Pitfalls in staging uterine neoplasm with imaging: a review

This review analyzes current pitfalls in pretreatment staging of endometrial and cervical carcinoma with magnetic resonance imaging (MRI) based on a critical review of the literature. Technical, patient, and tumor-related characteristics were analyzed to improve further staging of uterine neoplasm with MRI. For endometrial carcinoma staging, contrast-enhanced dynamic imaging appears essential to avoid false-positive findings for deep myometrial invasion by better delineating tumor from normal myometrium. However, leiomyomas, adenomyosis, and grade 3 tumors provide difficulties in staging for pathologists and radiologists. Slice orientation perpendicular to the long axis of the cervical channel might improve false-negative findings for deep stromal invasion on T2-weighted images in endometrial and cervical cancer. Contrast-enhanced sequences do not improve diagnosis of parametrial or vaginal invasion in cervical cancer. Assessment of lymph node invasion by any imaging modality has limited sensitivity in detecting lymph node metastasis smaller than 5 mm. Knowledge of diagnostic criteria is critical to avoid false-negative findings for bladder wall invasion. Higher spatial resolution with dedicated multichannel pelvic phase array coils, smaller fields of view and section thickness, and careful comparison of T2-weighted and contrast-enhanced sequences are strategies that might avoid misinterpretation of pelvic MRI in staging uterine neoplasm.     

超声造影在子宫平滑肌瘤诊断中的初步应用

目的探讨子宫平滑肌瘤的超声造影特征并与其他病变相鉴别.方法采用SonoVue造影剂结合新型CPS实时超声造影技术,对45例子宫肌瘤及子宫腺肌瘤的超声造影过程进行观察.结果超声造影诊断子宫肌瘤71个,其中经超声造影检出5个二维及彩色多普勒未能发现的小肌瘤,所有病例均经手术后病理检查或临床随访证实.子宫肌瘤造影表现为注入造影剂后可见肌瘤周边首先出现造影剂增强呈环状,然后内部迅速充盈;消退时肌瘤中央先消退,周边仍呈环状增强,然后周边逐渐消退.子宫腺肌瘤的造影表现与子宫肌瘤不相同,其特点为注入造影剂后可见多支较粗大的短线样增强信号自病灶周边伸入内部,未见周边环状增强.结论超声造影显示子宫肌瘤的血流灌注具有一定特征性,据此可为子宫肌瘤的诊断及鉴别诊断提供重要依据.     

In vitro uterine strain imaging: preliminary results.

OBJECTIVE: Uterine abnormalities, such as leiomyomas, endometrial polyps, and adenomyosis, are often clinically associated with irregular uterine bleeding. These abnormalities can have similar B-mode characteristics but require different treatment. The objective of this study was to develop diagnostic techniques based on ultrasound strain imaging that would allow in vivo visualization and characterization of endometrial and myometrial uterine abnormalities, enabling physicians to improve diagnosis and treatment. METHODS: Ultrasound strain imaging was performed on 29 uteri removed via elective hysterectomy. An ultrasound system with a linear array transducer was used to obtain radio frequency echo data during manual freehand compressions of the tissue. Radio frequency data were post-processed with a 2-dimensional block-matching algorithm to generate strain images. RESULTS: In the uteri involved in this study, there were 19 leiomyomas, 1 case of adenomyosis, and 3 endometrial polyps observed on strain imaging. Leiomyomas appeared stiffer than the surrounding normal myometrium in strain images and were characterized by a slipping artifact at their boundary. Endometrial polyps appeared softer than the normal surrounding myometrium. The average strain contrast in small leiomyomas (<1.5 cm) compared to the myometrium was 1.75 +/- 1.14; the strain contrast was 2.50 +/- 1.15 in large leiomyomas and 0.40 +/- 0.05 in endometrial polyps. Leiomyoma strain contrast results were consistent with modulus contrast values from mechanical testing results. CONCLUSIONS: Ultrasound strain imaging can differentiate between endometrial polyps and leiomyomas. More data are necessary to validate these results and to ascertain whether other uterine abnormalities can also be differentiated.     

子宫肌瘤和局限型腺肌病超声弹性图像特征分析

目的探讨经阴道超声弹性成像应用于子宫肌瘤和局限型腺肌病诊断中的可行性及其价值。方法回顾性分析经手术后病理证实的50例子宫肌瘤患者(60枚肌瘤)和15例子宫局限型腺肌病患者(15处腺肌病病灶)的经阴道超声弹性图像,以及病灶与正常肌层间的顺应性比值(B/A)。结果 60枚肌瘤与正常肌层的B/A为1.05~10.40,平均3.13±1.80;15处局限型腺肌病病灶与周围正常肌层的B/A为0.32~0.83,平均0.52±0.15。肌瘤与正常肌层B/A、局限型腺肌病病灶与正常肌层B/A比较差异有统计学意义(P=0.00)。结论经阴道超声弹性成像能较准确地反映子宫常见疾病的硬度变化,肌瘤硬度大于正常肌层,腺肌病的硬度小于正常肌层,在子宫疾病的鉴别诊断中有一定的应用前景。     

MR imaging of benign uterine disease

MR provides excellent depiction of the female pelvic anatomy and has become the imaging modality of choice for the accurate diagnosis of numerous benign gynecologic conditions. Detection and characterization of leiomyomata and adenomyosis is performed routinely at many centers, and MR plays an important role in stratifying patients into appropriate treatment options. MR imaging is also uniquely well suited to the evaluation of gynecologic conditions that occur during pregnancy and in the postpartum period. This article describes MR protocols and the typical findings of various benign conditions of the uterine corpus and cervix, including congenital anomalies, leiomyomas, adenomyosis, and complications related to pregnancy.     

MRI用于子宫腺肌病和子宫月肌瘤鉴别诊断的临床研究

目的:了解子宫腺肌病、子宫肌瘤的MRI影像学表现及特征性征像,以进一步提高MRI对两者鉴别诊断的临床指导价值。方法:回顾性分析经手术病理证实的子宫腺肌病、子宫肌瘤各40例病例的MRI影像学表现,并对各种常见征像进行统计学分析。结果:子宫腺肌病和子宫肌瘤在病灶数目、部位、分布等征像差异均有统计学意义(P<0.05)。结论:病变中有5个观察指标最能提示为子宫肌瘤,其中前3个征像为子宫肌瘤特有征象。MRI对子宫腺肌病和子宫肌瘤的临床鉴别诊断具有重要指导价值。     

Androgen-producing, atypically proliferating endometrioid tumor arising in endometriosis

A case of androgen-secreting borderline endometrioid tumor arising in endometriosis of the rectovaginal septum is presented. It occurred 10 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy for extensive endometriosis of the fallopian tubes and ovaries, adenomyosis, and leiomyomas of the uterus. We believe 7 years of unopposed continuous oral estrogen replacement therapy contributed to the malignant transformation of the endometriosis.     

Magnetic resonance imaging of the female pelvis

Evaluation of pelvic pathology is an important part of most radiology practices. Magnetic resonance imaging (MRI) has proven itself to be a useful and cost-effective method in evaluating many of these diseases. This article reviews appropriate MR imaging techniques and findings of common gynecologic disorders. Uterine pathology is categorized into congenital anomalies, benign lesions (leiomyomas, adenomyosis, endometrial polyps, and nabothian cysts), and malignancies (endometrial and cervical carcinoma). Adnexal pathology reviewed includes endometriosis, polycystic ovaries, teratomas, and benign and malignant ovarian epithelial tumors.     

High-risk stress fractures

High-risk stress fractures require precise assessment and treatment because of their propensity for delayed union, nonunion, or complete fracture and their resulting disabling complications. Proper diagnosis necessitates a thorough clinical evaluation, centering on the patient's diet and history, particularly the training regimen. For a definitive diagnosis, plain radiography, ultrasound, bone scintigraphy, magnetic resonance imagery (MRI), and computed tomography (CT) are helpful, and each plays a specific role. High-risk stress fractures typically require aggressive treatment such as nonweight-bearing immobilization coupled with therapy and often surgery.     

子宫肌瘤与子宫腺肌病的CT鉴别诊断

鉴于子宫肌瘤与子宫腺肌病的鉴别诊断困难，故本文评估了CT对这两种疾病的鉴别诊断价值，本组31例病例均为手术和病理所证实，研究结果表明：CT术前对子宫肌瘤和子宫腺肌病的确诊率分别为86％和80％，在CT影像上，子宫肌瘤大多有较明确的边界，但子宫腺肌病没有明确边界，而是呈现点状或斑片状强化区，结论是：CT对这两种疾病的鉴别具有很高的应用价值。     

Gynecologic applications of MRI

Gynecologic anatomy is consistently depicted with MRI. Abnormal developmental anatomy is also well assessed. In cases of complete or partial vaginal agenesis where ultrasound is equivocal, MRI can be definitive. The various subtypes of uterine anomalies are well delineated with MRI. MRI is the optimal technique in the therapeutic evaluation of leiomyomas, because the number, size, location, and degeneration can be documented. It is particularly useful in the identification of the ovaries in the presence of an enlarged leiomyomatous uterus. Adenomyosis, an often neglected diagnosis, is distinguishable from leiomyomas. In the setting of an equivocal ultrasound, MRI is useful in discerning whether a mass is ovarian or uterine in origin. Endometriosis, a disease routinely diagnosed and staged by laparoscopy, does have a typical MR appearance and therefore can usually be differentiated from other adnexal masses. Dermoids are readily diagnosed with MRI. Other adnexal masses do not have a specific MR appearance and morphologic criteria as used with ultrasound or CT must be relied upon in suggesting whether or not the mass is benign or malignant. MRI is the procedure of choice in the staging of cervical and endometrial cancer.     

Spectrum of imaging findings on MRI and CT after uterine artery embolization

Uterine artery embolization (UAE) is an effective treatment for symptomatic uterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis, and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post-UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE-associated common and uncommon MRI and CT appearances and discuss post-UAE complications that require urgent medical or surgical intervention.     

Adenomyosis:common and uncommon manifestations on sonography and magnetic resonance imaging.

OBJECTIVE: The purpose of this presentation is to show the imaging findings of the common and uncommon variants of adenomyosis as seen on sonography and magnetic resonance imaging (MRI). METHODS: A 3-year database search was performed to identify women who had pelvic sonography and pelvic MRI within a 6-month interval. Images of these cases were retrospectively reviewed. RESULTS: Eighty women were identified. Adenomyosis was diagnosed on MRI, which was used as the reference standard, in 45 of these women. The correct diagnosis was made on sonography in 73% of the cases. CONCLUSIONS: Awareness of the spectrum of imaging features of adenomyosis is important to use sonography effectively for diagnosing this entity and to help avoid misdiagnosis.     

Intrauterine cystic adenomyosis:Report of two cases

BACKGROUND Cystic adenomyosis is a special type of adenomyosis. Its clinical manifestations lack specificity. Pelvic ultrasound and nuclear magnetic resonance imaging can help clarify the diagnosis. Because cystic uterine adenomyosis is rare in clinical work, it can be easily misdiagnosed or its diagnosis can be missed. Early surgical treatment and postoperative drug treatment can alleviate dysmenorrhea,menorrhagia, anemia, and other symptoms.CASE SUMMARY Two cases complained about abnormal vaginal bleeding and were diagnosed with intrauterine cystic adenomyosis by gynecological ultrasound and pathological examination. The clinical manifestations included dysmenorrhea,hypermenorrhea, and a history of cesarean section. Both cases underwent a surgery, and chocolate-like liquid was released from the cystic mass in the uterus and the manifestations were relieved.CONCLUSION Intrauterine cystic adenomyosis could be diagnosed by pathological examination and treated by hysterectomy or hystscopy to release the liquid inside.     

脊柱结核的诊断与治疗现状

脊柱结核是常见的肺外结核,占全身骨与关节结核的一半以上,其诊断主要依靠影像学检查、实验室检查和临床表现。若能早期诊断与治疗脊柱结核,即可避免畸形和瘫痪的发生。CT、MRI扫描在早期诊断中具有重要价值。目前脊柱结核的治疗分为非手术治疗和手术治疗,前者是治疗的基础,后者包括病灶清除术、植骨融合术及内固定技术的应用。对于有手术适应证的患者,须根据其具体病情选择恰当的手术方式,以达到满意的疗效。     

三维彩超在鉴别诊断子宫肌瘤和子宫腺肌病中的应用

目的用三维彩超(3D)观察子宫肌瘤和子宫腺肌病的图像特征,提高对这两种疾病的鉴别诊断水平。方法对58例子宫肌瘤(共82个子宫肌瘤)和61例子宫腺肌病(共61个子宫腺肌病)患者,手术前经2D和3D检查,两种方法诊断结果与手术后病理对照。结果子宫肌瘤的三维图像特征:病灶边界清晰,有球体感,甚至内部见漩涡状结构,周边环状血管向内延伸,呈彩球状;子宫腺肌病的三维图像特征:病灶边界不清,无球体感,呈扇形放射状,血管分布散,呈星点状。结论三维彩超图像更直观,为临床提供更多的帮助。     

Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain

Advances in technology and improved availability have led to increased use of computed tomography (CT) and magnetic resonance imaging (MRI) to evaluate women presenting to the emergency department or to their primary care provider with abdominal and/or pelvic pain. Computed tomographic examinations are often performed to evaluate the presence of appendicitis or renal stone disease. However, gynecologic abnormalities are frequently identified on these examinations. Although ultrasound remains the primary modality by which complaints specific to the pelvis are evaluated, in many instances, CT and MRI imaging occurs before sonographic evaluation.Historically, because of cost, radiation exposure, and relative ease of use, ultrasound examinations have preceded all other imaging modalities when evaluating pelvic disorders. However, as CT and MRI technology have improved, their use in diagnosing causes of pelvic pain has become equal to that of ultrasound. In some cases, primarily because of historic comfort with sonographic evaluation, gynecologic abnormalities originally diagnosed on CT or MRI may be immediately and unnecessarily reevaluated by ultrasound.For a woman in her reproductive years, the most common adnexal masses are physiological cysts, endometriomas, and cystic teratomas. Although lesions are often asymptomatic and incidentally detected, they can present with pain, and they increase the risk of ovarian torsion. Common causes of chronic pelvic pain in this population include leiomyomata and adenomyosis. In postmenopausal women, ovarian carcinoma, which often does not present clinically until a late stage, has to be included in the differential diagnosis of adnexal masses.If a gynecologic pathology is discovered on CT or MRI, an immediate follow-up ultrasound need not be pursued if the lesion can be characterized as benign, needing immediate surgical intervention, or a variant of normal anatomy. If, on the other hand, findings demonstrate a mass that either is uncharacteristic of a benign lesion, has an indeterminate risk for malignancy, or demonstrates suspicious characteristics for malignancy (such as enhancing mural nodules), further evaluation by serial ultrasound, biochemical marker, and/or CT or MRI is warranted.The purpose of this review is to present a series of commonly encountered gynecologic abnormalities with either CT or MR to make radiologists more familiar with gynecologic pathology on CT and MRI.     

选择性子宫动脉碘油栓塞治疗子宫腺肌病的临床疗效观察

目的 探讨用超液态碘油选择性栓塞子宫动脉治疗子宫腺肌病的价值。方法 采用Seldingers方法经股动脉穿刺，治疗17例子宫腺肌病患者，将导管通过髂内动脉选择性进入子宫动脉，注入超液态碘油和明胶海绵条，阻断子宫供血。结果 血管造影可见双侧子宫动脉增粗，子宫血管走向紊乱，呈网格状，子宫呈球形增大，动脉栓塞后，血流中断，术后6个月随访，子宫体积平均缩小24．1％，76．4％患者痛经消失，23．5％明显缓解，第二个月经周期月经量恢复正常。结论 选择性子宫动脉碘油栓塞治疗子宫腺肌病是一种创伤小，临床效果好的新方法。     

Prognostic factors in patients presenting with severe neurological forms of Wilson's disease

BACKGROUND: Wilson's disease (WD), a metabolic disorder, is believed to be potentially reversible, even in its severe form. However, some patients do not respond to treatment. AIM: To analyse prognostic factors in severe WD. DESIGN: Retrospective audit. METHODS: A total of 140 patients were regularly followed from February 2002 to May 2004. Twenty-nine (18 males, 11 females) had severe disease, as defined by Modified Schwab and England Activities of Daily Living score (MSEADL) of < or=50% or Chu stage of 3. We analysed their clinical, laboratory and MRI features with respect to prognosis. RESULTS: For the severe form, mean age at symptom onset was 11.5 +/- 6.4 years, and at diagnosis, 13.3 +/- 7.0 years. Mean Neurological Symptom Score (NSS), Chu stage, and MSEADL were 26.5 +/- 8.2, 2.7 +/- 0.5 and 24.8 +/- 17.4, respectively. Twenty-one patients underwent MRI; 14 had repeat MRI. Following treatment, 14 (group A) had progressive worsening, including death in two, while 15 (group B) had sustained clinical improvement. Baseline demographic, clinical and laboratory features and MRI scores did not significantly differ between the two groups. However, diffuse white-matter abnormalities were more extensive in group A. Full-dose initial penicillamine therapy could have contributed to worsening in four patients. Drug compliance was poor in both groups but resumption of treatment did not benefit patients in group A. Serial MRI showed regression of lesions only among patients with clinical improvement. DISCUSSION: Severe WD remains a therapeutic challenge, with early diagnosis and treatment are essential. Specific MRI observations, a 'start low-go slow' regimen for penicillamine, and compliance may have prognostic significance. In absence of clinical predictors, genetic attributes need to be explored.     

子宫腺肌病87例诊治分析

目的：分析近年来子宫腺肌痛的发病情况、临床表现、诊断和治疗。方法：回顾性分析2000年1月-2002年12月本院收治的87例子宫腺肌痛患者的临床资料。结果：87例子宫腺肌痛患者占我院同期妇科住院人数的9．6％、妇科子宫切除手术的21．3％。术前痛经者58例(66．7％)，月经过多者35例(40．2％)，人流后急性腹疼3例(3．4％)。术前诊断为子宫腺肌病51例，诊断符合率为58．6％，B超诊断符合率为49．4％，血CA125测定阳性率为69．2％。除3例行腺肌瘤剔除术外，其余均行全子宫切除术，其中32例术前曾使用内美通、丹那唑、米非司酮、避孕1号等治疗达3个月以上，76．0％痛经明显缓解，但73．7％患者停药后第1个月经周期痛经即复发。结论：子宫腺肌病目前仍以手术治疗为主，治疗子宫内膜异位症的常用药物对子宫腺肌病痛经均有效，但停药后易复发。