Uterine leiomyomas in the infertile patient: preoperative localization with MR imaging versus US and hysterosalpingography

Eleven women with a history of infertility and uterine leiomyomas underwent magnetic resonance (MR) imaging of the pelvis prior to myomectomy. Nine also underwent preoperative pelvic ultrasonography (US), and ten underwent hysterosalpingography. All studies were interpreted prospectively by independent observers. With each imaging modality, the location (one of 11 anatomic segments), size, and appearance of detected uterine leiomyomas were determined and compared with surgical and histologic findings. Among the nine patients who underwent both MR and US, the sensitivity (85%) and accuracy (94%) of MR imaging for abnormal segments was significantly better than that of US (sensitivity = 69%, P = .015; accuracy = 87%, P = .043). For the ten patients who underwent both MR and hysterosalpingography, the sensitivity (91%) and accuracy (96%) of MR imaging was better than that of hysterosalpingography (sensitivity = 18%, P = .0005; accuracy = 72%, P = .0005). The specificities of the three modalities did not significantly differ (100%, 97%, and 98% for MR, US, and hysterosalpingography, respectively). These data suggest that MR imaging is superior to US or hysterosalpingography for preoperatively locating uterine leiomyomas.     

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.     

Complications of prostate cryosurgery: CT findings in three patients

We present the computed tomographic (CT) findings of complications of prostate cryosurgery in three patients. One patient had injury to the bladder base and rectum, which resulted in ureteral obstruction and vesicorectal fistula. The other two patients had urethral injuries. All three patients had CT evidence of prostate necrosis. If utilization of prostate cryosurgery increases, complications will be encountered more frequently on imaging studies. Received: 12 December 1996/Accepted: 30 January 1997     

CT evaluation of congenital and acquired abnormalities of the azygos system

Congenital and acquired abnormalities may alter the anatomy, size, or position of the azygos system. Computed tomography is often able to depict these abnormalities and in many cases indicate the cause. In this article, the normal anatomy of the azygos system is discussed and examples of congenital and acquired abnormalities are presented.     

MR imaging of uterine carcinoma: correlation with clinical and pathologic findings

Thirteen patients with clinical stages I and II endometrial carcinoma were examined with magnetic resonance (MR) imaging before surgery. Depth of invasion and stage of disease were assessed, and the results were compared with those from MR images of the surgical specimens and pathologic findings. Staging with MR imaging was accurate in 11 of 13 patients (85%). Our results agree with previous reports that MR imaging is an accurate, noninvasive method of assessing depth of myometrial invasion and cervical involvement. We anticipate that MR imaging will have an increasing role in treatment of patients with endometrial carcinoma.     

Hysterosonography: a key to what is inside the uterus

The pursuit of endometrial histology is often prompted by postmenopausal or dysfunctional endometrial bleeding, a pathologically-thickened central endometrial complex on ultrasound, infertility, or routine screening caused by risk factors for underlying pathology. If a focal endoluminal process is responsible, it can remain undiagnosed when a blind method of biopsy is used. Transvaginal ultrasound coupled with hysterosonography can provide the necessary information to triage these patients to the most appropriate tissue sampling technique and avoid the common problem of a false-negative biopsy result. In many circumstances, a focal process can be more specifically characterized and localized during hysterosonography, information which could also help direct subsequent hysteroscopic biopsy if needed.     

Ultrasound of the scrotum.

High-resolution real time ultrasound of the scrotum, including gray-scale and color Doppler sonography is presented. The normal anatomy of the scrotum with sonographic correlation is reviewed. The sonographic features of scrotal pathology, including congenital, neoplastic, inflammatory, and traumatic conditions are presented.     

Resistive indices in the evaluation of infants with obstructive and nonobstructive pyelocaliectasis.

Diagnosing obstructive uropathy by renal resistive indices calculated from duplex Doppler sonographic waveforms has been supported as well as challenged in the radiology literature relating to adults. Despite reports of normally higher resistive indices in children as compared to adults, two studies have documented high sensitivity and specificity of renal Doppler sonography in the diagnosis of obstructive uropathy in children, using the same discriminatory criterion of a resistive index of 0.7 or greater as used in adults. We evaluated 43 infants with significant or bilateral pyelocaliectasis secondary to both obstructive and unobstructive uropathy and found no significant difference in the mean resistive indices or the mean difference in resistive indices of two kidneys in one patient. We conclude that Doppler sonography in infants has no value in differentiating obstructive from nonobstructive pyelocaliectasis.