In chronic pelvic inflammatory disease, MRI with T2-weighted imaging may demonstrate edema, fluid collections, and distension of endometrial canal or fallopian tubes [15]. When infection is long standing, distinguishing between inflammatory and neoplastic masses is particularly difficult. Postcontrast T1-weighted imaging and diffusion-weighted imaging are particularly important in this setting [23]. Adhesive disease may be directly evident at MRI as low-signal bands between structures on nonfat saturated T2-weighted imaging or inferred in the presence of peritoneal inclusion cysts [11,15]. Variant 2: Postmenopausal subacute or chronic pelvic pain, clinically suspected pathologies in perineum, vulva, or vagina. Initial imaging. Physical examination is the foundation of clinical evaluation of suspected pathology in the perineum, vulva, or vagina. The evidence supporting the use of imaging procedures in this clinical context largely assumes that the physical examination is abnormal. Radiography Abdomen and Pelvis To our knowledge, there is currently no evidence to support the use of radiography to evaluate postmenopausal subacute or chronic pelvic pain localized to the perineum, vulva, or vagina. US Pelvis Transvaginal Physical examination is the basis of diagnosis for most conditions localized to the vulvar skin [31]. Perineal and vaginal cysts are subcutaneous but often palpable and are appropriately evaluated with either translabial or transvaginal US, or both [8]. As with pelvic pain localized to the deep pelvis, US is widely regarded as the initial imaging study of choice for pelvic pain localized to the perineum, vulva, or vagina, but there is little high-quality evidence specifically supporting its use. Postmenopausal Subacute or Chronic Pelvic Pain US Duplex Doppler Pelvis Color and spectral Doppler are routinely used in pelvic sonography to evaluate internal vascularity of pelvic observations and distinguish cysts from soft tissue.
Postmenopausal Subacute or Chronic Pelvic Pain. In chronic pelvic inflammatory disease, MRI with T2-weighted imaging may demonstrate edema, fluid collections, and distension of endometrial canal or fallopian tubes [15]. When infection is long standing, distinguishing between inflammatory and neoplastic masses is particularly difficult. Postcontrast T1-weighted imaging and diffusion-weighted imaging are particularly important in this setting [23]. Adhesive disease may be directly evident at MRI as low-signal bands between structures on nonfat saturated T2-weighted imaging or inferred in the presence of peritoneal inclusion cysts [11,15]. Variant 2: Postmenopausal subacute or chronic pelvic pain, clinically suspected pathologies in perineum, vulva, or vagina. Initial imaging. Physical examination is the foundation of clinical evaluation of suspected pathology in the perineum, vulva, or vagina. The evidence supporting the use of imaging procedures in this clinical context largely assumes that the physical examination is abnormal. Radiography Abdomen and Pelvis To our knowledge, there is currently no evidence to support the use of radiography to evaluate postmenopausal subacute or chronic pelvic pain localized to the perineum, vulva, or vagina. US Pelvis Transvaginal Physical examination is the basis of diagnosis for most conditions localized to the vulvar skin [31]. Perineal and vaginal cysts are subcutaneous but often palpable and are appropriately evaluated with either translabial or transvaginal US, or both [8]. As with pelvic pain localized to the deep pelvis, US is widely regarded as the initial imaging study of choice for pelvic pain localized to the perineum, vulva, or vagina, but there is little high-quality evidence specifically supporting its use. Postmenopausal Subacute or Chronic Pelvic Pain US Duplex Doppler Pelvis Color and spectral Doppler are routinely used in pelvic sonography to evaluate internal vascularity of pelvic observations and distinguish cysts from soft tissue.