EDUCATION EXHIBIT 41 MR Imaging Appearances of the Female Pelvis after Trachelectomy 1 Anju Sahdev, MRCP, FRCR ● Jonathan Jones, MRCP, FRCR ● John H. Shepherd, FRCR, FRCOG ● Rodney H. Reznek, FRCP, FRCR 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 in- vestigated. One such procedure is radical trachelectomy with pelvic lymphadenectomy, in which the corpus uteri is preserved, thus main- taining fertility potential. Magnetic resonance (MR) imaging is useful in the selection of suitable patients for trachelectomy and in postsurgi- cal follow-up. The MR imaging findings in 45 patients who underwent trachelectomy at one institution between 1996 and 2004 were retro- spectively reviewed. The uterovaginal anastomosis has variable appear- ances, with an end-to-end anastomotic appearance or a vaginal neofor- nix 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 trache- lectomy have been reported and should be treated as high-risk preg- nancies. Knowledge of these MR imaging appearances will help radi- ologists distinguish between normal postsurgical variations, benign postsurgical changes, and recurrent disease in patients who have un- dergone trachelectomy. © RSNA, 2005 RadioGraphics 2005; 25:41–52 ● Published online 10.1148/rg.251045047 ● Content Codes: 1 From the Department of Radiology, Homerton University Hospital, Homerton Row, London E9 6SR, England (A.S.); the Department of Radiology, St Bartholomew’s Hospital, Barts and the London NHS Trust, London (J.J., R.H.R.); and the Department of Surgical Gynaecology, St Bar- tholomew’s Hospital, London (J.H.S.). Presented as an education exhibit at the 2003 RSNA Scientific Assembly. Received March 17, 2004; revision requested April 14 and received May 10; accepted May 13. All authors have no financial relationships to disclose. Address correspondence to A.S. (e-mail: anju.sahdev@homerton.nhs.uk). © RSNA, 2005 RadioGraphics