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MR Imaging of Carcinoma of the Vulva

S. A. Aslam Sohaib1,2, Polly S. Richards1, Thomas Ind2, Arjun R. Jeyarajah3, John H. Shepherd3, Ian J. Jacobs3 and Rodney H. Reznek1

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.



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  		Fig. 1. —75-year-old woman with carcinoma of vulva that measured 3 x 2 cm with less than 2-mm depth of invasion that was not visualized on MR imaging. Axial T2-weighted fast spin-echo MR image fails to show tumor.

 


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  		Fig. 2. —21-year-old woman with carcinoma of vulva. Axial T2-weighted fast spin-echo MR image shows 3-cm tumor (arrow) arising from right labia.

 


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  		Fig. 3. —75-year-old woman with large central carcinoma of vulva (straight arrow) involving clitoris (curved arrow). Axial T2-weighted fast spin-echo MR image shows intermediate-signal-intensity tumor extending to involve clitoris.

 


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  		Fig. 4. —75-year-old woman with carcinoma of vulva with left superficial inguinal lymph node metastases. Axial T2-weighted fast spin-echo MR image shows enlarged left superficial inguinal lymph node (arrow).

 


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  		Fig. 5. —58-year-old woman with carcinoma of vulva and bilateral femoral node metastases. Axial T2-weighted fast spin-echo MR image shows bilateral 8-mm femoral lymph nodes (arrows).

 


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  		Fig. 6. —Scatter diagram shows relationship between size of lymph nodes (short-axis diameter) in benign and malignant nodes for inguinal and femoral groups of nodes. Note that although malignant nodes are larger, there is considerable overlap in size between benign and malignant lymph nodes.

 


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  		Fig. 7. —Receiver operating characteristic curve shows relationship between sensitivity and specificity for deep (femoral, {blacktriangleup}) and superficial (inguinal, •) nodes at different size (short-axis diameter) threshold criteria. Note that using size as criterion for malignant nodes results in high specificity but poor sensitivity.

 

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