Intraperitoneal paravesical spaces: CT delineation with US correlation

Ovarian cancer reporting lexicon for computed tomography (CT) and magnetic resonance (MR) imaging developed by the SAR Uterine and Ovarian Cancer Disease-Focused Panel and the ESUR Female Pelvic Imaging Working Group

OBJECTIVES

Imaging evaluation is an essential part of treatment planning for patients with ovarian cancer. Variation in the terminology used for describing ovarian cancer on computed tomography (CT) and magnetic resonance (MR) imaging can lead to ambiguity and inconsistency in clinical radiology reports. The aim of this collaborative project between Society of Abdominal Radiology (SAR) Uterine and Ovarian Cancer (UOC) Disease-focused Panel (DFP) and the European Society of Uroradiology (ESUR) Female Pelvic Imaging (FPI) Working Group was to develop an ovarian cancer reporting lexicon for CT and MR imaging.

METHODS

Twenty-one members of the SAR UOC DFP and ESUR FPI working group, one radiology clinical fellow, and two gynecologic oncology surgeons formed the Ovarian Cancer Reporting Lexicon Committee. Two attending radiologist members of the committee prepared a preliminary list of imaging terms that was sent as an online survey to 173 radiologists and gynecologic oncologic physicians, of whom 67 responded to the survey. The committee reviewed these responses to create a final consensus list of lexicon terms.

RESULTS

An ovarian cancer reporting lexicon was created for CT and MR Imaging. This consensus-based lexicon has 6 major categories of terms: general, adnexal lesion-specific, peritoneal carcinomatosis-specific, lymph node-specific, metastatic disease -specific, and fluid-specific.

CONCLUSIONS

This lexicon for CT and MR imaging evaluation of ovarian cancer patients has the capacity to improve the clarity and consistency of reporting disease sites seen on imaging.

KEY POINTS

• This reporting lexicon for CT and MR imaging provides a list of consensus-based, standardized terms and definitions for reporting sites of ovarian cancer on imaging at initial diagnosis or follow-up. • Use of standardized terms and morphologic imaging descriptors can help improve interdisciplinary communication of disease extent and facilitate optimal patient management. • The radiologists should identify and communicate areas of disease, including difficult to resect or potentially unresectable disease that may limit the ability to achieve optimal resection.

Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel

Endometriosis is a common gynecologic disorder characterized by the presence of ectopic endometrial tissue outside the endometrial cavity. Magnetic Resonance Imaging (MRI) has become a mainstay for diagnosis and staging of this disease. In the literature, significant heterogeneity exists in the descriptions of imaging findings and anatomic sites of involvement. The Society of Abdominal Radiology's Endometriosis Disease-Focused Panel presents this consensus document to establish an MRI lexicon for endometriosis MRI evaluation and anatomic localization.

Patterns of peritoneal spread of tumor in the abdomen and pelvis

The spread of tumor in the peritoneum can be understood, although it is a complex organ. A study of its embryology, anatomy and function is of clear benefit. It is formed from a network of folds, reflections, and potential spaces produced by the visceral and parietal peritoneum. These folds and reflections begin as a dorsal and ventral mesentery, supporting the primitive gut in early embryologic development. The dorsal mesentery connects the stomach and other organs to the posterior abdominal wall, while the ventral mesentery connects the stomach to the ventral abdominal wall. As the embryo develops, there is further organ growth, elongation, cavitation and rotation. The dorsal and ventral mesentery also develops along with the viscera, forming ligaments, mesenteries, omenta and potential spaces from the resulting reflections and folds. These ligaments, mesenteries, and omenta, support and nurture the organs of the peritoneum, providing a highway for arteries, veins, nerves and lymphatics. The potential spaces created from these folds and reflections of the visceral and parietal peritoneum are also important to realize. For example, the transverse mesocolon divides the peritoneal cavity into a supramesocolic and inframesocolic space in the abdomen and paravesicular spaces within the pelvis. The falciform ligament is well known in the supramesocolic space, dividing it further into a left and right compartment. Knowledge of the peritoneal vascular anatomy is beneficial in locating the spaces and ligaments about the peritoneum. For example, identifying the left gastric artery or vein will lead to the gastrohepatic ligament, which is part of the supramesocolic space. Besides serving a life sustaining role, the multiple compartments, ligaments, mesenteries and omenta within the peritoneum can also facilitate the spread of disease. Tumors can spread directly from one organ to another, seed metastatic deposits in the peritoneal cavity, and travel through the lymphatic or hematogenous route to invade other organs in the peritoneum.

Helicobacter pylori virulence factors and their role in peptic ulcer diseases in Turkey

BACKGROUND AND STUDY AIMS

The role of virulence factors present in Helicobacter pylori (H. pylori) strains and the characterization of such factors being predictive of specific disease is still not clear. In this study, the cagA, vacA alleles and the recently characterized vacA i-region and dupA and their association with the severity of the disease was determined.

PATIENTS AND METHODS

Antral biopsies from 91patients with peptic ulcer (PU) (n = 41), gastritis (n = 48) and gastric cancer (GC) (n = 2) were analyzed for the presence of H. pylori by the CLO-test and PCR. A 79/91 (86%) patients were positive for H. pylori by either PCR or by both PCR and CLO-test. PCR-based typing of H. pylori isolates was performed on DNA extracted directly from biopsy samples.

RESULTS

The cagA+ strains were found more likely to be associated with vacA s1 than s2. The vacA i1 allele detected in 16/23 (70%) of samples had significant association with duodenal ulcers than those 16/37 (44%) of gastritis (P < 0.04). No significant association was found between dupA and duodenal ulcer. This study provided more evidence that the vacA i1 allele is one of the virulence factors of H. pylori that had significant association with severe outcome.

[Peritoneum and mesenterium. Radiological anatomy and extent of peritoneal diseases]

The abdominal cavity is subdivided into the peritoneal cavity, lined by the parietal peritoneum, and the extraperitoneal space. It extends from the diaphragm to the pelvic floor. The visceral peritoneum covers the intraperitoneal organs and part of the pelvic organs. The parietal and visceral layers of the peritoneum are in sliding contact; the potential space between them is called the peritoneal cavity and is a part of the embryologic abdominal cavity or primitive coelomic duct. To understand the complex anatomical construction of the different variants of plicae and recesses of the peritoneum, an appreciation of the embryologic development of the peritoneal cavity is crucial. This knowledge reflects the understanding of the peritoneal anatomy, deep knowledge of which is very important in determining the cause and extent of peritoneal diseases as well as in decision making when choosing the appropriate therapeutic approach, whether surgery, conservative treatment, or interventional radiology.

Diagnosis of blunt bladder injury: A prospective comparative study of computed tomography cystography and conventional retrograde cystography

BACKGROUND

This study was designed to evaluate prospectively the accuracy of computed tomography (CT) cystography for the detection of bladder rupture, performed concurrently with screening abdominal/pelvic CT, in patients at risk for blunt bladder injury. The study also aimed to validate our proposed method of performing CT cystography, which was designed to minimize the time and effort required to image the bladder.

METHODS

CT cystography was performed on patients at risk for blunt bladder injury. Retrograde filling of the bladder with dilute iodinated contrast material was performed before routine abdominal/pelvic CT scanning, performed with oral and intravenous contrast. Conventional cystography, when performed, followed CT cystography.

RESULTS

CT cystography, followed by conventional cystography, was performed in 212 patients, among whom 19 had bladder rupture. The CT cystography sensitivity and specificity for bladder rupture in these patients was 95% and 100%, respectively; for conventional cystography, sensitivity and specificity were 95% and 100%, respectively. CT cystography was performed without conventional cystography in 283 patients, among whom 27 had bladder rupture. The sensitivity and specificity of CT cystography for bladder rupture in these patients were both 100%.

CONCLUSIONS

CT cystography is equivalent to conventional cystography for detecting the presence or absence of blunt bladder injury. CT cystography can be performed as an integral part of the CT screening undergone by many blunt trauma patients and, in the vast majority of these patients, it can alleviate the need for a separate conventional cystogram.

CT of the medial umbilical folds

PURPOSE

The goal of our study was to investigate the appearance of the medial umbilical folds on CT.

METHOD

We retrospectively reviewed the CT images of 30 consecutive patients with massive ascites. In addition, we inspected the inner pelvic wall in cadavers.

RESULTS

The medial umbilical folds were well recognized on CT in 21 of 30 patients, bilaterally in 20 and unilaterally in 1. In four patients the folds were undetectable after the ascites resolved. The CT findings were supported by those studied in cadavers, in which the folds were recognized as a peritoneal reflection in 13 of 20.

CONCLUSION

We concluded that medial umbilical folds could be commonly visualized on CT when ascites was present.

The direction of bladder displacement by adnexal masses

Impression on the bladder, or its displacement, indicates the presence of a mass or mass effect. The direction of the displacement aids in the formulation of an appropriate differential diagnosis. We present for discussion two cases in which preoperative lateral bladder displacement was attributed to adnexal masses. When the anatomy of the paravesical spaces is reviewed, it is apparent that lateral bladder displacement is generally not compatible with such masses.