Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis

Introduction

Endometriosis represents an important clinical problem in women of reproductive age with high impact on quality of life, work productivity and health care management. The aim of this study is to define the role of 3 T magnetom system MRI in the evaluation of endometriosis.

Materials and methods

Forty-six women, with transvaginal (TV) ultrasound examination positive for endometriosis, with pelvic pain, or infertile underwent an MR 3.0 T examination with the following protocol: T2 weighted FRFSE HR sequences, T2 weighted FRFSE HR CUBE 3D sequences, T1 w FSE sequences, LAVA-flex sequences. Pelvic anatomy, macroscopic endometriosis implants, deep endometriosis implants, fallopian tube involvement, adhesions presence, fluid effusion in Douglas pouch, uterus and kidney pathologies or anomalies associated and sacral nervous routes were considered by two radiologists in consensus. Laparoscopy was considered the gold standard.

Results

MRI imaging diagnosed deep endometriosis in 22/46 patients, endometriomas not associated to deep implants in 9/46 patients, 15/46 patients resulted negative for endometriosis, 11 of 22 patients with deep endometriosis reported ovarian endometriosis cyst. We obtained high percentages of sensibility (96.97%), specificity (100.00%), VPP (100.00%), VPN (92.86%).

Conclusion

Pelvic MRI performed with 3 T system guarantees high spatial and contrast resolution, providing accurate information about endometriosis implants, with a good pre-surgery mapping of the lesions involving both bowels and bladder surface and recto-uterine ligaments.     

Magnetic Resonance Imaging in the Evaluation of Female Infertility

Pelvic MRI plays an important adjunctive role in the clinical workup of female infertility. Hysterosalpingography is the first line imaging modality in evaluation of female infertility, and hysterosalpingo-contrast sonography can also be used to evaluate both the uterine cavity and fallopian tubes. Pelvic MRI can be helpful in the workup of female infertility, particularly in cases of Mullerian duct anomalies, fibroids, adenomyosis, endometriosis, and tubal disease. These conditions and their appearance on imaging will be reviewed in this article.     

特殊部位异位妊娠的MRI表现

目的:探讨特殊部位异位妊娠的MRI表现及诊断价值。方法:回顾性分析12例经手术病理证实特殊部位异位妊娠的MRI表现,术前均行MRI平扫,其中5例行Gd-DTPA增强扫描。结果:12例中,子宫疤痕妊娠5例,均位于子宫肌壁下段原疤痕处;子宫角妊娠3例(左侧1例,右侧2例);输卵管间质部妊娠2例(左右各1例);左侧卵巢及左侧子宫底部肌壁间妊娠各1例。本组伴发子宫腺肌症4例,腹壁切口子宫内膜异位症1例。MRI显示病灶部位与手术结果基本一致,病灶呈圆形或椭圆形,边界尚清,在T1WI、T2WI及STIR序列上均呈高低混杂信号;增强示病灶明显强化,部分液化坏死区不强化。结论:不同部位异位妊娠的MRI表现具有相同特征,对临床早期明确诊断及治疗有重要价值。     

CT and ultrasonographic findings in a patient with endometriosis of the bladder after cesarean section

We report ultrasonographic and CT findings in a patient with endometriosis of the bladder wall after cesarean section. Endometriosis is defined as ectopic endometrial tissue which responds to the endocrine changes of the menstrual cycle [1]. The incidence of the condition may be as high as 20% of all menstruating women [2]. The most common locations of endometriosis are in the true pelvis, particularly the fallopian tubes and the ovaries. The sacrouterine ligaments and Douglas' cul-de-sac are also frequently affected. Rarer sites of endometriotic implants include the gastrointestinal tract, urogenital organs, and extraabdominal sites. The diagnosis is suggested by the results of modern imaging techniques and the usually typical clinical findings and is confirmed by histopathology of a surgical specimen. The literature contains few reports on ultrasound and computed tomography (CT) findings in patients with endometriosis [3, 4]. Correspondence to: K. W. Preidler     

MR imaging of normal extrinsic wrist ligaments using thin slices with clinical and surgical correlation

Eighty-nine MR examinations of the wrist were retrospectively analyzed. MRI results were compared with clinical findings and/or arthroscopy. Thin proton density and T2 weighted sequences and 3D DESS weighted sequences were applied on a 1.5 T scanner. On the palmar side three radiocarpal ligaments are recognized including the radioscaphocapitate, radiolunotriquetral, radioscapholunate, and midcarpal triquetroscaphoidal ligaments. Ulnocarpal ligaments include the ulnolunate ligament and the ulnotriquetral ligament. On the dorsal side three ligaments are recognized: the dorsal radiolunotriquetral, and the midcarpal triquetroscaphoidal and triquetro-trapezoido-trapezial. The collateral ligaments include the radial and ulnar collateral ligament. MR is a valuable technique in the assessment of the extrinsic and midcarpal ligaments. Depiction of the extrinsic ligaments can best be accomplished with coronal 3D DESS sequences and sagittal and transverse proton density and T2 weighted sequences with thin slices.     

Staging of pelvic endometriosis using magnetic resonance imaging compared with the laparoscopic classification of the American Fertility Society: a prospective study

PURPOSE: To introduce a staging of pelvic endometriosis based on Magnetic Resonance Imaging (MRI) features, compared with the American Fertility Society (AFS) laparoscopic classification. MATERIALS AND METHODS: Thirty-five consecutive females with clinically suspected endometriosis underwent MRI examination using TSE T1, T2W, and SE FAT-SAT T1W sequences, to demonstrate the presence of endometriomas and pelvic implants. Laparoscopy was performed within two weeks (mean 8 days) of the examination. A radiologist experienced in pelvic pathology evaluated the presence of endometriomas and implants and calculated a score to classify endometriosis in four classes, comparable with those of AFS laparoscopic staging. The MRI score was based on size, edges, wall thickness, septations, signal intensity on T2-weighted images of endometriomas and presence of pelvic implants. The concordance between MRI and laparoscopic classification was evaluated using k-statistics. RESULTS: Laparoscopy confirmed 47/48 endometriomas, ranging in size from 10 to 62 mm, detected by MRI, with only one false positive due to an hemorrhagic corpus luteum. Nevertheless, 2 intra-ovarian endometriomas were detected by laparoscopy only thanks MRI guidance. Implants were discovered in 17/30 patients with MRI, laparoscopically in 18/30. MRI detected 46 endometrial implants out of 57 detected by laparoscopy (80.7%): 17/46 implants were directly confirmed by laparoscopy, 29/46 were indirectly confirmed by the presence of adhesions. As regards staging, there was agreement between the MRI and AFS classification in 33/35 patients with only two case of discordance (K= 0,892). CONCLUSIONS: Although MRI has limitations such as suboptimal depiction of small implants and adhesions, this technique is very useful for guiding laparoscopy. Moreover, the high level of agreement (96.6%) between the MRI staging proposed in this paper and laparoscopic classification demonstrates a further advantage of the use of MRI in the preoperative staging of endometriosis.     

Diffuse abdominal and pelvic endosalpingiosis: A case report

Endosalpingiosis is defined as the ectopic location of benign ciliated tubal epithelium outside of the fallopian tubes. It is a rare entity that was previously regarded as an incidental finding on pathology, and is becoming more prevalent within the medical literature. Diagnosis is made based on histologic sampling. There are no specific radiological features but commonly reported findings include numerous cystic and solid masses scattered throughout the pelvis. Common ectopic locations seen on imaging include the serosa of the uterus, fallopian tubes, ovaries and the pelvic cul-de-sac. Less common locations include the bladder wall, omentum, bowel serosa, and skin. We present the clinical presentation of a patient with histologically proven endosalpingiosis. Atypical imaging findings and correlative histology are also reviewed.     

子宫肌瘤的低场MRI诊断

目的 :探讨低场MRI对子宫肌瘤的诊断价值。方法 :对 16例子宫肌瘤患者行MRT1 WI和T2 WI多方位扫描。结果 :14例B超和DSA表现支持MRI诊断 ,2例为子宫阔韧带肌瘤而手术证实。肌瘤在低场MRT1 WI上表现等信号和T2 WI上表现为特征性低信号。结论 :低场MRI对子宫肌瘤在观察大小、形态、位置与子宫腔的关系和肌瘤在定性方面上有较高的诊断价值     

MRI在MRKH综合征诊断中的应用价值

目的：分析 MRK H 综合征的 MRI影像学特征,探讨 MRI在 MRK H 综合征临床诊断中的应用价值。方法回顾性分析经临床或手术证实为 MRKH 综合征的18例 MRI影像学特征。所有患者均行1.5T 或3.0T MRI 检查。患者取仰卧位,使用相控阵线圈对其进行检查。由2位经验丰富的放射科医生对所得 MRI图像进行评估并达成共识。评估内容包括阴道、子宫、卵巢的位置、形态,以及扫描范围内盆腔内的任何异常。结果18例中,除1例无子宫,1例为单侧(左侧)始基子宫,余16例均可见双侧始基子宫;33个始基子宫中,4个始基子宫分化成3层结构,即子宫内膜、结合带和肌壁。除1例双侧卵巢形态异常外,余17例患者双侧卵巢形态、大小及信号未见明显异常。所有患者阴道及宫颈缺如,其中1例阴道区可见囊性液体信号。结论 MRI在 MRK H综合征的明确诊断中发挥重要作用,可对患者手术方案的选择起指导作用。     

MR hysterosalpingography in a rabbit model

Our objective was to evaluate the efficacy of MR imaging as compared with conventional hysterosalpingography (HSG) for the detection of fallopian tube patency after uterine injection of contrast material. Rabbit uterine horns (n = 18) were catheterized transvaginally. Five fallopian tubes were ligated and 11 were left unaltered. T1-weighted gradient-echo MR images were obtained before, during, and after injection of 1.0–3.0 mL of a dilute gadolinium-containing contrast agent. Corresponding conventional studies were performed with an equivalent volume of iohexol. Images were evaluated by two blinded readers. Observers agreed in all cases on the presence (n = 11) or absence (n = 5) of peritoneal spill with conventional HSG. Interpretation of MR HSG concurred with conventional HSG in 14 of 16 cases for each observer (P > .05). Reasons for misdiagnosis included small amounts of spill (n = 2), artifact (n = 1), and subtle spill between bowel loops (n = 1). Sensitivity and specificity for MR HSG were 95.5% and 70%, respectively, for the diagnosis of tubal patency/occlusions. No statistical difference was found between MR HSG and conventional HSG for the diagnosis of fallopian tube patency/obstruction. Potential advantages of MR HSG include no ionizing radiation, potentially diminished local contrast toxicity, superior visualization of uterine fibroids and endometriosis, and visualization of ovaries. We conclude that this technique warrants further study, including the use of a primate model to better simulate human anatomy.     

Assessment of ovarian movement on consecutive pelvic MRI examinations in patients with gynaecological malignancies: what is the planning organ-at-risk volume for radiotherapy?

Objectives The aims of this study are to assess the extent of ovarian movement on consecutive MRI examinations in patients with gynaecological malignancies and to define potential safety volumes around the ovaries that may avoid ovarian ablation during pelvic irradiation. Methods Patients with cervical, vaginal and endometrial cancer who underwent MRI examinations of the pelvis before and during radiotherapy were included in the study. The position of the ovaries was retrospectively determined on two consecutive axial and sagittal T(2) weighted MRI examinations of the pelvis. Ovarian movement was determined in craniocaudal, anteroposterior and mediolateral directions. Safety volumes were calculated by computing elliptical volumes based on the derived 95% and 99% reference intervals. Results 30 patients with a gynaecological malignancy were included. Both ovaries could be identified on the MRI examinations in all cases. The safety volumes around the ovaries encompassing 95% and 99% of ovarian movement were 11 and 25 cm(3) (95%), and 24 and 54 cm(3) (99%), for the left and right ovary, respectively. Conclusion Adding a safety volume around the ovaries may reduce the high radiation dose to the ovaries. This could potentially avoid ovarian ablation, reducing significant fertility morbidity.     

Case report: A case of polypoid endometriosis: MR pathological correlation

We report a case of polypoid endometriosis and correlate the MRI findings with the pathological findings. The polypoid endometriosis appeared as multiple polypoid masses protruding into the adjacent pelvic organs, including the uterus and rectum. The masses were found to show hyperintensity on T(2) weighted images, which was similar to the signal intensity of the uterine endometrium, reflecting the presence of abundant endometrial-type glands. The masses were also surrounded by hypointense rim-like structures on T(2) weighted images. These structures were confirmed by pathology to correspond with fibrous tissues arising from endometriosis. These features, together with an intense enhancement similar to the adjacent uterus, may be a diagnostic clue to this rare entity.     

脊柱后侧韧带群损伤的MRI诊断

目的探讨急性期胸腰椎外伤病人脊柱后侧韧带群(PLC)损伤的MRI表现及其临床意义.方法回顾分析60例急性期胸腰椎外伤病人MRI,观察PLC损伤与各型脊柱骨折的关系及其MRI表现.结果PLC损伤共20例(33%).屈曲压缩型骨折、爆裂型骨折及脱位型骨折PLC损伤的发生率分别为21%、38%及70%.MRI表现为正常低信号韧带中断,局部呈斑片状短T1、长T2或中等T1、长T2信号.PLC损伤以棘上韧带最好发(19例),其次为棘间韧带(18例)、黄韧带(7例)及椎小关节囊(4例).18例病人为两种或两种以上韧带同时损伤.结论MRI可以明确脊柱外伤时有无PLC损伤以及明确PLC损伤的范围和程度.     

正常颅颈交界区韧带结构的影像研究

目的 探讨颅颈交界区(CCJ)韧带结构的影像特点,优化该区域韧带的检查方法 及序列.方法 各选取51名健康志愿者,分别行CT和MR检查.分析CCJ韧带结构的CT和MRI表现,并由2名高年资影像医师比较T1WI、T2WI、质子密度加权像(PDWI)、T2*WI、短时反转恢复序列(STIR)及质子密度加权脂肪饱和序列(PDFSAT)对CCJ韧带的显示效果.对原始数据进行标准正态秩变换,然后进行重复测量方差分析.结果 CT和MRI均能清晰显示除寰枕前膜(仅在MRI上显示)以外的CCJ韧带结构及其毗邻结构,其中MRI更具优势.寰枕前膜在MRI上显示率为100%(51/51),齿突尖韧带在CT和MRI上显示率分别为29.4%(15/51)、43.1%(22/51),寰枕后膜-硬膜复合体、覆膜-硬膜复合体、横韧带及翼状韧带在CT和MRI上的显示率均为100%(51/51).2名医师对于PDWI的评分结果 M均为5.0分,差异无统计学意义(F=0.000 P>0.05);PDWI明显高于T1WI(M=3.0分)、T2WI(M=3.0分)、T2*WI(M=1.0分)、STIR(M=1.0分)及PDFSAT(M=3.0分),P值均<0.01.结论 MRI在显示CCJ韧带结构方面优于CT,PDWI为CCJ韧带的最佳MR成像序列.通过对正常CCJ韧带的影像学研究,能够为该区各韧带病变的诊断和治疗提供客观依据.     

15例子宫平滑肌瘤MRI征象分析

目的：通过手术病理对照，分析了１５例子宫产滑肌瘤的ＭＲＩ表现。探讨子宫平滑肌瘤的ＭＲＩ征象及诊断意义，材料与方法：１５例患者包括单发者１０例，多发者５例，ＭＲＩ检查采用Ｄｉａｓｏｎｉｃｓ０．３５Ｔ超导成像系统，行横断面和／或矢状面Ｔ１、Ｔ２加权成像，观察ＭＲＩ对子宫肌瘤的定位及定量价值，总结其信号变化规律。结果：ＭＲＩ共发现病灶３５个，病灶发现率８７．５％（手术发现４０个），包括浆膜下１０个，肌内     

Mayer-Rokitansky-Kuster-Hauser syndrome: US aid to diagnosis

The Mayer-Rokitansky-Kuster-Hauser syndrome is composed of vaginal atresia with other variable Müllerian duct abnormalities such as bicornuate or septated uterus. The fallopian tubes, ovaries, and broad and round ligaments are normal. Unilateral renal and skeletal anomalies are associated in 50% and 12% of cases, respectively. Patients have a normal female karyotype and normal secondary sexual development. Previously, one had to rely on radiographic contrast studies and surgical exploration for accurate definition of the reproductive tract anatomy. The authors performed ultrasound (US) examinations on 12 patients, aged 5 days to 18 years, with the Mayer-Rokitansky syndrome. US allowed correct identification of the genitourinary anomalies found in these girls, including eight cases of unilateral renal agenesis; one absent, one rudimentary, and ten duplicated or obstructed uteri; eight duplicated or obstructed vaginas; and associated complications such as endometriosis. Eight of the patients had lower abdominal pain, often cyclical in nature. The findings demonstrate that high-resolution, real-time US in conjunction with water vaginography permits the anatomy of these complex anomalies to be defined.     

膝关节损伤的MR应用价值

目的 :分析膝关节损伤的MR表现并评价其应用价值。方法 :选择 60例经临床或手术证实的膝关节损伤患者 ,回顾性分析、总结其MR表现。采用 1 .0TMR扫描机 ,常规应用矢状位 ,SET1 W、T2 W ,冠状位T1 W、T2 W成像。结果 :2 9例半月板损伤 ,其中Ⅰ° 1 0例 ,Ⅱ°1 2例 ,Ⅲ°7例 ;前交叉韧带损伤 1 8例 ,撕裂 2 2例 ;后交叉韧带损伤 7例 ,撕裂1例 ;内侧侧副韧带损伤 2 8例 ,撕裂 1 7例 ;外侧侧副韧带损伤 1 2例 ,撕裂 9例 ;韧带损伤表现为韧带不同程度增粗 ,但韧带连续性仍然存在 ,正常低信号内出现不规则高信号影 ,韧带撕裂表现为韧带明显增粗 ,呈弥漫性高信号 ,韧带的连续性部分或完全中断 ;股骨下端或胫骨上端骨质损伤 9例 ;关节积液 54例 ;多种损伤可同时出现。结论 :MR检查可很好显示膝关节损伤的各种表现 ,可作为膝关节损伤检查的重要或首选手段     

MR imaging of the female pelvic region.

Magnetic resonance (MR) imaging is a valuable technique for noninvasive evaluation of the female pelvic region. This article presents the normal anatomy and abnormalities of the female pelvis. MR imaging may be more useful than clinical evaluation or other imaging modalities in diagnosing or staging developmental anomalies, leiomyomas, adenomyosis, endometrial or cervical carcinoma, vaginal neoplasms, ovarian cysts, endometriosis, teratomas, polycystic ovaries, or other ovarian masses. It could potentially replace laparoscopy as a more useful tool in the diagnosis of uterine anomalies. MR imaging is generally capable of helping determine whether a pelvic mass is uterine or adnexal in origin and may be used to characterize some adnexal masses. In some cases, MR imaging is used to differentiate recurrent disease from posttreatment fibrosis, which aids in treatment planning.     

Inferior Mesenteric Artery Collaterals to the Uterus during Uterine Artery Embolization: Prevalence,Risk Factors,and Clinical Outcomes

PurposeTo evaluate the prevalence of inferior mesenteric artery (IMA) collaterals to the uterus found during uterine artery embolization (UAE), associated risk factors, and clinical outcomes.Materials and MethodsThe records of 559 women who underwent UAE during the period 2008–2011 for uterine fibroids or adenomyosis found on magnetic resonance imaging were retrospectively analyzed. If IMA collaterals to the uterus were suspected on aortography performed after embolization, selective angiography was performed. Risk factors for IMA collaterals to the uterus were analyzed, including the presence of adenomyosis, baseline uterine volume, or prior pelvic surgery.ResultsCollaterals to the uterus were found from the ovarian artery (n = 21; 3.8%), IMA (n = 7; 1.3%), round ligament artery (n = 1; 0.2%), and internal pudendal artery (n = 1; 0.2%). IMA collaterals were found in seven patients. Of 185 patients, 6 (3.2%) had adenomyosis, with or without fibroids, which was significantly more frequent than the 1 (0.27%) of 374 patients who had fibroids only (P = .006). On multiple logistic regression analysis, the presence of adenomyosis (odds ratio, 19.556; P = .0168) and uterine volume (odds ratio, 1.003; P = .0069) were independent factors for the presence of IMA collaterals. Of the seven patients with IMA collaterals, embolization was not attempted in six, resulting in clinical failure in four. One patient who underwent IMA embolization with coils experienced clinical improvement.ConclusionsThe IMA was the second most common (1.3%) source of collaterals to the uterus. IMA collaterals were more frequent in patients with adenomyosis than in patients with fibroids only, resulting in high frequency of treatment failure.     

Inguinal endometriosis attaching to the round ligament

We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm x 2.5 cm mass in the right inguinal canal and a 5.4 cm x 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location.