Magnetic resonance imaging in the measurement of clinical stage IB cervical carcinoma

MRI can accurately define the extension of cervical carcinoma to the parametria. However, in patients with cervical carcinoma clinical stage IB, the definition of the dimensions of the tumour, prior to surgery, may also modify the treatment procedure. Recently pre-operative neoadjuvant chemotherapy has been proposed for patients with bulky tumours. Multiple factors may influence the prognosis of clinical stage IB and survival varies greatly among these patients. In particular the maximum dimensions of the tumour seem to have a prognostic relevance. The aim of this paper is to evaluate the potential of MRI to measure tumour size, in order to discriminate between patients needing surgery alone or pre-operative therapy followed by surgery. In 20 patients with clinical stage IB cervical carcinoma we performed MRI to measure the radius of the cervix, the radius of the tumour and their ratios. The measurements obtained have been compared with the corresponding data from histopathology of the operative specimens. The close correspondence between these linear measurements allows us to propose MRI as a reliable method to define tumour size in clinical stage IB patients before surgery.     

Magnetic resonance imaging in the preoperative assessment of Mayer-Rokitansky-Kuster-Hauser syndrome

Purpose

We evaluated the accuracy of magnetic resonance imaging (MRI) in young women with primary amenorrhoea with suspected Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (congenital absence of both vagina and uterus and presence of normal ovaries).

Materials and methods

Fifty-eight women (age range 14–30 years, mean 20.9) with primary amenorrhea were studied with MRI performed with a 1.0-T superconducting magnet (Philips NT Intera). All patients were examined in the supine position using a phased-array coil (four channels). Turbo spin-echo T2-weighted images were acquired in the sagittal, axial and coronal planes with the following parameters: TR 4,750–6,686, TE 100–120, FOV 350–375, 4- to 5-mm sections with a 0.4- to 0.5-mm intersection gap and NSA 6. T1-weighted images were acquired in the axial and coronal planes (TR 470, TE 15, FOV 350, 4-mm sections with a 0.6-mm intersection gap, NSA 3). Two experienced radiologists evaluated all the examinations in consensus to assess the presence, position and morphology of vagina, uterus, ovaries and kidneys and any pelvic abnormalities. MRI results were judged on the basis of laparoscopic findings in 41 patients.

Results

MRKH syndrome was confirmed in 56 patients with 100% sensitivity and specificity. MRI identified bilateral Müllerian buds in 34/56 (61%) and unilateral in 10/56 (18%) patients. MRI sensitivity was 81.42%, and there was good agreement with laparoscopy (k=0.55) and full agreement in the identification of cavitation between MRI and intraoperative sonography. Both ovaries were visualised in 54 patients, with regular morphology in 46 (82.1%), polycystic in 10 (17.8%), pelvic in 47 (83.6%) and extrapelvic in eight (14.5%). We found associated abnormalities of the upper urinary tract in six patients (solitary kidney in four and ptosis in two).

Conclusions

MRI is a useful diagnostic tool in the preoperative evaluation of MRKH syndrome and is less expensive and invasive than laparoscopy. Strong cooperation between radiologists and surgeons is highly recommended.     

MRI对子宫内膜癌术前分期的应用价值

子宫内膜癌又称子宫体癌,是指原发于子宫内膜的上皮恶性肿瘤,是女性生殖系统最常见的恶性肿瘤之一。治疗前准确估计分期、病理分级、淋巴结转移有助于合理选择治疗方案及判断预后。磁共振成像（magnetic resonance imaging,MRI）具有多方位、多角度、多序列成像、组织分辨力高及软组织对比度好等特点,可准确显示盆腔及子宫的解剖结构,并且对病变范围、肌层浸润深度较准确定位,从而可指导临床制定正确的治疗方案。本研究对42例子宫内膜癌行高场强MRI检查,并与手术后病理结果进行对比分析,以期探讨MRI在子宫内膜癌术前分期中的应用价值。     

MR功能成像在子宫内膜癌的术前分期中的价值

子宫内膜癌术前准确分期对治疗方案的选择,尤其是手术方案的选择有很重要的影响,MRI是目前最准确的术前分期方法之一。综述MR动态增强成像及扩散加权成像在子宫内膜癌术前分期中的价值,并就其各自的适用范围、技术优势和局限性进行探讨。     

MR功能成像在子宫内膜癌的术前分期中的价值

子宫内膜癌术前准确分期对治疗方案的选择,尤其是手术方案的选择有很重要的影响,MRI是目前最准确的术前分期方法之一.综述MR动态增强成像及扩散加权成像在子宫内膜癌术前分期中的价值,并就其各自的适用范围、技术优势和局限性进行探讨.     

MRI对直肠癌术前诊断的价值

目的 探讨MRI在直肠癌术前分期中的作用.方法 将32例经病理证实的直肠癌患者的术前MRI所见与术中所见及术后病理进行对照研究.结果 32例经术后病理证实直肠癌患者MRI正确T分期26例,诊断总体准确度81.3%(26/32),其中T1~T2期、T3期、T4期诊断准确度分别为83.3%(5/6)、77.8%(14/18)、87.5%(7/8).MRI正确判定环周切缘状态29例,总体准确度为90.6 %(29/32),敏感度、特异度、阳性预测值、阴性预测值分别 为93.3%(14/15)、88.2%(15/17)、87.5%(14/16)、93.8%(15/16).盆腔转移性淋巴结MRI表现不同,正常淋巴结、转移性淋巴结及反应性淋巴结增生在直径及形态方面均有重叠.MRI上测量25例中下段直肠癌肿瘤下缘距肛缘距离平均为(6.36±0.91) cm,术中测量肿瘤下缘距肛缘的平均距离(7.32±0.42) cm,统计学分析P值为0.243,P>0.05,二者无统计学意义.结论 MRI对直肠癌患者的术前T分期、判断环周切缘状态及测量肿瘤下缘距肛缘距离方面具有重要临床应用价值,对判断盆腔淋巴结转移存在困难.     

MRI对子宫内膜癌术前分期的研究现状与进展

子宫内膜癌是女性常见生殖系统肿瘤,肿瘤肌层浸润深度、宫颈间质受累及淋巴结转移是决定内膜癌分期及预后的重要因素。MRI是子宫内膜癌术前评估的重要检查方法,多种功能成像技术的应用提高了MRI对内膜癌的术前评估准确性。从国际妇产科联盟（FIGO）分期的修订、成像技术、常规MRI表现和功能MRI的补充作用,以及宫颈间质及淋巴结转移等方面对子宫内膜癌的MRI术前评估进行综述。      

Magnetic resonance imaging pitfalls in determining myometrial invasion in stage I endometrial cancer: A case report and literature review

The degree of myometrial invasion (MI) is crucial in the preoperative diagnosis of endometrial cancer (EC) using MRI in terms of therapeutic and prognostic implications. However, several pitfalls should be kept in mind when using this modality. We report a case of EC on a 64-year-old woman, identified preoperatively without MI based on ultrasonography and MRI, implying a low risk of lymph node metastasis; surprisingly, the uterine incision showed the lesion had invaded <50% of the myometrium. Thus, a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performed, and histopathologic analysis confirmed that the EC was on stage IA (cancer is in the endometrium only or less than halfway through the myometrium). In our case, thinning myometrium and uterine atrophy due to aging, multiple leiomyomas, previous curettage, and blood clots were all pitfalls for MRI in detecting MI. By detecting tiny or isointense tumors and depicting distinct vascularity of the malignancy in postmenopausal women, functional MRI techniques such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) can help reduce pitfalls when assessing MI. Clinicians can employ DWI preoperatively, which is more reliable and superior to DCE-MRI in determining tumor areas without contrast injection and perform a postoperative histopathological examination to confirm MI in EC.     

Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment

The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4–5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied.     

Magnetic resonance imaging of pancreatic carcinoma

The authors have used MRI for investigation of 41 patients with pancreatic tumours. MR examinations were performed with 0.5 T superconductive equipment. Short TR, short TE spin echo (SE) sequences were obtained with 8 averages and 256×256 matrix. T2-weighted sequences were also acquired. T1-weighted SE sequences provided more detail, with high intrinsic contrast between the tumour and the normal pancreas; small lesions (19 smaller than 3 cm in diameter) were always detected on these images. T2-weighted SE sequences were not useful for lesion detection, due to the lower intrinsic contrast and the number of artefacts. T2-weighted sequences proved helpful for lesion characterisation in two cases of cystoadenocarcinoma only. Staging of the tumour was possible with MRI, with good assessment of local spread, lymphoadenopathy, vascular involvement and hepatic metastases. MRI of the pancreas at medium field strength can be an alternative to CT in selected cases. Offprints requests to: P.Pavone     

Magnetic resonance imaging in the assessment of cervical nodal metastasis in oral squamous cell carcinoma

OBJECTIVE: The accurate pre-operative assessment of cervical lymph nodes is a well recognized problem in the management of patients with oral squamous cell carcinoma. Imaging techniques have improved the accuracy of staging but cannot determine if nodal enlargement is due to reactive changes or malignant involvement. We assessed the diagnostic performance of magnetic resonance imaging (MRI) in detecting metastatic disease within the neck in oral cancer patients. MATERIALS AND METHODS: A retrospective study was performed on 58 patients treated for oral squamous cell carcinoma. All patients had pre-operative MR imaging including axial and coronal short tau inversion recovery (STIR) sequences and pre- and post-gadolinium axial T1 weighted sequences. Nineteen patients had bilateral neck dissections giving 77 sides of neck for study. MR images were reviewed for nodal involvement at each anatomical level within the neck and correlated with findings at histology. RESULTS: Twenty-seven of the 77 sides of neck contained histologically positive nodes (35.1%). MRI sensitivity was 66.7% and specificity 68%. There was a false-negative rate of 20.9% and false-positive rate of 47.1%. Some enlarged, histologically positive nodes were not detected by MRI. Furthermore, in five cases the only histological evidence of nodal malignancy was the presence of a micrometastasis (<3 mm tumour deposit). MRI detected two of these. CONCLUSION: MRI lacks sufficient sensitivity and specificity to replace elective neck dissection for both staging and prognostic purposes.     

Magnetic resonance imaging assessment of labyrinthine pathology

Membranous labyrinth pathologies are quite rare. They were until recently difficult to demonstrate by imaging technics, CT being the modality of choice. Our purpose was to stress the interest of MR examination for investigating patients complaining of vertigo, tinnitus, and profound sensorineural hearing loss. Normal anatomy as well as the main pathologically encountered changes are illustrated. Correspondence to: K. Marsot-Dupuch     

Magnetic resonance imaging in recurrent carcinoma of the cervix

Twenty patients with suspected recurrent cervical carcinoma were evaluated with computed tomography (CT) and high-field magnetic resonance imaging (MRI). Histological verification of the imaging findings were available in all cases. Computed tomography and MRI were equally effective in making the diagnosis of disease recurrence. The extent of vaginal recurrence and involvement of pelvic floor muscles was better shown on MRI than on CT.     

Magnetic resonance imaging of adrenal cortical carcinoma

Five cases of adrenal cortical carcinoma examined with magnetic resonance (MR) are presented. Clinical histories, computed tomographic (CT) scans, and final pathologic findings were reviewed in each case. All masses were hypointense compared to the liver on T1-weighted images and became hyperintense compared to the liver on T2-weighted images. Signal intensity of adrenal masses, fat, and liver were measured. Adrenal/liver and adrenal/fat signal intensity ratios were then calculated. All the masses were readily identified with MR. The MR also demonstrated displacement or invasion of adjacent organs, as well as liver metastases. The inferior vena cava was also identified in each case. Even though there were no consistent MR findings to diagnose adrenal cortical carcinomas accurately, superior blood vessel identification and multiplanar capabilities may make MR the imaging modality of choice in evaluating the extent of disease and in planning surgical excision.     

Magnetic resonance imaging appearances of the uterus following microwave endometrial ablation

AIM: Microwave endometrial ablation (MEA) is a treatment for dysfunctional uterine bleeding. It is a second generation ablative technique which is as effective as hysteroscopic methods but quicker and easier to perform. Our aim is to describe the Magnetic Resonance Imaging (MRI) appearances of the uterus following this procedure. METHODS: 15 women underwent MRI immediately before MEA, and again at one day and 4 months after treatment. T1 and T2 sequences were performed at 1.0T using a body coil. Images were assessed by 2 independent observers for quantitative and qualitative changes. Clinical questionnaires were completed before treatment and at 4 months. RESULTS: On images obtained one day post-ablation, 14 patients had a low signal intensity band subjacent to the treated area of the endometrial cavity on T2 images. Imaging at 4 months showed significant amounts of endometrial tissue in 11 patients, including 3 of the 6 patients who were amenorrhoeic. There were no changes in the appearances of myometrium or uterine dimensions and there were no haematometra. CONCLUSIONS: The detection of residual endometrium by MRI means that unopposed oestrogen hormone replacement therapy should be avoided after MEA, even in women who have amenorrhoea. Thepost-operative sub-endometrial low signal intensity zone corresponds to the region of tissue necrosis detected on vital staining of the treated uterus in in vivotesting. Depth of tissue destruction is a surrogate marker for clinical effectiveness. MRI may have a role in early assessment of patients participating in clinical research who are undergoing a modified MEA technique while retaining their uterus.     

Magnetic resonance imaging of primary vaginal carcinoma

AIMS: To describe the magnetic resonance imaging (MRI) features of vaginal carcinoma and to suggest a role for MRI in its management. MATERIALS AND METHODS: Twenty-five patients with primary vaginal carcinoma treated at our institution between 1996 and 2005 were included in the study. The MRI examinations were reviewed and tumour dimensions, signal characteristics and involvement of pelvic structures were documented, as were sites of enlarged lymph nodes and metastases. Details of patient treatment and outcome were obtained from the clinical notes. RESULTS: The median patient age was 54 years (range 31-86 years). Tumour maximum diameter ranged from 1.6-11.3 cm (mean 3.7 cm). Most tumours were of iso-intense signal to muscle on T1-weighted images and hyper-intense to muscle on T2-weighted images. Eighty-eight percent of patients had tumour extending beyond the vagina and 56% of patients had Figo stage III or above tumours. Sixteen patients were treated with radiotherapy (two with chemoradiotherapy), five with surgery and four with supportive care. Ten patients (40%) died of their disease during the study period. The MRI stage of the tumour correlated with survival. CONCLUSION: MRI identified over 95% of primary vaginal tumours in the present study, enabled radiological staging, which correlated with outcome, and provided information of use in treatment planning.