Fig. 7

A 69-year-old woman with bladder adenocarcinoma status post transurethral resection receiving adjuvant pelvic external beam RT. Routine follow-up pelvic MRI demonstrates widening of the cervix and thickening of the anterior and posterior vaginal fornices with increased T2 signal intensity on axial and sagittal T2 TSE (dashed and solid white arrows respectively in a and c). Also note diffuse thickening and increased T2 signal in the rectum (R). Axial and sagittal T1 fat-saturated gradient echo images (c) after gadolinium injection also depict the findings (dashed arrows, R). Note pelvic free fluid (F), stranding and oedema in the pelvis. Follow-up pelvic MRI obtained 3 months later show similar but improving findings in the cervix (dashed arrows) and vagina (solid arrows) on axial (d) and sagittal (e) T2 TSE sequences consistent with acute radiation cervicitis and vaginitis. Note worsening radiation proctitis (R) with increasing pelvic free fluid (F). Bladder wall thickening and increased T2 signal (B) was felt to be due to radiation cystitis in this patient post resection, although residual or recurrent tumour could have a similar appearance