MR imaging appearances of the female pelvis after trachelectomy

Abstract

Carcinoma of the cervix has a predilection for affecting young women. In recent years, surgical procedures that combine local radical surgery with maintenance of fertility potential in young women have been investigated. One such procedure is radical trachelectomy with pelvic lymphadenectomy, in which the corpus uteri is preserved, thus maintaining fertility potential. Magnetic resonance (MR) imaging is useful in the selection of suitable patients for trachelectomy and in postsurgical follow-up. The MR imaging findings in 45 patients who underwent trachelectomy at one institution between 1996 and 2004 were retrospectively reviewed. The uterovaginal anastomosis has variable appearances, with an end-to-end anastomotic appearance or a vaginal neofornix seen after surgery; suture artifacts can also occur. Possible changes affecting the vagina include diffuse wall thickening and hematomas, whereas lymphoceles and exaggeration of the pelvic venous plexuses can occur in the pelvis. Adenomyosis and endometriosis may be found incidentally in this patient group. Successful pregnancies after trachelectomy have been reported and should be treated as high-risk pregnancies. Knowledge of these MR imaging appearances will help radiologists distinguish between normal postsurgical variations, benign postsurgical changes, and recurrent disease in patients who have undergone trachelectomy.