Non-neoplastic diseases of the fallopian tube: MR imaging with emphasis on diffusion-weighted imaging.

Pietro Valerio Foti,Saveria Spadola,Pietro Milone,Giovanni Carlo Ettorre,Stefano Palmucci,Renato Farina,Noemi Ognibene,Rosario Caltabiano

doi:10.1007/s13244-016-0484-7

Pietro Valerio Foti, Saveria Spadola + Show 6 more

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ObjectiveWe illustrate the magnetic resonance imaging (MRI) features of non-neoplastic tubaric conditions.BackgroundA variety of pathologic non-neoplastic conditions may affect the fallopian tubes. Knowledge of their imaging appearance is important for correct diagnosis. With recent advances in MRI, along with conventional MR sequences, diffusion-weighted imaging (DWI) sequences are available and may improve lesion characterization by discriminating the nature of the content of the dilated tube. Tubal fluid with low signal intensity on T1-weighted images, high signal intensity on T2-weighted images and no restricted diffusion on DWI is indicative of hydrosalpinx. Content with high signal intensity on T1-weighted images and restricted diffusion on DWI is suggestive of hematosalpinx associated with endometriosis or tubal pregnancy. A dilated tube with variable or heterogeneous signal intensity content on conventional MR sequences and restricted diffusion on DWI may suggest a pyosalpinx or tubo-ovarian abscess. We describe morphological characteristics, MR signal intensity features, enhancement behaviour and possible differential diagnosis of each lesion.ConclusionMRI is the method of choice to study adnexal pelvic masses. Qualitative and quantitative functional imaging with DWI can be of help in characterization of tubaric diseases, provided that findings are interpreted in conjunction with those obtained with conventional MRI sequences.Teaching Points• Nondilated fallopian tubes are not usually seen on MR images.• MRI is the method of choice to characterize and localize utero-adnexal masses.• MRI allows characterization of lesions through evaluation of the fluid content’s signal intensity.• DWI in conjunction with conventional MRI sequences may improve tissue characterization.• Pelvic inflammatory disease is the most common tubal pathology.

Highlights

A wide variety of pathologic non-neoplastic conditions may affect the fallopian tubes, including common conditions such as pelvic inflammatory disease (PID), or uncommon ones such as isolated tubal torsion
Multiplanar magnetic resonance imaging (MRI) can be useful in characterizing female pelvic disease, because it is capable of identifying normal ovaries, demonstrating the tubular C- or S-shaped cystic nature of tubaric lesions, and differentiating pyosalpinx from hematosalpinx by characterizing the signal intensity of the tubal fluid [1, 2]
Diffusionweighted imaging is an evolving technology with the potential to improve tissue characterization when findings are interpreted in conjunction with those obtained with other conventional MR imaging sequences [5]

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Introduction

A wide variety of pathologic non-neoplastic conditions may affect the fallopian tubes, including common conditions such as pelvic inflammatory disease (PID), or uncommon ones such as isolated tubal torsion. Multiplanar magnetic resonance imaging (MRI) can be useful in characterizing female pelvic disease, because it is capable of identifying normal ovaries, demonstrating the tubular C- or S-shaped cystic nature of tubaric lesions, and differentiating pyosalpinx from hematosalpinx by characterizing the signal intensity of the tubal fluid [1, 2].

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