cardiac weakness) can be the trigger for the peritoneal ascites.
MRI is also a comprehensive tool for monitoring peritoneal carcinosis – a metastases-induced infiltration of the abdominal cavity.
The lumbar spine consists of five vertebrae separated by discs. These have primarily a buffer function to soften load influences on the spine. They consist of a fibre-containing ring and a soft, gelatinous core. Due to misconduct or overload or age-related wear, the discs can deform and protrude into the spinal cord, or even the outer rings rupture and the inner mass enters the spinal canal. In this case, nerve roots can be irritated, which can lead to considerable pain mostly radiating into the legs. In the latter case it’s the so-called prolapse or herniated disc, but a disc protrusion is often asymptomatic.
MRI imaging is also a useful tool to depict disease-related bone marrow processes. We measure and analyze cell losses of the bone marrow due to anaemia or the morbid proliferation of blood cells in leukaemia.
During the medical check-ups, the smallest changes of the spinal cord can already be detected providing accurate further diagnosis.
The sacroiliac joint establishes the connection between the sacral and the iliac bone.
This articulated connection is visualised by MR imaging. This is very important with regard to the inflammatory-rheumatic Bechterew’s disease, which is characterized by a slow disease processing. It causes severe discomfort over a long period of time.
This is how we gain important data about the typical symptoms and progression of this disease, which can be used interdisciplinary for further diagnosis and therapy.
Untreated, Bechterew’ s disease can lead to long-term stiffening of the spine and sacroiliac joint.
With the whole-body MR imaging we also aim at supporting early detection and better treatment of hip joint disorders.
The high-resolution MRI images reveal whether the two hip joints are already affected by osteoarthritis. Osteoarthritis is a wear disorder that does not only occur within older patients. Due to lack of exercise, overweight, imbalances, obesity and injuries, cartilage degradation can occur in the joint. Patients suffer from joint pain, and joint inflammations are formed. Bone grinds on bone without being buffered by the cartilage.
Osteoarthritis in the initial stage is very well controlled by targeted therapeutic movement, so that patients can master their daily routine.
Arthritis is an inflammatory hip disorder that is noticeable by classical inflammatory signs such as swelling of the joint, redness or warmth. The causes of inflammation can be very different. By means of MRI, different distinct inflammatory stages can be visualised. In particular, the so-called Coxitis fugax (the irritable hip), which was not diagnosable before making use of MRI, can be depicted safely.
A femoral head necrosis is a circulatory disorder of the hip head, wherein part of the bony portion can degenerate and thereby leave the hip head in an abnormal shape. In case of findings at an early stage, the attending orthopaedist can stop disease progression, for example, by bone-cartilage graft surgery. Early detection helps to maintain the hip.
An osteopenia of the hips might be a precursor of osteoporosis. The changes in bone density are clearly shown on the MRI images. The earlier these pathological changes of the hip bone are detected, the better the subsequent therapy works.
Femoro-acetabular impingement (FAI): There is a mechanical problem between the femoral head and the acetabulum. We differentiate between:
- Pincer-FAI: The discomfort is caused by an oversized femoral head canopy.
- Cam-FAI: Bony anomalies of the hip bone in the vicinity of the joint cause the discomfort.
The space between both parts is too narrow, therefore the joint lip or the cartilage can be pinched during movement, pain in the inguinal canal and in the hip joints arises. Damage to the joint lip or of the cartilage can be revealed with the help of the MRIs.
Bursitis inflammations are perfectly visualised in the MRI. They may be the cause of hip pain. Athletes are often affected by bursitis inflammation due to the overload of the hips. Since the bursae are partly covered by hip muscles, an inflammation can be easily differentiated from the healthy tissue by means of the multilayer technique.