Teaching objectives: - to describe role of MRI findings in the assessment of uterine fibroids; - to review FIGO classification of uterine fibroids; - to provide examples of uterine myoma subtypes; - to indicate the advantages of MRI in imaging of leiomyomas. Review of the topic: Uterine fibroids present the most common benign gynecologic tumours, which arise from smooth muscle cells of the myometrium. They are hormonally dependent tumours, often multiple and asymptomatic. When they occur, symptoms include abnormal uterine bleeding, pain, dysmenorrhea, infertility, or symptoms related to mass effect. Ultrasound presents an initial method, which can be sufficient especially in small and well defined masses. However, MRI provides accurate location, type, number and potential complications of myomas. Furthermore, MRI is effective in case of significant uterine enlargement and presents the problem-solving tool in case of fibroid mimics. Non-degenerated leiomyomas have typical MRI features which include well circumscribed lesions, homogenous iso- or mildly hypointense on T1W and hypointense on T2W MR images (relative to the myometrium). They are hypointense on DWI and ADC maps. After administration of gadolinium, myomas often show early homogenous enhancement similar to the myometrium. Degeneration of leiomyoma include cystic, hemorragic, fatty, hyaline and myxoid changes. The FIGO classification system for uterine fibroids provides uniform assessment and reporting of the localization of myomas. Conclusion: Uterine leiomyomas are frequently seen in clinical practice. Although the US usually presents the initial and most widely available imaging modality, evaluation of myoma is more accurate with MRI. Due to its high tissue resolution and larger field of view, it allows precise localization and characterization of uterine myomas, as well as differentiation from its mimics. Using the FIGO classification system provides a uniform approach in evaluation of uterine fibroids and better communication between radiologists and physicians.

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MRI is very useful in the diagnosis of the most common renal masses.

Endometriosis is a chronic disease presenting with a wide range of symptoms and manifestations. Imaging plays a crucial role in the diagnosis of this disease, and, in particular, MRI allows an accurate evaluation of the different features of endometriosis.

Pelvic floor disorders usually prevail in female population, but also in men can lead to debilitating pathologies with a significant reduction of quality of life. Causes can be patient related, iatrogenic (postsurgical /postradiation), traumatic or due to a pathological increase of abdominal pressure. Posterior compartment disorders are quite similar to the female counterpart, while anterior compartment diseases are more sex-specific. In male the most frequent disorders occur after prostate cancer treatment, such as post-prostatectomy urinary incontinence and erectile dysfunction. Pelvic floor muscles (puborectalis and ischiocavernosus) play important roles in the regulation of continence and erectile mechanisms and can be well detected by MR Defecography. This imaging technique is frequently used in studying female pelvic floor disorders but less performed in male pathologies despite its evident value, in this contest. MR study provides important anatomic and functional information about pelvic floor muscles, quantifying post-surgical and post-radiation changes, helping in the planning of repair treatment. Muscular structures integrity is evaluated as well as a quantification of pelvic organ descent is reported, using specific male pelvic floor landmarks.

Pelvic venous congestion syndrome (PVCS) is a common and still overlooked cause of chronic pelvic pain (CPP). Other symptoms, yet aspecific, of PVCS include dyspareunia, dysmenorrhea, and urinary urgency. The etiology of PVCS includes, to name a few, pelvic venous insufficiency (PVI), retro-aortic left vein, Nutcracker syndrome and May-Thurner syndrome. Currently, there is no consensus on diagnostic algorithms, nor the treatment management of PVCS. Ultrasonography (US) is considered the first line imaging study; the criteria proposed by Coakley can be used for its diagnosis with Computed Tomography (CT) and Magnetic Resonance (MR) with time resolved imaging (TRI). Venography remains the gold standard but invasive and normally reserved for patients who are selected for interventional treatment.

Ovarian cancer is the gynecological cancer with the highest mortality. In most cases it is diagnosed at an advanced stage, when the tumor is already spread throughout the peritoneum. The only prognostic factor that improves survival in patients with ovarian cancer is complete cytoreduction (R0). To assess whether this resection is feasible, the most effective imaging study, with the best correlation with the results of surgery, is whole-body MRI with diffusion weighted sequences (WB-DW-MRI). The aim of this work is to provide a practical and complete guide so that any radiologist can confidently perform a study of good diagnostic quality as well as a complete report that contains all the relevant information so that an appropriate decision can be made on the management of the patient.

Hematometrocolpos is the accumulation of blood products within uterine cavity and vagina because of anatomical outflow obstruction to menstrual blood passage. Vaginal septum is an important aetiology of obstruction amenable to surgical correction, among other causes such as imperforate hymen and distal vaginal atresia.However, the visualisation of vaginal septum in conventional MRI or ultrasound can be challenging due to lack of contrast between the septum and adjacent vaginal soft tissue. Gel instillation is used to achieve vaginal distension for better delineation for vaginal septum for surgical planning. We present companion cases of pelvic MRI assessment of vaginal septum, with and without vaginal gel instillation, to illustrate the optimized visualisation of vaginal septum with gel usage. Surgical and pathological correlation regarding fibrous nature of vaginal septum characteristics were addressed.