surgical planning (Fig. 10). The detection of the cervix at MRI is important in these patients, for differentiating between a high transverse septum and congenital absence of the cervix. The surgical procedure of choice for the latter condition is hysterectomy, instead of reconstructive surgery (Walker et al. 2011; López et al. 2005).

4.3\ Vaginal Agenesis

Vaginal agenesis, both complete and partial is rare and may be isolated or associated with other MDAs. The commonest cause is Mayer– Rokitansky–Kuster–Hauser (MRKH) syndrome, presenting with two types. Type 1 is an isolated abnormality, with normal ovaries, fallopian tubes, and external genitalia. Type 2 is associated with urinary tract abnormalities in 40% of cases. Although the diagnosis of vaginal agenesis is primarily made at clinical examination, imaging is often performed, especially in patients who present with a palpable abdominal mass (Walker et al. 2011; Griffin et al. 2010; López et al. 2005).

5\ Benign Conditions

of the Vagina and Vulva

5.1\ Vaginal Cysts

Vaginal cysts are often seen as incidental findings at imaging evaluation. MRI helps in assessing the anatomic location of these cysts and in differentiating them from other regional cystic structures, including periurethral cysts (skene gland cysts), cervical (nabothian) cysts, and urethral diverticula (Walker et al. 2011; Griffin et al. 2010; Hahn et al. 2004; Chaudhari et al. 2010). Vaginal cysts are typically detected as well-delineated lesions, isointense relative to fluid at MRI, with low T1 signal and very high T2 signal. In the presence of proteinaceous, mucinous, or hemorrhagic contents, intermediate to high T1 signal may be seen. Neither the cyst nor its wall normally enhances. Infection should be suggested if there is thickening of the cyst wall or wall enhancement (Fig. 11) (Walker et al. 2011; Griffin et al. 2010; Hahn et al. 2004; Chaudhari et al. 2010).

Fig. 11  Bartholinitis complicated by abscess in a 31-year-old woman presenting with a painful vulvar mass. Axial (a) T2WI, (b) fat-saturated T1WI after gadolinium administration, and (c) ADC map demonstrate a thickwalled cystic mass within the distal right posterolateral vaginal wall (arrow). The lesion is hyperintense on T2WI,

with high signal intensity in the surrounding tissues due to edema and irregular rim enhancement. The presence of a small amount of air (arrowhead) within the mass and significantly restricted diffusion suggests abscess formation (Courtesy Dr. Forstner R, Salzburg, Austria)

5.1.1\ Gardner Duct Cyst (Mesonephric Cyst)

Gartner duct cysts are embryologic secretory retention cysts that arise from incomplete regression of the mesonephric ducts. These cysts typically occur in the anterolateral wall of the upper third of the vagina, above the level of the most inferior aspect of the pubic symphysis. They are detected in 1–2% of female pelvic MRIs. They are usually small, less than 2 cm in diameter and asymptomatic. Occasionally, Gartner duct cysts are seen in association with other Wolffian abnormalities, such as unilateral renal agenesis, renal hypoplasia, and ectopic ureteral insertion. On imaging, differential diagnosis from urethral diverticula is usually not difficult, because diverticula form around the urethra, and Gartner duct cysts are located posteriorly in the vagina (Siegelman et al. 1997; Walker et al. 2011;

Griffin et al. 2010; López et al. 2005; Hahn et al. 2004; Chaudhari et al. 2010).

5.1.2\ Bartholin Gland Cyst

Bartholin glands are small, mucin-secreting glands that derive from the urogenital sinus and are located at the posterolateral vaginal introitus, medial to the labia minora. Bartholin gland cyst formation results from blockage of the drainage duct by a stone or a stenosis related to prior infection or trauma. It represents the commonest vulval cyst predominantly seen in women of reproductive age. These cysts are usually small, 1–4 cm in diameter and asymptomatic, but may require drainage in cases of superimposed infection or abscess formation (Fig. 11). Their typical location in the posterolateral inferior third of the vagina, medial to the labia minora and at or below the level of the pubic symphysis, helps to differentiate