LAUSR

Radiol Bras. 2017 Jan/Fev;50(1):V–VI Guidelines that review the criteria and technical parameters for indicating and conducting diagnostic imaging can optimize radiology care. In an article published in this issue of Radiologia Brasileira, the criteria established by the American College of Radiology for conducting magnetic resonance imaging (MRI) examinations of the female pelvis were compared with those employed at a national referral center for cancer in Brazil. The results were compatible with those of the renowned American institution and show that MRI was correctly indicated in most (76.7%) of the patients. The authors found that the main indications were as follows: tumor recurrence after resection (25.9%); detection and staging of malignancies (23.3%); and evaluation of pain or pelvic mass (17.1%). There is a well-defined role for MRI in the study of the female pelvis after the initial ultrasound evaluation, as has been amply demonstrated in the literature. When the examination is indicated in the appropriate clinical context, the inherent characteristics of the method (related to its multiplanar capacity, the possibility of tissue differentiations of the pelvic organs, and the absence of ionizing radiation) outweigh its disadvantages (longer examination time, possible motion artifacts, lower availability, and higher costs) when compared with computer tomography. As observed by the authors of the cited study, one of the main indications for MRI of the female pelvis is for the diagnosis or oncological follow-up of primary gynecological lesions. In relation to primary uterine lesions, diffusion-weighted imaging facilitates the identification of tumors in the uterine body and cervix. The use of diffusion-weighted imaging also facilitates the restaging of such tumors after chemotherapy and radiotherapy, as well as allowing the identification of tumor remnants and recurrence. These diagnostic processes tend to be challenging, since actinic and fibrotic alterations, which are typical of these treatments, alter the morphology of the pelvic organs. Still within the field of oncology, MRI is frequently used for the evaluation of adnexal lesions that are considered “indeterminate” in the ultrasound study . The interpretation of an MRI of the female pelvis begins with the characterization of the origin of the pelvic lesion as ovarian or extraovarian. Specifically, when the