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MR of Fallopian Tubes. Magn Reson Imaging Clin N Am 2023; 31:29-41. [DOI: 10.1016/j.mric.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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2
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Udayakumar N, Smith E, Boone A, Porter KK. A Common Path: Magnetic Resonance Imaging of Müllerian and Wolffian Duct Anomalies. Curr Urol Rep 2023; 24:1-9. [PMID: 36595101 DOI: 10.1007/s11934-022-01138-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the pathway of Mullerian and Wolffian duct development, anomalies that result from disruptions to this pathway, and the characteristics on advanced imaging that identify them. RECENT FINDINGS In-office evaluation for reproductive anomalies is usually inadequate for the diagnosis of congenital reproductive anomalies. Magnetic resonance imaging (MRI) has usurped invasive diagnostic methods including laparoscopy, hysteroscopy, and vasography as the new gold standard. Because of its superior soft-tissue delineation and the availability of advanced functional sequences, MRI offers a sophisticated method of distinguishing reproductive anomalies from one another, characterizing the degree of defect severity, and evaluating for concomitant urogenital anomalies non-invasively and without radiation exposure to the patient. Congenital anomalies of the Mullerian and Wolffian duct can be incredibly nuanced, requiring prompt and accurate diagnosis for management of infertility. Definitive diagnosis should be made early with MRI.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Elainea Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Boone
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Mattos LAD, Sauer LJ, Blasbalg R, Petta CA, Pereira RM, Carvalho LFPD. Hysterosalpingography using Magnetic Resonance Imaging for infertility patients. JBRA Assist Reprod 2021; 25:403-411. [PMID: 33900058 PMCID: PMC8312299 DOI: 10.5935/1518-0557.20210002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Some studies have shown that it is possible to evaluate tubal permeability through MRI. Our aim is to perform a prospective study and to perform a comprehensive review in the literature regarding HSG-MRI. METHODS We carried out a PUBMED search using the following keywords: hysterosalpingogram, hysterosalpingography, magnetic resonance imaging and MRI. As inclusion criteria, we included only papers published in English, and exams ran on humans. We also conducted a prospective inclusion of patients who had visited a human reproduction clinic between May/2017 and April/2019 for laboratory image diagnoses using HSG-MRI. RESULTS Following the inclusion and exclusion criteria, we included seven original papers. Review papers and those written in a language other than English, were excluded. Between the period of May/2017 and April/2019, we selected ten patients for our study. The average exam duration was 30 minutes. Cervical catheterization was possible in all cases. There were no major complications. We highlight that in 8/9 of patients, we could directly visualize uterine tubes with contrast (excluding one patient with bilateral tubal ligation). CONCLUSIONS Our initial experience with HSG-MRI shows promise. We demonstrated an optimized protocol for conducting an HSG-MRI (with excellent image quality). HSG-MRI had some advantages, such as not using ionized radiation, less pain and being able to analyze pelvic anatomy. Patients referred for a pelvic MRI as part of a more detailed investigation into infertility can also benefit from undergoing a simultaneous HSG using MRI.
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Affiliation(s)
- Leandro Accardo de Mattos
- ALTA Excellency Diagnostic/DASA Department of Diagnostic Imaging/DASA, São Paulo Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil
| | - Luísa Jacques Sauer
- ALTA Excellency Diagnostic/DASA Department of Diagnostic Imaging/DASA, São Paulo Brazil
| | - Roberto Blasbalg
- ALTA Excellency Diagnostic/DASA Department of Diagnostic Imaging/DASA, São Paulo Brazil
| | | | | | - Luiz Fernando Pina de Carvalho
- Baby Center - Center for Reproductive Medicine, São Paulo, Brazil
- College - Institute of Clinical Research and Teaching Development, São Paulo, Brazil
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Wu V, Mar W, Milad MP, Horowitz JM. Magnetic Resonance Imaging in the Evaluation of Female Infertility. Curr Probl Diagn Radiol 2021; 51:181-188. [PMID: 33487486 DOI: 10.1067/j.cpradiol.2020.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
Pelvic MRI plays an important adjunctive role in the clinical workup of female infertility. Hysterosalpingography is the first line imaging modality in evaluation of female infertility, and hysterosalpingo-contrast sonography can also be used to evaluate both the uterine cavity and fallopian tubes. Pelvic MRI can be helpful in the workup of female infertility, particularly in cases of Mullerian duct anomalies, fibroids, adenomyosis, endometriosis, and tubal disease. These conditions and their appearance on imaging will be reviewed in this article.
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Affiliation(s)
- Victoria Wu
- University of Illinois Hospital and Health Systems, Chicago, IL.
| | - Winnie Mar
- University of Illinois Hospital and Health Systems, Chicago, IL
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5
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The relationship between hysterosalpingography findings and female infertility in a Nigerian population. Pol J Radiol 2020; 85:e188-e195. [PMID: 32419884 PMCID: PMC7218450 DOI: 10.5114/pjr.2020.94488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aims to explore the relationships between abnormal hysterosalpingography (HSG) findings and all types of infertility. Material and methods This retrospective study was carried out at a private radiodiagnostic centre in Lagos, Nigeria. The radiologist reports of all consecutive patients who had HSG evaluation from 2016 to 2018 were analysed. Biodemographic information and indications for HSG evaluation were also documented. Logistic regression was used to test correlations between the explanatory and outcome variables. P ≤ 0.05 represented a statistically significant result. Results A total of 450 patients were involved in this study, with ages ranging from 21 to 51 years and a mean age of 34.6 ± 5.56 years. The age group 31-35 years had the highest frequency of infertility. There were 299 patients referred for infertility. Secondary infertility was seen in 211 patients (46.9%), primary infertility was seen in 79 patients (17.6%), and subfertility was seen in nine patients (2%). There were 49 patients (10.9%) with cornual tubal blockage, while 57 patients (12.7%) had perifimbrial adhesion and/or blockage. There were 56 patients (12.4%) with hydrosalpinx and nine patients (2.0%) with tubal occlusion. Multivariate logistic regression analysis showed women with hydrosalpinx were 2.11 times more likely to be infertile than those without hydrosalpinx (95% CI: 1.02-4.36, p = 0.042). Conclusions The presence of hydrosalpinx was a significant risk factor in developing all types of infertility. Understanding the HSG patterns and their correlations with infertility will help physicians across the world when evaluating infertility in patients of similar background to our patient population.
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Wall DJ, Reinhold C, Akin EA, Ascher SM, Brook OR, Dassel M, Henrichsen TL, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Uyeda JW, Glanc P. ACR Appropriateness Criteria® Female Infertility. J Am Coll Radiol 2020; 17:S113-S124. [PMID: 32370955 DOI: 10.1016/j.jacr.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Abstract
The most common known causes of female infertility are male factor (26%), ovulatory failure (21%), and tubal damage (14%), while in 28% a couple's infertility remains unexplained. Female-specific causes of infertility include deterioration of oocyte quality with increasing maternal age; ovulatory disorders, most notably polycystic ovarian syndrome; history of salpingitis such as that caused by chlamydia infection; endometriosis; and uterine cavity abnormalities interfering with implantation causing inability to become pregnant or causing recurrent pregnancy loss. These potential causes of female infertility are discussed in this document and the appropriate imaging recommendations for each variant are provided. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | | | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Merritt BA, Behr SC, Khati NJ. Imaging of Infertility, Part 1: Hysterosalpingograms to Magnetic Resonance Imaging. Radiol Clin North Am 2020; 58:215-225. [PMID: 32044003 DOI: 10.1016/j.rcl.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infertility, or subfertility, is the inability to achieve a clinical pregnancy after a 1-year period of regular unprotected sexual intercourse in women younger than 35 and after 6 months in women older than 35. Although initial assessment involves a multitude of factors, including a detailed medical history, physical examination, semen analysis, and hormonal evaluation, diagnostic imaging of the female partner often plays an important role in establishing the etiology for infertility. This article provides an overview of the multimodality imaging assessment of female infertility and details the developmental and acquired pelvic abnormalities in which diagnostic imaging aids in evaluation.
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Affiliation(s)
- Bryce A Merritt
- Diagnostic Radiology, UCSF Department of Radiology & Biomedical Imaging, 505 Parnassus Avenue, Moffitt, Suite 307H, San Francisco, CA 94143, USA
| | - Spencer C Behr
- UCSF Department of Radiology & Biomedical Imaging, 505 Parnassus Avenue, Moffitt, Suite 307H, San Francisco, CA 94143, USA
| | - Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
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Patkar D. Presidential address 2020. Indian J Radiol Imaging 2020; 30:4-6. [PMID: 32476743 PMCID: PMC7240891 DOI: 10.4103/ijri.ijri_133_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepak Patkar
- Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India
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Grover SB, Antil N, Katyan A, Rajani H, Grover H, Mittal P, Prasad S. Niche role of MRI in the evaluation of female infertility. Indian J Radiol Imaging 2020; 30:32-45. [PMID: 32476748 PMCID: PMC7240899 DOI: 10.4103/ijri.ijri_377_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/16/2020] [Accepted: 02/11/2020] [Indexed: 02/05/2023] Open
Abstract
Infertility is a major social and clinical problem affecting 13-15% of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero- salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono-hysterography (syn: hystero-sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in diagnosing entities comprising the garden variety, however, extensive pelvic inflammatory disease, complex tubo-ovarian pathologies, deep-seated endometriosis deposits with its related complications, Mulllerian duct anomalies, uterine synechiae and adenomyosis, often remain unresolved by both transabdominal and transvaginal US. Thus, MRI comes to the rescue and has a niche role in resolving complex adnexal masses, endometriosis, and Mullerian duct anomalies with greater ease. This is a review, based on the authors' experience at tertiary care teaching hospitals and aims to provide an imaging approach towards the abnormalities which are not definitively diagnosed by ultrasound alone.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neha Antil
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Katyan
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Heena Rajani
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hemal Grover
- Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA
| | - Pratima Mittal
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sudha Prasad
- Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
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Al-Jaroudi D, Aldughayyim AA, Alshamry WS, Alrashidi AS, Bahnassy AA. Hysterosalpingogram findings among subfertile women undergoing assisted reproductive technology. Int J Womens Health 2018; 10:431-436. [PMID: 30147380 PMCID: PMC6097507 DOI: 10.2147/ijwh.s156157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The objectives of our study included comparing reproductive histories and causes of infertility between patients with and without a hysterosalpingogram (HSG) investigation, and summarizing the prevalence and extent of tubal abnormalities among patients who underwent HSG. Outcomes following assisted reproductive technology (ART) were compared between HSG and non-HSG groups. MATERIALS AND METHODS A cross-sectional study was conducted to review the medical records of 200 Saudi women with subfertility. In addition to information on HSG, patient data extracted included age, body mass index (BMI), infertility duration, miscarriage experience, parity, cause of infertility, and history of previous surgery, ectopic pregnancy, endometriosis, tubal surgery, pelvic inflammatory disease (PID), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), pregnancy, and live birth. RESULTS One hundred and ninety six (98.0%) patients had either IVF (n=18; 9.0%) or ICSI (n=178; 89.0%) performed; ICSI was performed in 157 (90%) and 21 (81%) patients. Of the 12 women with tubal factor who did not undergo HSG, 3 (25.0%) became pregnant after ART, 8 (66.7%) did not, and the status of 1 (8.3%) is yet unknown. CONCLUSIONS Our study aimed to contribute to resolving the debate regarding the continuing role of HSG in an environment where ART has become established as a successful approach to treat infertility. Most of the HSGs were done as per the attending physician's discretion, and not according to any specific policy.
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Affiliation(s)
- Dania Al-Jaroudi
- Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia,
| | | | | | | | - Ahmed A Bahnassy
- Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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MRI is it complementary or mandatory to ultrasound in classification of different congenital anomalies of female reproductive tract? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Boumosleh JM, Grundy SM, Phan J, Neeland IJ, Chang A, Vega GL. Metabolic Concomitants of Obese and Nonobese Women With Features of Polycystic Ovarian Syndrome. J Endocr Soc 2017; 1:1417-1427. [PMID: 29264465 PMCID: PMC5695651 DOI: 10.1210/js.2017-00323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/27/2017] [Indexed: 02/08/2023] Open
Abstract
Context: Polycystic ovarian syndrome (PCOS) is often associated with obesity and diabetes. Objective: The present study measured body fat distribution and metabolic risk factors in women with features of PCOS. Design: Cross-sectional, multiethnic study of cardiovascular risks. Setting: General community. Study Participants: 145 PCOS and 344 non-PCOS women. Exposure Measures: Body composition by dual x-ray absorptiometry; abdominal fat masses measured by magnetic resonance imaging and hepatic triglyceride by magnetic resonance spectroscopy. Outcomes Measures: Body composition, liver fat content, homeostatic model assessment for insulin resistance (HOMA-IR), revised, and metabolic syndrome components. Results: PCOS women had a higher free androgen index compared with the non-PCOS women. Nonobese PCOS and non-PCOS women had a similar body fat content and distribution, HOMA-IR, and hepatic triglyceride content. Obese PCOS women had a similar total body fat percentage compared with their non-PCOS counterparts (41.4% and 41.4% respectively). Both obese groups had similar intraperitoneal fat (1.4% of total body mass in PCOS vs 1.4% in non-PCOS). However, obese PCOS women had a greater ratio of truncal/lower body fat (1.42 vs 1.27; P < 0.016). They also had greater insulin resistance (HOMA-IR: PCOS, 2.24% vs non-PCOS, 1.91%; P < 0.016), higher liver triglyceride content (6.96% in PCOS vs 4.44% in non-PCOS; P < 0.016), and a greater incidence of hypertension (33% vs 24%; P < 0.05). No differences were observed in other metabolic risk factors. Conclusions: Both obese and nonobese women with PCOS features had a greater free androgen index compared with non-PCOS women, but neither had greater intraperitoneal fat or abnormal lipid levels. Obese, but not nonobese, women with PCOS had a greater truncal/lower extremity fat ratio, HOMA-IR, and liver triglyceride content.
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Affiliation(s)
- Jocelyne Matar Boumosleh
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Scott M Grundy
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Veterans Affairs Medical Center, Dallas, Texas 75216
| | - Jennifer Phan
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Ian J Neeland
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Alice Chang
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Gloria Lena Vega
- The Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Department of Clinical Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390.,Veterans Affairs Medical Center, Dallas, Texas 75216
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13
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The spectrum of imaging appearances of müllerian duct anomalies: focus on MR imaging. Jpn J Radiol 2017; 35:697-706. [DOI: 10.1007/s11604-017-0681-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/30/2017] [Indexed: 11/26/2022]
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Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M. Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation. Radiographics 2016; 36:1579-1596. [PMID: 27618331 DOI: 10.1148/rg.2016150202] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.
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Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Haatal B Dave
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Matthew L Macer
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Michael Spektor
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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Cipolla V, Guerrieri D, Pietrangeli D, Santucci D, Argirò R, de Felice C. Role of 3.0 Tesla magnetic resonance hysterosalpingography in the diagnostic work-up of female infertility. Acta Radiol 2016; 57:1132-9. [PMID: 26663038 DOI: 10.1177/0284185115617351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Imaging evaluation plays a crucial role in the diagnostic work-up of female infertility. In recent years, the possibility to evaluate tubal patency using 1.5 Tesla magnetic resonance (1.5T MR) has been studied. PURPOSE To assess the feasibility of 3.0 Tesla magnetic resonance (3.0T MR) hysterosalpingography and its role in the diagnostic work-up of female infertility and to evaluate if this fast "one-stop-shop" imaging approach should be proposed as a first-line examination. MATERIAL AND METHODS A total of 116 infertile women were enrolled in this prospective study; all underwent 3.0T MR hysterosalpingography. After standard imaging of the pelvis, tubal patency was assessed by acquiring 3D dynamic time-resolved T1-weighted (T1W) sequences during manual injection of 4-5 mL of contrast solution consisting of gadolinium and normal sterile saline. Images were evaluated by two radiologists with different experience in MR imaging (MRI). RESULTS The examination was successfully completed in 96.5% of cases, failure rate was 3.5%. Dynamic sequences showed bilateral tubal patency in 64.3%, unilateral tubal patency in 25.9%, and bilateral tubal occlusion in 9.8%. Extratubal abnormalities were found in 69.9% of patients. Comprehensive analysis of morphological and dynamic sequences showed extratubal abnormalities in 43.1% of patients with bilateral tubal patency. CONCLUSION 3.0T MR hysterosalpingography is a feasible, simple, fast, safe, and well-tolerated examination, which allows evaluation of tubal patency and other pelvic causes of female infertility in a single session, and it may thus represent a "one-stop-shop" solution in female infertility diagnostic work-up.
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Affiliation(s)
- Valentina Cipolla
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Daniele Guerrieri
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Daniela Pietrangeli
- Department of Obstetrics, Gynaecology and Urological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Domiziana Santucci
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Renato Argirò
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Carlo de Felice
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
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Montoliu-Fornas G, Martí-Bonmatí L. Magnetic resonance imaging structured reporting in infertility. Fertil Steril 2016; 105:1421-31. [DOI: 10.1016/j.fertnstert.2016.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
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Al-Turki HA, Gullenpet AH, Syed A, Al-Saif HS, Aldhafery BF. Uterine and Tubal Abnormalities in Infertile Saudi Arabian Women: A Teaching Hospital Experience. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2016; 4:89-92. [PMID: 30787704 PMCID: PMC6298322 DOI: 10.4103/1658-631x.178293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background and Objective: Hysterosalpingography (HSG) is commonly used in the evaluation of the subfertile and infertile women. This study was undertaken to assimilate the findings observed during HSG in Saudi Arabian infertile patients and to find the most common pathology identified by the HSG. Patients and Methods: A retrospective analysis was conducted of subfertile and infertile patients who had undergone HSG between June 2007 and May 2012. Patients’ demographic data were collected from the medical records of the King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The data included age, years of marriage, menstrual history either regular or irregular, primary/secondary infertility, hormonal profile, previous infection or pelvic surgery, and diagnostic laparoscopy. Radiographic reports of HSG were collected from the IPAC system and analyzed for fimbrial findings, tubal patency, and cervical and uterine cavitary pathology. The data were entered in the database and analyzed using a t-test to compare means between the age, type of infertility, different pathologies and for all the parameters assessed. All tests were performed using Statistical Package for the Social Sciences, version 14.0, Chicago, Illinois, USA. A P < 0.05 was considered statistically significant with a confidence interval of 95%. Results: Data from the medical records of 117 patients with an average age of 32.59 ± 5.48 years were analyzed. Of this total, 48 (41%) had been diagnosed as having primary infertility. In 95 (81.2%) patients, there was an abnormality in the fallopian tubes and in 27 (23%) patients, there was an abnormality in the uterus. Patients with primary infertility were significantly younger (29.7 ± 5.6 vs. 34.58 ± 4.75; P < 0.001), and tubal and uterine pathology was more common (P < 0.08 and 0.01). Conclusions: Our review indicates that the most common pathology found through HSG in women presenting with infertility is tubal blockage.
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Affiliation(s)
- Haifa A Al-Turki
- Department of Obstetrics and Gynecology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Abid H Gullenpet
- Department of Radiology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Anjum Syed
- Department of Radiology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Hind S Al-Saif
- Department of Radiology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Bander F Aldhafery
- Department of Radiology, College of Medicine, University of Dammam and King Fahd Hospital of the University, Al Khobar, Saudi Arabia
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Sadro CT. Pictorial Review of Complications of Uterine Anomalies. Can Assoc Radiol J 2015; 66:368-76. [PMID: 26601928 DOI: 10.1016/j.carj.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 07/25/2015] [Accepted: 08/01/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Claudia T Sadro
- Harborview Medical Center, University of Washington, Seattle, Washington, USA.
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DeBenedectis C, Ghosh E, Lazarus E. Pitfalls in imaging of female infertility. Semin Roentgenol 2015; 50:273-83. [PMID: 26542428 DOI: 10.1053/j.ro.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Erica Ghosh
- University of Massachusetts Medical School, Worcester, MA
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Gynecologic Emergencies: Findings Beyond US and Advances in Management. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Magnetic resonance imaging for diagnosis of pelvic lesions associated with female infertility. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Aluwee SAZBS, Kato H, Zhou X, Hara T, Fujita H, Kanematsu M, Furui T, Yano R, Miyai N, Morishige KI. Magnetic resonance imaging of uterine fibroids: a preliminary investigation into the usefulness of 3D-rendered images for surgical planning. SPRINGERPLUS 2015; 4:384. [PMID: 26240782 PMCID: PMC4516148 DOI: 10.1186/s40064-015-1170-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022]
Abstract
Purpose This study aimed to assess the efficacy of 3D surface-rendered (SR) magnetic resonance (MR) images for surgical planning of uterine fibroids. Methods Ten patients with uterine fibroids underwent 3D volume isotropic turbo spin-echo acquisition (VISTA) sequences in sagittal planes. SR images showing the uterine body, endometrium, and fibroids were extracted from the raw MR data. The preoperative assessment for fertility-preserving fibroid enucleation was independently performed by two gynecologists using 2D sagittal and 3D SR images separately. Results The required interpretation times [second] for sagittal versus SR images were 19.7 ± 9.5 versus 10.4 ± 5.1 for observer 1 (p < 0.05) and 47.5 ± 12.3 versus 19.7 ± 9.5 for observer 2 (p < 0.01). The accuracy rates of the planned surgical procedures from sagittal versus SR images were 50 versus 70% for observer 1 and 70 versus 70% for observer 2. The accuracy rates of the numbers of fibroids to be removed from sagittal versus SR images were 70 versus 80% for observer 1 and 70 versus 80% for observer 2. Conclusion Compared with sagittal images, SR images could significantly reduce the time required for surgical planning of uterine fibroids without sacrificing the accuracy of the preoperative assessment.
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Affiliation(s)
- Sayed Ahmad Zikri B Sayed Aluwee
- Division of Regeneration and Advanced Medical Sciences, Department of Intelligent Image Information, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Xiangrong Zhou
- Division of Regeneration and Advanced Medical Sciences, Department of Intelligent Image Information, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Takeshi Hara
- Division of Regeneration and Advanced Medical Sciences, Department of Intelligent Image Information, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Hiroshi Fujita
- Division of Regeneration and Advanced Medical Sciences, Department of Intelligent Image Information, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Masayuki Kanematsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Tatsuro Furui
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Ryuichiro Yano
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Nao Miyai
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
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24
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Ganeshan D, Morani A, Ladha H, Bathala T, Kang H, Gupta S, Lalwani N, Kundra V. Staging, surveillance, and evaluation of response to therapy in renal cell carcinoma: role of MDCT. ACTA ACUST UNITED AC 2015; 39:92-107. [PMID: 24077815 DOI: 10.1007/s00261-013-0040-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Renal cell carcinoma is the most common malignant renal tumor in the adults. Significant advances have been made in the management of localized and advanced renal cell carcinoma. Surgery is the standard of care and accurate pre-operative staging based on imaging is critical in guiding appropriate patient management. Besides staging, imaging plays a key role in the post-operative surveillance and evaluation of response to systemic therapies. Both CT and MR are useful in the staging and follow up of renal cell carcinoma, but CT is more commonly used due to its lower costs and wider availability. In this article, we discuss and illustrate the role of multi-detector CT in pre-operative staging, post-operative surveillance, and evaluation of response to systemic therapy in renal cell carcinoma.
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Badawy ME, Elkholi DGEY, Sherif MF, Hefedah MAE. Magnetic resonance imaging of uterovaginal lesions associated with female infertility. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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27
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Accuracy of magnetic resonance imaging in diagnosis of deeply infiltrating endometriosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Robbins JB, Broadwell C, Chow LC, Parry JP, Sadowski EA. Müllerian duct anomalies: Embryological development, classification, and MRI assessment. J Magn Reson Imaging 2014; 41:1-12. [DOI: 10.1002/jmri.24771] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jessica B. Robbins
- Department of Radiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Christy Broadwell
- Department of Obstetrics and Gynecology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Lawrence C. Chow
- Department of Radiology; Oregon Health and Science University; Portland Oregon USA
| | - John P. Parry
- Department of Obstetrics & Gynecology; University of Mississippi Medical Center; Jackson Mississippi USA
| | - Elizabeth A. Sadowski
- Department of Radiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
- Department of Obstetrics and Gynecology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
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Mohammadifard M, Saburi A. The role of other imaging modalities in evaluating the tubal patency. J Hum Reprod Sci 2014; 7:154-5. [PMID: 25191032 PMCID: PMC4150145 DOI: 10.4103/0974-1208.138877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mahyar Mohammadifard
- Department of Radiology, Imam Reza University Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Amin Saburi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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30
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Chabrol A, Rousset P, Charlot M, Chateau F, Cotton F, Golfier F, Rety F. Lesions of the ovary with T1-hypersignal. Clin Radiol 2014; 69:e404-13. [PMID: 25017450 DOI: 10.1016/j.crad.2014.05.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/08/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
Abstract
Pelvic magnetic resonance imaging (MRI) has been used successfully to diagnose ovarian masses that cannot be adequately evaluated using pelvic ultrasound. T1 hyperintensity is a common finding in an ovarian mass and has important diagnostic implications. The aims of this review are to list the substances that may produce high signal intensity on T1-weighted MRI, to explain the physical basis for causes of the high T1 signal intensity, and to describe common and uncommon T1 hyperintense ovarian lesions. The morphological findings, the imaging features of the additional sequences, and clinical variables can help in the differential diagnosis, and in some cases, enable a specific diagnosis, leading to appropriate management of the patient.
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Affiliation(s)
- A Chabrol
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France.
| | - P Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - M Charlot
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Chateau
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Cotton
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Golfier
- Department of Gynaecological and Oncological Surgery-Obstetrics, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Rety
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
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31
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Sudderuddin S, Helbren E, Telesca M, Williamson R, Rockall A. MRI appearances of benign uterine disease. Clin Radiol 2014; 69:1095-104. [PMID: 25017452 DOI: 10.1016/j.crad.2014.05.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
Benign uterine disease is a common entity affecting women of all ages. Ultrasound has historically been the predominant imaging method used in the evaluation of benign gynaecological disease, magnetic resonance imaging (MRI) being reserved for use in the staging of malignant uterine and cervical disease. MRI is now increasingly used in the diagnosis of benign uterine disease as well as a tool for problem-solving in cases of diagnostic dilemma. It allows detailed assessment of benign conditions, such as endometrial lesions, leiomyomas, and adenomyosis, and can be helpful in the stratification of patients to different treatment modalities, including surgical resection, uterine artery embolization, and medical therapies. In this article, we review the MRI findings in the common benign uterine diseases.
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Affiliation(s)
- S Sudderuddin
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
| | - E Helbren
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - M Telesca
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - R Williamson
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - A Rockall
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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El Ameen NF, Ebraheem MA, Nour El Dien NM. MR assessment of Müllerian duct anomalies: Does it help? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Siddiqui N, Nikolaidis P, Hammond N, Miller FH. Uterine artery embolization: pre- and post-procedural evaluation using magnetic resonance imaging. ACTA ACUST UNITED AC 2014; 38:1161-77. [PMID: 23471598 DOI: 10.1007/s00261-013-9990-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance (MR) imaging has become the preferred method in assessing the uterus and pelvis prior to and following uterine artery embolization (UAE). The multiplanar imaging capabilities, increased spatial and contrast resolution, anatomic detail and assessment of fibroid viability that MR provides over ultrasound allows for accurate pre-treatment planning and post-treatment assessment. The purpose of this article is to demonstrate the use of MR in the selection of patients, anatomic evaluation and procedural planning before UAE, describe the use of MR in evaluating treatment response after UAE and illustrate the use of MR in identifying post-UAE complications. An understanding of these principles is essential in guiding appropriate therapy, determining treatment effectiveness and identifying associated complications before and after UAE.
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Affiliation(s)
- Nasir Siddiqui
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL, 60611, USA
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Santacana-Laffitte G, Ruiz L, Pedrogo Y, Colon E. Cystic adnexal mass in a 16-year-old female: Ovarian pathology or complication of a Müllerian anomaly? AMERICAN JOURNAL OF CASE REPORTS 2013; 14:153-156. [PMID: 23826455 PMCID: PMC3700479 DOI: 10.12659/ajcr.889050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
Abstract
Patient: Female, 16 Final Diagnosis: Pelvic mass Symptoms: None Medication: None Clinical Procedure: CT • MRI Specialty: Diagnostic radiology • pediatrics
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Affiliation(s)
- Guido Santacana-Laffitte
- Department of Diagnostic Radiology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
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35
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ATKIN KL, BALOGUN M. Hysterosalpingography: a resurgent study, 100 years after it was first performed. IMAGING 2013. [DOI: 10.1259/imaging/90763188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tulandi T, Akkour K. Role of reproductive surgery in the era of assisted reproductive technology. Best Pract Res Clin Obstet Gynaecol 2012; 26:747-55. [DOI: 10.1016/j.bpobgyn.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/11/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
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Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings. Insights Imaging 2012; 3:475-83. [PMID: 22802083 PMCID: PMC3443271 DOI: 10.1007/s13244-012-0183-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the spectrum of diagnostic findings in hysterosalpingography (HSG) examinations performed at our institution between 2006–2010 and their prognostic significance for treatment decisions and fertility outcomes. Methods Patients were filtered from our PACS. Pathological HSG studies were re-evaluated. Indications for referral, technical success and diagnostic findings were analysed. Pathological findings were correlated with further diagnostic workups, treatments and fertility outcomes. Results Of 411 HSG examinations, 226 (55 %) were normal, 94 (23 %) showed minor abnormalities and 5 (1.2 %) were not diagnostic. Eighty-six (21 %) examinations were pathological. Twenty-nine patients underwent subsequent laparoscopy, during which proximal tubal occlusion diagnosed at HSG was ruled out in 9/23 cases. Follow-up information was unavailable for 20 patients. Nineteen of 66 patients with follow-ups after pathological HSG had at least one subsequent successful pregnancy. Forty-one patients had no further treatment and no pregnancies. Conclusions The detection rate for pathologies at HSG was low (21 %). There was a high false-positive rate (39 %) for proximal tubal occlusion, most likely because of spasms, demonstrating the importance of delayed imaging after injection of antiperistaltic agents. HSG remains a valuable diagnostic tool. Our results, however, indicate that this technique should be more selectively indicated. Main Messages • Good acceptance of HSG by the patients. No complications with antibiotic prophylaxis. • Low detection rate (21 % pathological exams) for pathologies in our study. • High false-positive rate for proximal tubal occlusion. • This demonstrates the importance of waiting longer after injection of buscopan. • High pregnancy rate in pathological cases: Indication too broad or even a therapeutic effect of HSG?
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Omari EA, Varghese T, Kliewer MA. A novel saline infusion sonohysterography-based strain imaging approach for evaluation of uterine abnormalities in vivo: preliminary results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:609-615. [PMID: 22441918 PMCID: PMC3659397 DOI: 10.7863/jum.2012.31.4.609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this article, we demonstrate the feasibility of saline infusion sonohysterography-based strain imaging for the determination of stiffness variations in uterine masses in vivo. Strain images are estimated using a 2-dimensional multilevel hybrid algorithm developed for sector array ultrasound transducers. Coarse displacements are initially estimated using envelope echo signals, followed by a guided finer displacement estimation using window lengths on the order of 6 wavelengths and 7 A-lines on radiofrequency data. Strain images are obtained by estimating displacement slopes using least squares estimation. In this prospective study, we show that stiffer masses such as fibroids appear darker or as regions with low strain on strain images and are thus clearly differentiated when compared to normal uterine tissue. A high strain boundary around stiffer masses referred to as a "halo" due to increased slipping or sliding of the mass during the applied deformation is also visualized. Uterine polyps, on the other hand, are visualized as masses that are brighter or regions with high strain when compared to the background myometrium, indicating the presence of a softer mass. Axial strain images provide additional new information that may supplement current clinical B-mode imaging used for the diagnosis of uterine abnormalities. Our results show the feasibility of improving clinical diagnosis based on strain imaging.
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Affiliation(s)
- Eenas A Omari
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
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El Saman AM, Habib DM, Othman EER, Tawfik RM. Successful canalization of a noncommunicating uterine horn by horn-vaginal anastomosis: preliminary findings of a novel approach for an unclassified anomaly. J Pediatr Surg 2011; 46:1464-8. [PMID: 21763856 DOI: 10.1016/j.jpedsurg.2011.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis. METHODS Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months. RESULTS The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia. CONCLUSIONS Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods.
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Affiliation(s)
- Ali M El Saman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Women's Health University Hospital, Assiut University, Assiut, Egypt.
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Hori M, Kim T, Onishi H, Ueguchi T, Tatsumi M, Nakamoto A, Tsuboyama T, Tomoda K, Tomiyama N. Uterine Tumors: Comparison of 3D versus 2D T2-weighted Turbo Spin-Echo MR Imaging at 3.0 T—Initial Experience. Radiology 2011; 258:154-63. [DOI: 10.1148/radiol.10100866] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Bermejo Espinosa N, Isusi Fontán M, Diez Renovales F. [Solution to case 19: Herlyn-Werner-Wunderlich Syndrome]. RADIOLOGIA 2010; 52:366-8. [PMID: 20637362 DOI: 10.1016/j.rx.2008.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 10/07/2008] [Indexed: 11/25/2022]
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Novellas S, Chassang M, Bouaziz J, Delotte J, Toullalan O, Chevallier EP. Anterior pelvic endometriosis: MRI features. ACTA ACUST UNITED AC 2010; 35:742-9. [DOI: 10.1007/s00261-010-9600-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Uterine fibroid embolization imaging: interventionalist's perspective. Ultrasound Q 2009; 25:185-94. [PMID: 19956051 DOI: 10.1097/ruq.0b013e3181c47de4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Uterine fibroid embolization (UFE) is a minimally invasive and well-accepted form of treatment for patients with symptoms from fibroids. Imaging is routinely performed before the procedure for various reasons and after the procedure in cases with either complications or incomplete response to UFE. The interventionalists performing the procedure require specific information from these imaging studies. This article describes the imaging workup of patients referred for UFE, specifically the information from these imaging examinations before the procedure that are necessary to the interventionalist and the complications seen after the procedure.
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Patterns of ovarian morphology in polycystic ovary syndrome: a study utilising magnetic resonance imaging. Eur Radiol 2009; 20:1207-13. [DOI: 10.1007/s00330-009-1643-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 08/28/2009] [Indexed: 11/30/2022]
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Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics 2009; 29:1353-70. [PMID: 19755600 DOI: 10.1148/rg.295095047] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging plays a key role in the diagnostic evaluation of women for infertility. The pelvic causes of female infertility are varied and range from tubal and peritubal abnormalities to uterine, cervical, and ovarian disorders. In most cases, the imaging work-up begins with hysterosalpingography to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at hysterosalpingography but typically require further characterization with hysterographic or pelvic ultrasonography (US) or pelvic magnetic resonance (MR) imaging. Hysterographic US helps differentiate among uterine synechiae, endometrial polyps, and submucosal leiomyomas. Pelvic US and MR imaging help further differentiate among uterine leiomyomas, adenomyosis, and the various müllerian duct anomalies, with MR imaging being the most sensitive modality for detecting endometriosis. The presence of cervical disease may be inferred initially on the basis of difficulty or failure of cervical cannulation at hysterosalpingography. Ovarian abnormalities are usually detected at US. The appropriate selection of imaging modalities and accurate characterization of the various pelvic causes of infertility are essential because the imaging findings help direct subsequent patient care.
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Affiliation(s)
- Jill A Steinkeler
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA.
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Junqueira BLP, Allen LM, Spitzer RF, Lucco KL, Babyn PS, Doria AS. Müllerian duct anomalies and mimics in children and adolescents: correlative intraoperative assessment with clinical imaging. Radiographics 2009; 29:1085-103. [PMID: 19605658 DOI: 10.1148/rg.294085737] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Müllerian duct anomalies (MDAs) are congenital entities that result from nondevelopment, defective vertical or lateral fusion, or resorption failure of the müllerian (paramesonephric) ducts. MDAs are common, although the majority are asymptomatic, and have been classified by the American Society of Reproductive Medicine according to clinical manifestations, prognosis, and treatment. Accurate diagnosis of an MDA is essential, since the management approach varies depending on the type of malformation. In females, when a müllerian duct becomes obstructed, the patient may present with an abdominal mass and dysmenorrhea. If the patient is not treated in a timely fashion, the consequences can be severe, extending even to infertility. When an MDA is suspected, ultrasonography (US) should be performed initially to delineate any abnormalities in the genital tract. However, US cannot help identify the type of MDA. In contrast, magnetic resonance imaging is a valuable technique for noninvasive evaluation of the female pelvic anatomy and accurate MDA classification. If obstruction is present, surgical correction of the MDA may be required, and further counseling of the patient with regard to reproductive possibilities becomes important. Supplemental material available at http://radiographics.rsnajnls.org/cgi/content/full/29/4/1085/DC1.
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Affiliation(s)
- Beatriz L P Junqueira
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8
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Ribeiro SC, Tormena RA, Peterson TV, Gonzáles MDO, Serrano PG, Almeida JAMD, Baracat EC. Müllerian duct anomalies: review of current management. SAO PAULO MED J 2009; 127:92-6. [PMID: 19597684 PMCID: PMC10964807 DOI: 10.1590/s1516-31802009000200007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 03/20/2009] [Accepted: 03/23/2009] [Indexed: 01/09/2023] Open
Abstract
The aim of this paper was to discuss the embryological aspects of Müllerian duct anomalies and to analyze the current diagnostic methods and therapy. Müllerian anomalies are congenital defects of the female reproductive tract resulting from failure in the development of the Müllerian ducts and their associated structures. Their cause has yet to be fully clarified, and it is currently believed to be multifactorial. Symptoms appear principally during adolescence or early adulthood, and affect the reproductive capacity of these women. When clinically suspected, investigations leading to diagnosis include imaging methods such as hysterosalpingography, ultrasonography and magnetic resonance. The classification of these malformations relates to their embryogenesis, and defines the therapy and prognosis. Müllerian anomalies consist of a wide range of defects that may vary from patient to patient. Therefore, their management must also be individual, taking anatomical and clinical characteristics into consideration, as well as the patient's wishes.
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Affiliation(s)
- Sérgio Conti Ribeiro
- Department of Gynecology and Obstetrics, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Kim MY, Rha SE, Oh SN, Jung SE, Lee YJ, Kim YS, Byun JY, Lee A, Kim MR. MR Imaging Findings of Hydrosalpinx: A Comprehensive Review. Radiographics 2009; 29:495-507. [DOI: 10.1148/rg.292085070] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Minaif K, Shigueoka DC, Minami CCS, Sales DM, Ruano JMC, Noguti AS, Ajzen S, Szejnfeld J. Endometriose pélvica: comparação entre imagens por ressonância magnética de baixo campo (0,2 T) e alto campo (1,5 T). Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000600005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Comparar a ressonância de baixo campo (0,2 T) com a de alto campo (1,5 T) na avaliação da endometriose pélvica e adenomiose. MATERIAIS E MÉTODOS: Foram estudadas, prospectivamente, 27 pacientes do sexo feminino com suspeita clínica de endometriose, realizando-se exames de ressonância magnética de alto campo e baixo campo. Um mesmo radiologista realizou a leitura dos exames, iniciando pelo baixo campo, seguido pelo alto campo, usando como padrão-ouro o alto campo. RESULTADOS: Das 27 pacientes estudadas, 18 (66,7%) apresentaram alguma lesão indicativa de endometriose nos exames realizados no alto campo. Foram corretamente diagnosticados pelo baixo campo 14 destas pacientes. Endometriomas, lesões tubárias e focos de endometriose maiores do que 7 mm identificados pelo alto campo foram também identificados no baixo campo, com acurácia, sensibilidade e especificidade de 100%. Das nove pacientes com adenomiose caracterizadas pelo alto campo, oito foram corretamente identificadas pelo baixo campo, com acurácia, sensibilidade e especificidade de 88,9%. CONCLUSÃO: A ressonância de baixo campo apresentou baixa sensibilidade na detecção de pequenos focos de endometriose, alta sensibilidade na detecção de endometriomas e focos de endometriose grandes, e boa acurácia na detecção da adenomiose quando comparada com a ressonância de alto campo.
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