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Figure 24. Periurethral cyst. (a, b) Sagittal T2weighted turbo spin-echo (4900/120) image (a) and axial
T2-weighted turbo spin-echo (4900/120) image (b) demonstrate the cystic mass (arrow). (c) Color Doppler US
image demonstrates the vascularity surrounding the periurethral cyst (arrows).
Nabothian Cysts
Nabothian cysts are common, benign lesions seen
on the surface of the cervix. They are presumed
to be inflammatory inclusions created when cervical mucous glands are obstructed after new tissue
regenerates on the cervix after childbirth. They
are also commonly found in menopausal women
whose cervix has thinned with age. Less frequently, nabothian cysts are associated with
chronic cervicitis.
Most nabothian cysts are a few millimeters in
diameter and asymptomatic, although in rare
cases they can enlarge and become symptomatic.
Ordinarily, most cases are not treated because the
cysts are entirely benign; however, excision biopsy
is sometimes indicated in large, complex, cystic
lesions to rule out rare forms of mucus-producing
neoplasia, including adenoma malignum. Symptomatic nabothian cysts can occur as a late complication of subtotal hysterectomy, in which internalization of the transformation zone and partial
obliteration of the canal are postulated as predisposing factors (56).
Nabothian cysts are a common finding at
transvaginal US and MR imaging. These lesions
demonstrate a wide variety of sizes on transvaginal US images. On T2-weighted MR images,
nabothian cysts have characteristic high signal
intensity.
Conclusions
The purpose of this article was to describe the
transvaginal US and MR imaging appearances of
conditions that can cause chronic pelvic pain.
These gynecologic conditions have often been
overlooked and underdiagnosed in the past.
Transvaginal US is not completely reliable for
diagnosis unless the examination is performed
meticulously with use of color and power Doppler
analysis for evaluation of the myometrial focal
abnormalities. In contrast, MR imaging is objective, highly accurate, and not operator dependent.
Thus, it is often appropriate to perform MR imaging to make the definitive diagnosis. Radiologists familiar with the clinical, pathologic, and
radiologic characteristics of the underlying causes
of chronic pelvic pain will be able to make an accurate diagnosis in most cases and facilitate referral for appropriate therapy.
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This article meets the criteria for 1.0 credit hour in category 1 of the AMA Physician’s Recognition Award. To obtain
credit, see accompanying test at http://www.rsna.org/education/rg_cme.html.