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MR Imaging of Carcinoma of the Vulva

¹ Department of Diagnostic Imaging, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom.
² Present address: Academic Department of Diagnostic Radiology, Royal Marsden Hospital, Downs Rd., Sutton Surrey SM2 5PT, United Kingdom.
³ Department of Gynaecological Oncology, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom.

OBJECTIVE. The aim of this study was to describe the MR imaging features of cancer of the vulva and to determine the accuracy of MR imaging in staging the disease.

MATERIALS AND METHODS. We reviewed the MR images of 22 patients (range, 21-85 years; median, 74 years) with cancer of the vulva who were treated at our institution between 1995 and 2000. Note was made of the primary tumor size, site, signal characteristics, enhancement, and local extension and of lymph node number, size, and position. The MR imaging features were correlated with surgical and pathologic findings.

RESULTS. The tumors were isointense to muscle on T1-weighted images and showed intermediate-to-high signal intensity on T2-weighted scans. After IV gadolinium was administered to four patients, tumor enhancement was seen in two (50%). MR imaging correctly staged the primary site in 14 (70%) of the 20 patients. If superficial inguinal nodes 10 mm or greater in short-axis diameter are considered abnormal, then the sensitivity for detection of malignant nodes was 40% and the specificity, 97%. If deep inguinal nodes 8 mm or greater in short-axis diameter are considered abnormal, then the sensitivity for detection of malignant nodes was 50% and the specificity, 100%.

CONCLUSION. MR imaging is highly specific for the detection of nodal involvement in patients with cancer of the vulva but correlates only moderately with clinicopathologic staging of the primary tumor.

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