The spectrum of sonographic findings in hemorrhagic ovarian cysts

The sonograms of 76 hemorrhagic ovarian cysts were reviewed to ascertain the full spectrum of sonographic findings. All cases were proved either by surgery or by documented resolution on sonography and/or clinical follow-up. The overwhelming majority (92%) had increased sound through-transmission, signifying the basic cystic nature of the lesion. The sonographic patterns were variable. The most common appearance was that of a heterogeneous mass (83%), almost half of which were predominantly anechoic with hypoechoic material. The other cases (17%) were completely homogeneous, either hypo- or hyperechoic. No masses were completely anechoic. Additional sonographic features included a thick rim, septations, and associated cul-de-sac fluid. A rounded hyperechoic mass, representing blood clot, was contained within 13 masses. In addition, some women appeared to have an increased tendency to form ovarian cysts, suggested by the fact that 26% of them had a past, concurrent, or future episode of simple or hemorrhagic ovarian cysts. Because hemorrhagic ovarian cysts have variable sonographic findings, they should be included in the differential diagnosis of any adnexal mass that has good sound through-transmission.     

"Daughter cyst" sign: a sonographic finding of ovarian cyst in neonates, infants, and young children

OBJECTIVE: The purpose of this study was to assess the value of the "daughter cyst" sign, a sonographic finding of neonatal ovarian cysts, in differentiating ovarian cysts from other cystic masses in neonates, infants, and young children. SUBJECTS AND METHODS: In a prospective study, 23 neonates, infants, and young children (age range, 1 day to 36 months) with a lower abdominal cystic mass underwent sonography. We defined the daughter cyst sign as the presence of a small cyst along the wall of a cystic mass. The diagnosis of ovarian cyst was made when this sign was present. Detailed pathologic correlation was available in four ovarian cysts. The size, wall thickness, and contents of the cysts were also evaluated. RESULTS: The 23 cystic lesions included ovarian cyst (n = 11), lymphangioma (n = 3), enteric duplication cyst (n = 3), enteric cyst (n = 1), meconium pseudocyst (n = 2), hydrometrocolpos (n = 2), and urachal cyst (n = 1). The daughter cyst sign was seen in nine (82%) of 11 ovarian cysts but in none of the other cystic lesions. Sensitivity, specificity, and positive predictive value of the daughter cyst sign for differentiating ovarian cysts from other cystic lesions were 82%, 100%, and 100%, respectively. The daughter cyst corresponded to an ovarian follicle on pathologic examination. CONCLUSION: The daughter cyst sign is a specific sonographic finding for an ovarian cyst and may be useful in differentiating uncomplicated ovarian cysts from other cystic masses in neonates, infants, and young children.     

Fetal choroid plexus cysts: prevalence, clinical significance, and sonographic appearance

To determine the prevalence, sonographic appearance, and clinical significance of fetal choroid plexus cysts, we analyzed the sonograms and clinical records of 17 fetuses with cysts. Fetal and maternal age, sonographic indication, cyst size and multiplicity, and evolution on serial studies were recorded. Fetal outcome was available in 16 cases by genetic amniocentesis (n = 5) or neonatal clinical records (n = 11). The prevalence of fetal choroid plexus cysts was 0.8% (17/2084) during a 40-month period. All cysts were initially identified on sonograms performed between 14 and 21 weeks. Cysts ranged from 3 to 11 mm in size and were bilateral in four (36%) of 11 cases in which both lateral ventricles were visualized. In nine of 10 cases with serial sonograms 2-21 weeks after the initial study, the cysts were no longer present. One fetus had a small cyst persisting at term. All five cases with genetic amniocentesis had normal chromosomes. The only phenotypic abnormality in the 11 cases with clinical follow-up was a small hemangioma of the chest wall. We conclude that most fetuses with isolated choroid plexus cysts have a normal outcome and that serial sonography for cyst evaluation is not useful in determining fetal prognosis.     

Pelvic masses in pregnancy: MR imaging

The value of magnetic resonance (MR) imaging was assessed for 17 pregnant patients with sonograms suggestive of a pelvic mass. The MR imaging signal features improved lesion characterization in 47% (eight of 17) of cases, including two of four mature cystic teratomas of the ovary, three uterine fibroids, one solid ovarian tumor, one endometrioma, and a distended urinary bladder that had been mistaken for an ovarian cystic mass. Both MR imaging and sonography were accurate for the characterization of three ovarian cystadenomas and two simple ovarian cysts. On both MR images and sonograms, two simple ovarian cysts were incorrectly diagnosed as complex cystic masses and one teratoma was incorrectly diagnosed as a simple cyst. The origin of the pelvic mass (13 in the ovary, three in the uterus, and one distended urinary bladder) was accurately determined on 100% (17 of 17) of the MR images versus 71% (12 of 17) of the sonograms. In three cases, the results of MR imaging led to cancellation of surgery, which would have proceeded on the basis of the sonographic results alone. MR imaging is a valuable complement to sonography for preoperative evaluation of pelvic masses in pregnant patients.     

Early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities on sonograms

BACKGROUND AND PURPOSE: In the early 1980s, diagnosing periventricular leukomalacia (PVL) in neonates by using cranial sonography was possible for the first time. Our purpose was to investigate the possibility of diagnosing PVL in the acute stage by using MR imaging. We evaluated early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities (flares) on cranial sonograms to determine the added value of MR imaging over sonography alone for early diagnosis of brain damage. METHODS: In a prospective study, infants who showed flares and/or cysts on sonograms underwent MR imaging during the (sub)acute stage. RESULTS: Fifty infants were classified according to the highest sonographic grade up to the day of MR imaging: 23 infants had sonographic grade 1 (flares < 1 week), 15 had sonographic grade 2 (flares > or = 1 week), four had sonographic grade 3 (small localized cysts), and eight had sonographic grade 4 (extensive periventricular cysts); none had sonographic grade 5 (multicystic leukomalacia) on the day of MR imaging. Overall, the additional information provided by MR imaging (over sonography alone) consisted of the depiction of hemorrhagic lesions in 64% of the infants. Extent and severity of the hemorrhages varied from isolated punctate lesions to extensive hemorrhages throughout the white matter; the latter were followed by cystic degeneration at autopsy in two infants. In nine of the 12 infants with cystic PVL, MR images showed more numerous or more extensive cysts. In addition, in two infants, MR images showed cysts not present on sonograms. In 32% of the infants, MR imaging provided no additional information; in these children, all but one had flares on sonograms whereas MR images showed no abnormalities or a zone of mild periventricular signal change. CONCLUSION: MR imaging can depict the precise site and extent of hypoxic-ischemic brain injury at an earlier stage and allows a wider differentiation of lesions as compared with sonography alone. Hemorrhagic PVL is considered to be rare, but was present in 64% of our study population.     

卵巢囊肿蒂扭转的CT诊断

目的:探讨卵巢囊肿蒂扭转的CT表现及诊断价值.方法:回顾性分析6例经手术病理证实的卵巢囊肿蒂扭转的临床资料和CT征象.平扫6例,增强扫描4例.结果:6例CT平扫均出现囊实性双肿块、囊壁均匀或不均匀增厚、囊肿位置变化、盆腔积液等征象.3例子宫偏向扭转侧,1例囊内出血,1例囊肿破裂.增强扫描,强化减弱或无强化.结论:卵巢囊肿蒂扭转的CT表现有一定特征性,CT作为超声检查的一种补充检查方法,对卵巢囊肿蒂扭转的诊断和鉴别诊断具有重要价值.     

CT and MR imaging features of adnexal torsion.

In adnexal torsion, the ovary, ipsilateral fallopian tube, or both twist with the vascular pedicle, resulting in vascular compromise. Unrelieved torsion is likely to cause hemorrhagic infarction as the degree of arterial occlusion increases. Therefore, early diagnosis is important to preserve the affected ovary. Adnexal torsion commonly accompanies an ipsilateral ovarian neoplasm or cyst but can also occur in normal ovaries, usually in children. Although ultrasonography is typically the initial emergent examination, computed tomography (CT) and magnetic resonance (MR) imaging may also be useful diagnostic tools. Common CT and MR imaging features of adnexal torsion include fallopian tube thickening, smooth wall thickening of the twisted adnexal cystic mass, ascites, and uterine deviation to the twisted side. Uncommon imaging findings in adnexal torsion that are specific to hemorrhagic infarction include hemorrhage in the thickened fallopian tube, hemorrhage within the twisted ovarian mass, and hemoperitoneum. Additional imaging findings that can suggest hemorrhagic infarction include eccentric smooth wall thickening exceeding 10 mm in a cystic ovarian mass converging on the thickened fallopian tube and lack of contrast enhancement of the internal solid component or thickened wall of the twisted ovarian mass. Early diagnosis can help prevent irreversible structural damage and may allow conservative, ovary-sparing treatment.     

Imaging of pediatric ovarian masses

Ultrasonography is generally the initial diagnostic study of choice for evaluating suspected or known genital masses in young girls and adolescents. The authors reviewed the sonographic anatomy of the normal ovary and the sonographic spectrum in 88 pediatric patients with a variety of ovarian masses: simple and hemorrhagic cyst, teratoma, malignant tumor, tuboovarian abscess, torsion, and ectopic pregnancy. Among the various sonographic patterns observed, those of cystic ovarian masses and complex masses with mural nodules were the most specific, representing simple cysts and benign teratomas, respectively. Sonographic features of the remaining conditions were often similar, and diagnosis required correlation with clinical data and computed tomographic or magnetic resonance imaging findings.     

Sonographic evaluation of ovarian torsion in childhood and adolescence

Emergency sonographic examination of the pelvis was performed in 41 girls (mean age, 13 years old) with clinical suspicion of ovarian torsion. Sonographic features consistent with diffuse swelling of the ovarian parenchyma and follicular enlargement in the cortical zone were detected in eight patients and were considered highly suggestive for torsion of the ovary. Surgery revealed ovarian torsion in seven of these cases and hemorrhagic ovarian cyst in one case. A cystic or complex ovarian mass was detected by sonography in five additional cases, and ovarian torsion was included in the differential diagnosis. Surgery revealed ovarian torsion in four of these cases and hemorrhagic ovarian cyst in one. A 100% sonographic sensitivity for space-occupying disease of the ovary was obtained with a positive predictive value of 88% for the diagnosis of ovarian torsion. The specificity of the method was 93%. Sonography appears to be an excellent method to evaluate patients with suspected torsion of the ovary.     

Cystic lesions of the breast: sonographic-pathologic correlation

PURPOSE: To understand the pathologic basis for sonographic features of cystic lesions of the breast and determine appropriate assessment and management recommendations for these lesions based on sonographic appearance. MATERIALS AND METHODS: From a database of 2,072 image-guided procedures performed from July 1995 through September 2001, 150 cystic lesions were identified. Diagnosis was established with fine-needle aspiration (n = 55), 14-gauge core-needle biopsy (n = 81), or both (n = 14). Excision was performed for all malignant (n = 18) and atypical (n = 2) lesions and for 11 benign lesions, which recurred or enlarged at follow-up. Imaging follow-up was available for 92 of 119 benign lesions. Targeted sonography was performed with high-frequency (10-MHz center frequency) transducers. Imaging and histopathologic, cytologic, and/or microbiologic findings were reviewed. Lesions were categorized as simple cysts, complicated cysts (imperceptible wall, acoustic enhancement, low-level echoes), clustered microcysts, cystic masses with a thick (perceptible) wall and/or thick (> or =0.5 mm) septations, intracystic or mixed cystic and solid masses (at least 50% cystic), or predominantly solid masses with eccentric cystic foci. RESULTS: Of 150 lesions, 16 were simple cysts aspirated for symptomatic relief. Of 38 lesions characterized as complicated cysts and one cyst with thin septations, none proved malignant, nor did any of 16 lesions characterized as clustered microcysts. Of 23 masses with thick indistinct walls or thick septations, seven proved malignant. Of 18 intracystic or mixed cystic and solid masses, four proved malignant. Of 38 predominantly solid masses with eccentric cystic foci, seven proved malignant. CONCLUSION: Symptomatic complicated cysts generally warrant aspiration. All clustered microcysts were benign, but further study is required. Cystic lesions with thick indistinct walls and/or thick septations (> or =0.5 mm), intracystic masses, and predominantly solid masses with eccentric cystic foci should be examined at biopsy; 18 of 79 of such complex cystic lesions proved malignant in this series.     

婴幼儿甲状舌管囊肿的CT诊断（附23例分析）

目的：探讨婴幼儿甲状舌管囊肿的CT表现。方法：对23例手术和病理证实的婴儿甲状舌管囊肿进行回顾分析。结果：CT表现为颈前正中圆形或椭圆形囊肿18例,偏一侧者5例;6例与舌骨直接关联;17例与甲状腺直接关联。CT平扫囊肿呈低密度15例,等密度8例。14例增强扫描囊内均无强化,其中11例囊壁有强化。全部病例未见钙化、瘘管及囊肿向喉内延伸。结论：婴幼儿甲状舌管囊肿的CT表现具有特征性,可为临床提供明确诊断。     

小儿肠重复畸形的超声诊断

目的: 探讨小儿肠重复畸形的超声图像特征及与肠系膜囊肿的鉴别.材料和方法: 回顾性分析经手术、病理证实的13例肠重复畸形和17例肠系膜囊肿的超声图像表现.结果: 检出肠重复畸形9例,漏、误诊4例.与肠系膜囊肿对比,肠重复畸形声像图主要表现囊性肿块较小(直径<10cm),壁厚、分三层、多无分隔.结论: 观察肿块的大小、囊壁结构及囊内分隔,有助于鉴别肠重复畸形与肠系膜囊肿.     

Simple renal cysts in children: diagnosis and follow-up with US

To assess the sonographic frequency of simple renal cysts in children, the authors retrospectively reviewed the results of abdominal sonographic studies of 16,102 children performed over a 5-year period between January 1, 1985, and December 31, 1989. Patients with abnormal renal function, dysplastic kidneys, or a family history of polycystic kidney disease were excluded from the study. The authors' review of the sonograms revealed 37 simple cysts in 35 patients (0.22%); the cysts were evenly distributed by age and sex and measured from 0.3 to 7.0 cm in maximum diameter. Sixteen cysts (43%) were in the upper pole of the right kidney. Follow-up sonographic studies of 23 cysts in 22 patients for up to 5 years showed no change in size in 17 cysts (74%). The largest cyst was drained percutaneously; all other cysts were managed conservatively. No patient showed deterioration of renal function. Therefore, the authors concluded that in a pediatric patient demonstrating normal renal function, no further intervention is necessary when a simple renal cyst is identified at sonography.     

超声在睾丸表皮样囊肿诊断中的价值探讨

目的：探讨超声在睾丸表皮样囊肿诊断中的价值。方法：回顾性分析6例经病理证实为睾丸表皮样囊肿的声像图资料,进行分析和总结。结果：6例病灶均边界清晰,内无血流信号。4例病灶典型声像图为＂洋葱皮＂样或＂漩涡＂状改变,周边有环状或蛋壳样强回声,另2例为囊实性回声或囊性回声,内有斑片状回声或细点状回声。结论：睾丸表皮样囊肿的声像图表现具有一定的特征性,超声对其准确诊断有助于临床中手术方式的选择。     

产前MRI对胎儿卵巢囊肿的诊断价值

目的探讨产前MRI在胎儿卵巢囊肿中的诊断价值。方法回顾性分析产前诊断及手术确诊的40例胎儿卵巢囊肿的产前、产后MRI影像特征。结果产前MRI检查胎儿卵巢囊肿发生于单侧38例,双侧2例。病灶形态均为类圆形或椭圆形,边界光滑,囊壁较薄。32例病灶内部信号较均匀,T1WI呈均匀低或稍高信号,T2WI呈高信号,DWI扩散不受限,ADC图呈高信号;8例病灶内信号较混杂,T1WI呈稍低及稍高信号,T2WI呈不均匀的稍低信号并夹杂斑片状、点状高信号影,DWI部分扩散受限,ADC图呈低信号。病灶邻近的肠管均受压推移。产后随访发现20例肿块自行消退。有8例行腹腔镜探查手术,病理显示7例为卵巢单纯性囊肿伴出血,1例卵巢囊肿合并蒂扭转。结论产前MRI不仅能清晰显示胎儿卵巢囊肿的发生部位、形态、边界、范围、信号特点,还可评估肿块与邻近组织的结构以及其他合并症,能更好地为临床评估预后和产后治疗提供可靠的诊断依据。     

Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses

In a retrospective study, we compared transvaginal sonograms with transabdominal sonograms in 67 women referred for evaluation of palpable pelvic masses. The diagnoses included ovarian cyst (27), endometrioma (12), complex cyst (four), dermoid (three), infection (three), ovarian malignancy (two), and uterine fibroid (three). The final diagnosis was made surgically in 41 patients (61%) and by a combination of sonographic and clinical correlation in the remaining patients. More information about the internal architecture or anatomy of the mass was provided by the transvaginal images than by the transabdominal scans in 51 (76%) of the patients. Transabdominal sonography did not provide more diagnostic information in any of the patients examined. Transvaginal sonography was helpful in obese patients, in those with a large amount of bowel gas, and in those unable to achieve adequate bladder filling. Six simple cysts and four complex pelvic masses were identified solely on transvaginal sonograms. The results suggest that transvaginal sonography has considerable advantages over conventional transabdominal sonography in the evaluation of pelvic masses in women.     

Differentiation of suprasellar nonneoplastic cysts from cystic neoplasms by Gd-DTPA MRI.

Magnetic resonance imaging in 9 cases of surgically confirmed nonneoplastic intra- and/or suprasellar cysts was analyzed and compared with that from 17 cases of craniopharyngioma and 12 of cystic pituitary adenoma. Signal intensity did not help in distinguishing nonneoplastic cysts from cystic neoplasms. No postcontrast (Gd-DTPA) cyst wall enhancement was observed among the nonneoplastic cysts, although all 6 craniopharyngiomas and 12 cystic pituitary adenomas that underwent postcontrast study did enhance. Three nonneoplastic cysts were surrounded by the pituitary gland, thus mimicking wall enhancement in the postcontrast studies. Rapid enhancement in the early postcontrast-administration phase (dynamic studies) helped avoid confusion between the normal pituitary tissue and cyst wall enhancement. Magnetic resonance studies with contrast enhancement play an essential role in differentiating nonneoplastic cysts from cystic neoplasms in the sella region.     

Ovarian cysts on prenatal MRI

Objective

Ovarian cysts are the most frequently encountered intra-abdominal masses in females in utero. They may, at times, require perinatal intervention. Using magnetic resonance imaging (MRI) as an adjunct to ultrasonography (US) in prenatal diagnosis, we sought to demonstrate the ability to visualize ovarian cysts on prenatal MRI.

Materials and methods

This retrospective study included 17 fetal MRI scans from 16 female fetuses (23–37 gestational weeks) with an MRI diagnosis of ovarian cysts after suspicious US findings. A multiplanar MRI protocol was applied to image and to characterize the cysts. The US and MRI findings were compared, and the prenatal findings were compared with postnatal imaging findings or histopathology.

Results

Simple ovarian cysts were found in 10/16 cases and complex cysts in 7/16 cases, including one case with both. In 11/16 (69%) cases, US and MRI diagnoses were in agreement, and, in 5/16 (31%) cases, MRI specified or expanded the US diagnosis. In 6/16 cases, postnatal US showed that the cysts spontaneously resolved or decreased in size, and in 1/16 cases, postnatal imaging confirmed a hemorrhagic cyst. In 4/16 cases, the prenatal diagnoses were confirmed by surgery/histopathology, and for the rest, postnatal correlation was not available.

Conclusion

Our results illustrate the MRI visualization of ovarian cysts in utero. In most cases, MRI will confirm the US diagnosis. In certain cases, MRI may provide further diagnostic information, additional to US, which is the standard technique for diagnosis, monitoring, and treatment planning.     

Thyroglossal duct cysts: sonographic appearances in adults.

BACKGROUND AND PURPOSE: Previous reports have suggested that thyroglossal duct cysts (TDCs) appear on sonograms as well-defined cystic masses with thin walls and posterior enhancement. In our experience, however, TDCs have a variable sonographic appearance. We report our findings in 40 patients with TDCs and document the variability of sonographic patterns. METHODS: All patients in whom the diagnosis of TDC was made clinically (by at least two head and neck surgeons) and sonography detected a cystic mass related to the hyoid bone were included in this study. Sonograms of 40 patients with TDCs were reviewed. The features evaluated were the location, internal echogenicity, posterior enhancement, presence of septa, solid component, and fistulous tract. The echo pattern was not compared with the biopsy results. RESULTS: Four patterns of TDCs were identified: anechoic (28%), homogeneously hypoechoic with internal debris (18%), pseudosolid (28%), and heterogeneous (28%). The majority showed posterior enhancement (88%), were midline (63%), and infrahyoid in location (83%). Only half of all TDCs showed a typical thin wall. CONCLUSION: On sonograms, TDCs in adults are not simple cysts, as previously suggested, but have a complex pattern ranging from a typical anechoic to a pseudosolid appearance.     

40例鞍区囊性病变的MRI鉴别诊断分析

目的分析囊性垂体瘤、囊性颅咽管瘤及Rathke囊肿的MRI表现,提高鞍区常见囊性病变的MRI诊断水平。资料与方法搜集40例经手术及病理证实的鞍区囊性病变患者的临床和影像资料,其中囊性垂体瘤12例,囊性颅咽管瘤13例,Rathke囊肿15例。全部病例均行MRI平扫和增强扫描。分析囊性病灶的位置、大小、囊壁厚度以及"束腰征"、海绵窦包绕等特殊征象。应用SPSS 11.0软件包,采用卡方检验对病灶的大小及囊壁的厚度进行统计学分析。结果病灶位于鞍上者仅见于囊性颅咽管瘤,鞍内且位于垂体前后叶之间仅见于Rathke囊肿。三者囊的大小和囊壁厚度差异均有统计学意义(χ2=17.65,P=0.0001;χ2=6.26,P=0.04)。无壁或薄壁者多见于颅咽管瘤和Rathke囊肿,占40%(10/25),厚壁者多见于囊性垂体瘤,占53%(8/15)。病灶直径≥2 cm多见于颅咽管瘤,占63%(12/19),<2 cm多见于Rathke囊肿,占61%(13/21)。颅咽管瘤和Rathke囊肿信号较复杂,而囊性垂体瘤除1例T1WI等信号,T2WI低信号外,其余11例均为T1WI低信号,T2WI高信号。"束腰征"主要见于囊性垂体瘤(6/7例),亦可见于Rathke囊肿(1/7例)。海绵窦包绕仅出现于囊性垂体瘤。壁结节可见于颅咽管瘤和Rathke囊肿(各2例),颅咽管瘤壁结节增强扫描明显强化,Rathke囊肿未见强化。结论根据囊性病灶的位置、形态、囊内MRI信号以及特殊征象,可对上述3种囊性病变进行鉴别。