Septate or bicornuate uterus: Accuracy of three-dimensional trans-vaginal ultrasonography and pelvic magnetic resonance imaging

Objective

To estimate the accuracy of 3-dimensional transvaginal ultrasonography (3D-TVUS), hysterosalpingography (HSG) and pelvic magnetic resonance imaging (MRI) in the differentiation between septate and bicornuate uterus.

Patients and methods

Thirty-six patients with suspected septate or bicornuate uterus on 2D ultrasound or hysterosalpingography (HSG) underwent 3D-TVUS examination, MR imaging, diagnostic laparoscopy and hysteroscopy. HSG was performed only for those patients who did not undergo the procedure before (21 patients), we retrospectively revised the hysterosalpingography of 15 patients performed outside our hospital with acceptable quality.

Results

HSG showed sensitivity of 77.4%, specificity of 60% and overall accuracy of 75% in the differentiation between the septate and bicornuate uterus. MRI showed sensitivity of 93.5%, specificity of 80%, PPV of 96.6% and negative predicative value of 66.6%, with overall accuracy of 91.6%. The 3D ultrasound showed the highest diagnostic parameters, with sensitivity of 96.7%, specificity of 100%, PPV of 100% and negative predicative value of 83.3%, with overall accuracy of 97.2%.

Conclusions

Transvaginal 3-D ultrasonography is accurate for diagnosis and differentiation between septate uterus and bicornuate uterus. We recommend 3-D transvaginal ultrasonography as the first and only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus, especially before planning surgery. MRI should be preserved for patients in whom 3D TVS is not possible like virgins.     

Recurrent rectal cancer: diagnosis with MR imaging versus CT

During an 18-month period, a prospective study comparing the findings at computed tomography (CT) and magnetic resonance (MR) imaging was conducted on 35 patients who satisfied the following criteria: prior surgery for rectal cancer (11 curative resections, 24 rectal amputations), perineal pain and/or elevated carcinoembryonic antigen (CEA) level, and a soft-tissue mass in the presacral fossa demonstrated at CT. Twenty-two patients had tumor recurrence; 13 patients had only inflammatory changes or radiation fibrosis. At a single examination of each patient (with no reference to prior baseline studies), MR imaging was more accurate than CT, largely because MR imaging was more successful in the distinction of recurrence from fibrosis based on the differences in signal intensity on T2-weighted images.     

Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

Objective

To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis.

Materials and methods

We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher’s exact test.

Results

The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P?<?0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P?=?0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P?=?0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P?=?0.004). Interobserver reliability was very good (kappa?=?1) in Ewing sarcoma and moderate (kappa?=?0.6) in patients with osteomyelitis.

Conclusions

A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis.     

Radiation necrosis versus glioma recurrence: conventional MR imaging clues to diagnosis

BACKGROUND AND PURPOSE: Conventional MR imaging findings are considered to be inadequate for reliably distinguishing radiation necrosis from tumor recurrence in patients with glioma. Despite this belief, we hypothesized that certain conventional MR imaging findings, alone or in combination, though not definitive, may favor one or another of these diagnoses in proton beam-treated patients with new enhancing lesions on serial scanning. METHODS: MR imaging findings (axial T1-, T2-, and post-gadolinium T1-weighted) of 27 proton beam radiation therapy patients with high-grade gliomas were retrospectively reviewed. Entry criteria included new MR imaging enhancing lesions after treatment and histologically unequivocal biopsy proof of diagnosis. Readers rated corpus callosum involvement, midline spread, subependymal spread, new discrete multiple enhancing foci, a "spreading wavefront" appearance, and septum pellucidum involvement. Statistical analysis was by the Fisher exact test. RESULTS: Corpus callosum involvement in combination with multiple other findings was highly associated with progressive glioma. These combinations included involvement of the corpus callosum with multiple enhancing foci (P = .02), involvement of the corpus callosum with crossing the midline and multiple enhancing lesions (P = .04), and involvement of the corpus callosum with subependymal spread and multiple enhancing lesions (P = .01). CONCLUSIONS: In proton beam-treated patients with glioma, corpus callosum involvement, in conjunction with multiple enhancing lesions with or without crossing of the midline and subependymal spread, favors predominant glioma progression. Overall, combinations of enhancement patterns were more likely than individual patterns to distinguish necrosis from predominant tumor progression. Together with clinical and functional imaging findings, these results may assist in determining the need for biopsy.     

Thoracic disc herniation versus spinal metastases: optimizing diagnosis with magnetic resonance imaging

Thoracic disc herniation has been difficult to diagnose, both on clinical grounds and by conventional radiologic methods. This entity may masquerade as a neoplastic mass, particularly if there is a history of primary malignancy. Magnetic resonance imaging was able to establish the correct diagnosis in each of the four cases presented here.     

Diffusion-weighted imaging versus dynamic contrast-enhanced imaging for pre-operative diagnosis of deep myometrial invasion in endometrial cancer: A meta-analysis

PurposeThis study investigates the differences in diagnostic performance between diffuse-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE), either alone or in combination with T2-weighted imaging (T2WI), for diagnosing deep myometrial invasion (dMI) of endometrial cancers (EC).MethodsWe performed a comprehensive search for published studies comparing DWI and DCE for preoperatively diagnosing dMI of EC. The overall diagnostic accuracy of each test was calculated using the areas under the summary receiver operating characteristic curves (AUCs). The sensitivities and specificities were compared using bivariate meta-regression.ResultsPooled analysis of nineteen studies with 961 patients (main group) showed that DWI had a larger AUC (0.943, 95% confidence interval (CI) = 0.921–0.967) than DCE (0.922, 95% CI = 0.893–0.953). For the subgroup comprising 7 studies, DWI combined with T2WI and DCE combined with T2WI showed AUCs of 0.959 (95% CI, 0.932–0.986) and 0.929 (95% CI, 0.847–1.000), respectively. None of the differences in AUCs were statistically significant. All comparisons of the sensitivities and specificities of the main group and subgroup also showed no significant differences.ConclusionThis meta-analysis found no significant difference in diagnostic performance between DWI and DCE for diagnosis of dMI in EC. DWI may be preferred for its ease of use in clinical practice.     

Magnetic resonance imaging of bicornuate uterus with unilateral hematometrosalpinx and ipsilateral renal agenesis

A complex solid and cystic pelvic mass in a young patient was demonstrated by computed tomography (CT) and ultrasound (US). These modalities failed to accurately characterize the solid components as bicornuate uterus and the cystic areas as hemorrhage. Magnetic resonance imaging (MRI) using multislice multiecho spin echo (SE) sequences made it easier to characterize the mass, clearly depicting the abnormality in transaxial and coronal planes and at the same time demonstrating ipsilateral renal agenesis.     

Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography

To determine the efficacy of magnetic resonance (MR) imaging and myelography for the diagnosis of spinal cord compression due to metastatic disease, the authors prospectively examined 70 patients who had known or suspected spinal involvement by malignancy. Most MR examinations consisted of T1-weighted sagittal imaging of the entire spine, with additional sequences as needed for clarification. Extradural masses were found in 46 patients, 25 of whom had cord compression. For extradural masses causing cord compression, the sensitivity and specificity of MR imaging was .92 and .90, respectively, compared with .95 and .88 for myelography. For extradural masses without cord compression the sensitivity and specificity of MR imaging was .73 and .90, versus .49 and .88 for myelography. MR imaging was much more sensitive for metastases to bone (.90 vs .49), as expected. MR imaging is an acceptable alternative to myelography for diagnosing spinal cord compression and is preferable as a first study because it is noninvasive and better tolerated.     

Communicating bicornuate uterus with double cervix and septate vagina: an uncommon malformation diagnosed with MR imaging

We report a case of communicating uterus diagnosed with MRI. These uterine malformations are characterized by a communicating tract between two separate uterocervical cavities, which is usually detected with hysterosalpingography performed for a suspected uterine malformation. In our patient MRI was performed after the clinical finding of a double cervix and a vaginal septum and demonstrated two separate uterine cavities, each of them with its own junctional area, and an isthmian transverse communicating tract with endometrial tissue inside, which helped make the diagnosis of a type-4 a communicating uterus according to Toaff. Received 20 July 1995; Revision received 26 April 1996; Accepted 30 April 1996     

Analysis of errors in imaging diagnosis of varicocele. Duplex sonography, plate thermography and phlebography

Comparative investigations were done by duplex sonography, thermography and phlebography in 142 patients with 158 varicoceles. Verification of clinical varicoceles (130/158) was performed by duplex sonography in all cases and by thermography in 93%. Measurement errors were due to dorsally located varicoceles near the radix of the penis (3/130) and by small, two-sided varicoceles (6/130). Small subclinical varicoceles (28/158) were detected by real-time sonography in 89%, by Doppler sonography in 64%, and by thermography in 53%. In three patients with normal real-time sonography, subclinical varicoceles were found by Doppler sonography alone. The combination of both sonographic methods is highly sensitive for the detection of subclinical varicoceles and should be done in all cases without therapeutic results.     

Phase errors in multi-shot echo planar imaging

Field inhomogeneity related phase errors in multi-shot echo planar imaging (EPI) are directly visualized and analyzed in the spatial frequency domain data or ‘k-space’. The echo time shift (ETS) technique incrementally moves the position of the echo train and improves the phase error function by redistributing phase discontinuities away from the center of k-space.     

外突浆膜下子宫肌瘤的CT诊断与鉴别诊断

目的：探讨外突膜下子宫肌瘤的CT特点及其鉴别诊断。方法：选取瘤体的3／4以上突出于子宫轮廓之外的16例浆膜下子宫肌瘤为本组病例，共有17枚瘤体。结果：14／17（82．4％）格瘤体的轮廓与子宫的轮廓相连续，10／17（58．8％）枚瘤体内可见变低密度区且均位于瘤体中心区或呈同心圆关分布，7／10（41．2％）枚瘤体内见“旋窝状”混杂密度影，5／17（29．4％）格瘤体边缘见低密度带。结论：外突浆膜下子宫肌瘤的CT表现具有一定特征，其鉴别诊断尤应注意区别向子宫体两侧外突的肌瘤与卵巢肿瘤。