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Le Gal C, Carbonnel M, Balaya V, Richard C, Gelin V, Galio L, Sandra O, Hersant B, Bosc R, Charton J, Chavatte-Palmer P, Vialard F, Coscas R, Ayoubi JM. Analysis of Predictive Factors for Successful Vascular Anastomoses in a Sheep Uterine Transplantation Model. J Clin Med 2022; 11:5262. [PMID: 36142908 PMCID: PMC9503062 DOI: 10.3390/jcm11185262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Uterine transplantation is becoming an increasingly realistic therapeutic for uterine infertility. Surgical training on large animal models such as sheep is a prerequisite for establishing a program in humans. The objective of our study was to analyze the predictive factors for successful vascular anastomoses. We performed 40 autotransplants that involved end-to-side anastomoses from the uterine to the external iliac vessels. We analyzed vessel results in terms of success or failure; a total of 78.7% of arterial and 82.9% of venous anastomoses were successful in the immediate postoperative period. In multivariate analysis, independent factors associated with immediate successful vein anastomoses were as follows: a short warm ischemia time (<2 h, OR = 0.05; 95% CI [0.003−0.88], p = 0.04), the absence of any anastomotic complications (OR = 0.06; 95% CI [0.003−0.099], p = 0.049), and their realization by a vascular surgeon (OR = 29.3; 95% CI [1.17−731.9], p = 0.04). Secondly, we showed that an increase in lactate levels greater than 2.72 mmol/L, six hours after reperfusion was predictive of failure, with a sensibility of 85.7% and a specificity of 75.0%. In order to perfect the management of vascular anastomoses by a vascular surgeon, training on animal models and in microsurgery are mandatory in establishing a uterine transplantation program in humans.
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Affiliation(s)
- Claire Le Gal
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
| | - Marie Carbonnel
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - Vincent Balaya
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - Christophe Richard
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
- MIMA2 Platform, INRAE, 78350 Jouy-en-Josas, France
| | - Valerie Gelin
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
- MIMA2 Platform, INRAE, 78350 Jouy-en-Josas, France
| | - Laurent Galio
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
| | - Olivier Sandra
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
| | - Barbara Hersant
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor University Hospital, 94000 Creteil, France
| | - Romain Bosc
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor University Hospital, 94000 Creteil, France
| | - Johanna Charton
- Department of Vascular Surgery, Amboise Pare University Hospital, AP-HP, 92100 Boulogne-Billancourt, France
| | - Pascale Chavatte-Palmer
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
| | - François Vialard
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
- Department of Genetics, Medical Biology Laboratory, Poissy-St Germain en Laye University Hospital, 78300 Poissy, France
| | - Raphael Coscas
- Department of Vascular Surgery, Amboise Pare University Hospital, AP-HP, 92100 Boulogne-Billancourt, France
- UMR 1018, Inserm-Paris11-CESP, Versailles Saint-Quentin-en-Yvelines University, 78000 Versailles, France
| | - Jean-Marc Ayoubi
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
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Zhao S, Sun F, Bao L, Chu C, Li H, Yin Q, Guan W, Wang D. Pure dysgerminoma of the ovary: CT and MRI features with pathological correlation in 13 tumors. J Ovarian Res 2020; 13:71. [PMID: 32552845 PMCID: PMC7301981 DOI: 10.1186/s13048-020-00674-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/08/2020] [Indexed: 12/22/2022] Open
Abstract
Background To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary. Methods CT and MRI imaging of 12 patients with 13 histologically proven dysgerminomas of the ovary were retrospectively reviewed. Patients, ages ranged from 6 ~ 27 years (mean, 17.2 years). Two observers evaluated the following CT and MRI features of the tumor by consensus: (i) location, shape, and size; (ii) attenuation, T2 signal intensity, and ADC value; (iii) patterns of contrast enhancement; (iv) presence of fibrovascular septa; (v) presence of necrosis, hemorrhage, and calcification; (vi) presence of “ovarian vascular pedicle” sign. We also noted the extent or stage of the tumors. Results 75% lesions arised in the right ovary. Bilateral ovaries were involved in one case. Tumors displayed as a purely or predominantly solid mass (mean size, 17.0 ± 7.8 cm). Ten tumors were shaped multilobulated. The mean ADC value of lesions was 0.830 ± 0.154 × 10− 3 mm2/s. Characteristic fibrovascular septa were observed in all lesions. Among them, classic septa were present in 69% lesions. They were thin, hypointense on T2WI with a linear intense enhancement indicating the blood vessels in septa. Due to the stromal edema, fibrovascular septa may become thick even amorphous in shape, hyperintense on T2WI and even low attenuation on CT with a slight enhancement except for a bright blood vessel on the edge. Massive necrosis was observed only in one lesion. Calcification was present in 3 of the 5 tumors on CT. “Ovarian vascular pedicle” sign was present in 12 lesions. Lymphadenopathy, retroperitoneal spread, and distant metastases combined with an implantation in Douglas’ cul-de-sac were present in one patient respectively. Conclusion On CT and MR images, ovarian dysgerminoma often appears as a large solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging which then can guide the radiologists to make an accurate diagnosis. Calcifications often occur in the tumor. Nonspecific low ADC value and “ovarian vascular pedicle” sign may narrow the differential diagnosis.
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Affiliation(s)
- Shuhui Zhao
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Fan Sun
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lei Bao
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Caiting Chu
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Haiming Li
- Department of Radiology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, China
| | - Qiufeng Yin
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Wenbin Guan
- Department of Pathology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Chandramohan A, Panda S, Thomas A, Chandy R, Joel A, Ram TS, Peedicayil A. Management Driven Structured Reporting in Ovarian Cancer. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2019. [DOI: 10.1055/s-0039-1698480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractSince majority (80%) of ovarian cancer patients present at an advanced stage, imaging performed on these patients have numerous findings. The combination of multiple findings on imaging, complexity of anatomical structures which are involved in ovarian cancer, and the need to perceive certain subtle imaging features which would impact management often makes it challenging to systematically review images of these patients. Similarly, it is difficult to effectively communicate these findings in radiology reports. Structured reporting that is geared toward clinical decision-making has been an area of recognized need. An understanding of the review areas, which aid clinical decision-making in a multidisciplinary team setting at our institution led us to the proposed structured reporting template for ovarian cancer. Through this review, the authors would like to share this reporting template with examples.
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Affiliation(s)
| | - Sourav Panda
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anitha Thomas
- Department of Gynecological Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rachel Chandy
- Department of Gynecological Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Samuel Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abraham Peedicayil
- Department of Gynecological Oncology, Christian Medical College, Vellore, Tamil Nadu, India
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Tsili AC, Argyropoulou MI. Adnexal incidentalomas on multidetector CT: how to manage and characterise. J OBSTET GYNAECOL 2019; 40:1056-1063. [PMID: 31790612 DOI: 10.1080/01443615.2019.1676214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although CT is not considered the examination of choice for the detection and characterisation of adnexal diseases, adnexal masses may be incidentally detected during CT examination performed for other clinical indications. Most adnexal incidentalomas are benign, and therefore may not require further investigation, follow-up or intervention; however, few of them may prove malignant. Multidetector CT has improved the diagnostic performance of the technique in the detection and differentiation of adnexal mass lesions. Radiologists should be able to recognise the normal CT appearance of the ovaries and the CT characteristics of various adnexal incidentalomas. This may obviate unnecessary imaging evaluation and allow optimal treatment planning. Regarding the management of adnexal lesions incidentally found on CT, recommendations based on the collective experience of the members of the American College of Radiology Incidental Findings Committee II have recently been presented.
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Affiliation(s)
- A C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina, Greece
| | - M I Argyropoulou
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina, Greece
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Mahmood S, Johannesson L, Testa G, de Prisco G. DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation. SAGE Open Med 2019; 7:2050312119875607. [PMID: 31523428 PMCID: PMC6734610 DOI: 10.1177/2050312119875607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: Uterus transplantation is rapidly becoming a viable clinical option for women with uterine-factor infertility and a desire for parenthood. Radiological imaging plays a central role in selecting the optimal living donors for uterus transplantation and serves to exclude any pathology and evaluate the uterine vasculature. The latter is the most important variable in the ultimate technical success of the uterus transplant. In this first report of imaging in the setting of uterus transplantation, we report our experience with living-donor selection, and the evolution of the imaging techniques that ultimately allowed a significant improvement in donor selection and transplant outcome. We also suggest a framework for preoperative imaging in uterus transplantation. Methods: Between 2016 and 2018, 27 potential living donors were evaluated by imaging prior to uterine donation for uterus transplantation. Predonation imaging included a screening chest radiograph, dual-phase computed tomography (CT) angiograms of the abdomen and pelvis in the arterial and venous phases and pelvic sonography with Doppler. Seventeen potential donors additionally underwent multiphasic pelvic MR angiograms. The imaging performed was meant to display features of the vascular anatomy relevant for uterus transplantation. Results: Out of the 27 potential live donors who were evaluated by imaging, 9 eventually donated their uterus for transplantation. The most frequent reason for exclusion was suboptimal quality of the vessels (33%), including small uterine arteries, the presence of atherosclerosis or small size/poor quality of the uterine or utero-ovarian veins, or both. The next most common reason was voluntary patient withdrawal or failure to complete the evaluation process (28%). Three potential donors (16.6%) were rejected for uterine factors, fibroids, and/or adenomyosis. Other reasons for donor rejection included ABO incompatibility and unfavorable psychological evaluation. Conclusion: Diagnostic imaging plays a crucial role in selecting appropriate potential donors, screening prospective recipients, planning the graft procedure, and following up on any graft or nongraft-related complications in both the donor and recipient after the transplantation procedure is performed. Contrast-enhanced CT and MR angiographies have complementary roles, especially when evaluating the donor for adequacy of the arterial and venous supply to the uterine graft and the experience gained from our series indicates that the inclusion of both modalities contributed directly to successful uterus transplant graft survival by selecting patients with favorable arterial and venous vasculature.
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Affiliation(s)
- Soran Mahmood
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
- Department of Radiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
- Liza Johannesson, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA.
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Gregory de Prisco
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
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Zhao W, Wang X, Liang Y. Application of 64-slice MSCT with ovarian vein tracking technique in identification of suture-fixed transposed ovaries. Clin Imaging 2018; 52:113-116. [PMID: 30056288 DOI: 10.1016/j.clinimag.2018.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/12/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore the accuracy of 64-slice multislice computed tomography with ovarian vein tracking technique in identification of surgically transposed ovaries. METHODS The CT and clinical data of 84 patients with ovarian transposition were retrospectively analyzed. Two radiologists completed the assessments independently. The CT data were analyzed twice. During the first assessment, transposed ovaries were identified on both sides of the lower paracolic gutters on enhanced axial CT images. The second assessment was carried out two months later. The presence or absence of transposed ovaries was identified by ovarian vein tracking technique. If the adjacent colon of the transposed ovary was not filled with contrast agents, two radiologists measured the CT values of the solid-appearing area of the transposed ovary and the wall of the adjacent colon. RESULTS 84 patients with cervical cancer underwent ovarian transposition. There were 98 transposed ovaries and 70 non-transposed ovaries. The sensitivity, specificity and accuracy of the two assessments in identification of the ovaries were 72.4%, 98.6%, and 83.3% (first assessment), and 93.9%, 100% and 96.4% (second assessment). The sensitivity and accuracy of the two assessments were significantly different (p < 0.01). The solid-appearing area of the transposed ovaries and the wall of the adjacent colon in 33 cases showed soft tissue density. The CT values were (44.44 ± 5.78) HU and (44.50 ± 6.30) HU. The CT values were no significant difference (p > 0.05). CONCLUSION Ovarian vein tracking technique can accurately identify the unmarked transposed ovaries, which is crucial in the diagnosis of abdominal/pelvic lesions.
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Affiliation(s)
- Weijing Zhao
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University
| | - Xinlian Wang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University
| | - Yuting Liang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University.
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Tsuboyama T, Takei O, Okada A, Wada K, Kuriyama K. [3. Routine MRI Examination for the Contribution of the Suitable Treatment 3-3. MRI Diagnosis of Ovarian Masses]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:606-612. [PMID: 29925756 DOI: 10.6009/jjrt.2018_jsrt_74.6.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Oki Takei
- Department of Radiology, Osaka National Hospital
| | | | - Keiko Wada
- Department of Radiology, Osaka National Hospital
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Aikimbaev K, Balli T, Akgul E, Aksungur E. Ovarian vein diameters measured by MDCT in women without evidence of pelvic congestion syndrome. HEART VESSELS AND TRANSPLANTATION 2017. [DOI: 10.24969/hvt.2017.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Watanabe K, Kobayashi Y, Banno K, Matoba Y, Kunitomi H, Nakamura K, Adachi M, Umene K, Kisu I, Tominaga E, Aoki D. Recent advances in the molecular mechanisms of Mayer-Rokitansky-Küster-Hauser syndrome. Biomed Rep 2017; 7:123-127. [PMID: 28804623 DOI: 10.3892/br.2017.929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/11/2017] [Indexed: 12/25/2022] Open
Abstract
Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is a disease caused by congenital absence of the uterus and two-thirds of the upper vagina. The pathogenic mechanism of MRKHS may involve gene abnormalities, and there are various case reports associating MRKHS with the Wnt family member 4 (Wnt4) mutation. Analysis of genes mapped to regions in which deletion and duplication are frequently detected in patients with MRKHS has shown involvement of LIM homeobox 1 (LHX1), HNF1 homeobox B (HNF1B) and T-box 6 (TBX6). In addition, there are case reports of MRKHS caused by chromosomal translocation and epigenetic function may be involved in MRKHS onset. Overexpression of HOXA and overexposure to estrogen may contribute to the onset and regulation of expression by methylation as a pathogenic mechanism. Determination of the molecular basis of MRKHS is in progress, but current treatment only includes vaginal enlargement and vaginoplasty for improved quality of life. Clinical application of uterine transplantation to allow childbearing by MRKHS patients is under investigation and clinical trials are underway around the world.
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Affiliation(s)
- Keiko Watanabe
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yusuke Matoba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Haruko Kunitomi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kanako Nakamura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masataka Adachi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kiyoko Umene
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Iori Kisu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Eiichiro Tominaga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
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Kim SW, Kim HC, Yang DM, Won KY. Gastrointestinal stromal tumours (GISTs) with a thousand faces: atypical manifestations and causes of misdiagnosis on imaging. Clin Radiol 2015; 71:e130-42. [PMID: 26646370 DOI: 10.1016/j.crad.2015.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/21/2015] [Accepted: 10/20/2015] [Indexed: 11/28/2022]
Abstract
Gastrointestinal stromal tumours (GISTs) can lead to emergency situations, such as gastrointestinal bleeding, intestinal obstruction, and tumoural rupture with haemoperitoneum or peritonitis. In addition, if a GIST grows exophytically to a large size, it is often misdiagnosed as a tumour arising from adjacent organs. Sometimes, the atypical appearance of GISTs on imaging causes diagnostic confusion. In this article, we illustrate a variety of GISTs with atypical presentations and also discuss the important diagnostic clues for differentiating GISTs from other lesions.
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Affiliation(s)
- S W Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea.
| | - H C Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - D M Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - K Y Won
- Department of Pathology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
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Can a T2 hyperintense rim sign differentiate uterine leiomyomas from other solid adnexal masses? ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s00261-015-0510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kisu I, Banno K, Mihara M, Hara H, Umene K, Adachi M, Nogami Y, Aoki D. A surgical technique using the ovarian vein in non-human primate models of potential living-donor surgery of uterus transplantation. Acta Obstet Gynecol Scand 2015; 94:942-8. [PMID: 26095999 DOI: 10.1111/aogs.12701] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/14/2015] [Indexed: 01/25/2023]
Abstract
AIM Living donor surgery in organ transplantation should be performed in a minimally invasive manner under conditions that are as safe as possible. The objective of this study is to examine whether the procedure for using the ovarian vein makes donor surgery less invasive in a cynomolgus monkey model of potential living-donor surgery of uterus transplantation. MATERIAL AND METHODS Twenty-two female cynomolgus monkeys aged 6-9 years and with body weights of 3.55 ± 1.28 kg were used in the study. Vessels and tissues surrounding the uterus were dissected while preserving the uterine artery/vein. The deep uterine vein was used as a venous pedicle in four monkeys (Group 1), and the ovarian vein was used instead of the deep uterine vein in 18 monkeys (Group 2). With the uterine artery/vein and deep uterine vein (Group 1) or ovarian vein (Group 2) connected to the uterus, the vaginal canal was cut. The vessels were then clamped to produce a donor surgery model. Surgical time, intraoperative organ and vascular injury were examined in each animal. RESULTS The average surgical time from laparotomy to clamping of vessels was 230 ± 112 min in all 22 cynomolgus monkeys, and significantly longer in Group 1 (n = 4) than in Group 2 (n = 18) (393 ± 71 vs. 194 ± 84 min, p < 0.05). Surgical time in Group 2 showed a tendency to decrease in animals treated later in the study, with a significantly longer time in the first 10 monkeys compared with the last 8 (253 ± 65 vs. 120 ± 26 min, p < 0.05). All monkeys had no complications, including no injuries to other organs and no unanticipated vascular injury. CONCLUSION The procedure using the ovarian vein was less invasive than that using the deep uterine vein in mimicking living-donor surgery in a cynomolgus monkey model of uterus transplantation.
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Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Mihara
- Department of Vascular Surgery, Saiseikai General Hospital, Saitama, Japan
| | - Hisako Hara
- Department of Plastic and Reconstructive Surgery, Graduates School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoko Umene
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Adachi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yuya Nogami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Li Y, Zheng Y, Chen J, Chen X, Lin J, Cai A, Zhou X. Determining the organ of origin of large pelvic masses in females using multidetector CT angiography and three-dimensional volume rendering CT angiography. Eur Radiol 2015; 25:1032-9. [PMID: 25362537 DOI: 10.1007/s00330-014-3471-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/14/2014] [Accepted: 10/15/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To study the value of tumour feeding arteries and the ovarian vein in determining the organ of origin of large pelvic tumours in females using multidetector CT. METHODS One hundred and thirty patients with 131 pathologically proven tumours (>6.5 cm) were retrospectively reviewed. Conventional CT images and CT angiography were evaluated, with focus on assessing the value of tumour feeding arteries and the ovarian vein in differentiating ovarian from non-ovarian tumours. RESULTS For 97 ovarian tumours, the feeding arteries included the ovarian artery (n = 51) and the ovarian branch of uterine artery (n = 64). For 34 non-ovarian tumours, the feeding arteries included the ovarian artery (n = 2), the uterine artery (n = 21), the mesenteric artery (n = 5), and the internal iliac artery (n = 1). The ovarian vein was identified in 86 ovarian tumours and 12 non-ovarian tumours. When the feeding arteries and the ovarian vein were combined to confirm ovarian origin, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.8 %, 84.2 %, 93.8 %, 94.1 %, and 93.9 %, respectively. The accuracy was significantly higher than that of independently using the ovarian vein or the ovarian feeding arteries. CONCLUSION Combined application of tumour feeding arteries and the ovarian vein is valuable to differentiate large ovarian from non-ovarian tumours. KEY POINTS • CT is a valuable modality for diagnosing pelvic tumours. • Determining the organ of origin is difficult for large pelvic tumours. • Contrast-enhanced CT and CT angiography are helpful in depicting abdominopelvic vessels. • Tracking tumour-associated vessels can help differentiate large ovarian from non-ovarian tumours.
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Affiliation(s)
- YangKang Li
- Department of Radiology, Cancer Hospital, Shantou University Medical College, No7, Raoping Rd, Shantou, Guangdong Province, 515041, Peoples Republic of China,
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Abstract
OBJECTIVE Female pelvic masses have a broad differential diagnosis, including benign and malignant neoplasms and nonneoplastic entities. CONCLUSION By using a systematic approach to the evaluation of a complex pelvic mass, including incorporating the clinical and surgical history, and by using multiparametric MRI to identify the anatomic origin, morphologic features, and tissue composition of a mass, a short meaningful differential diagnosis or definitive diagnosis can often be established.
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15
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Algorithmic approach to solid adnexal masses and their mimics: utilization of anatomic relationships and imaging features to facilitate diagnosis. ABDOMINAL IMAGING 2014; 39:1284-96. [PMID: 24852312 DOI: 10.1007/s00261-014-0163-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Solid adnexal masses, while less common than their cystic counterparts, may present a challenge for radiologists given the wide range of histologic entities that occur in this region. Pelvic masses, especially when large, can seem overwhelming at first but application of an algorithmic approach allows for more confident assessment. This approach focuses first on the use of anatomic relationships and interactions of various pelvic structures to localize the mass' origin. For instance, the directionality of ureteral displacement can suggest if a mass is intra or extraperitoneal. Then, key discriminating imaging features, such as the presence of fat, hypervascularity, or low T2 signal on magnetic resonance imaging (MRI) can be applied to further narrow the list of diagnostic possibilities. Entities such as leiomyomas, nerve sheath tumors, congenital uterine anomalies, and vascular abnormalities (ovarian torsion or iliac vessel aneurysm) in particular are often accurately characterized with sonography and/or MRI. For solid adnexal masses in which a definitive diagnosis by imaging is not reached, information germane to clinicians regarding further management can still be provided, principally with regard to surgical vs. nonsurgical treatment.
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16
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Karcaaltincaba M. Demonstration of normal and dilated testicular veins by multidetector computed tomography. Jpn J Radiol 2011; 29:161-5. [PMID: 21519988 DOI: 10.1007/s11604-010-0527-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 10/03/2010] [Indexed: 11/24/2022]
Abstract
Recent advances in multidetector computed tomography (MDCT) technology enabled better visualization of testicular (gonadal) vein using submillimeter slice thickness and three-dimensional images. Normally, the testicular vein measures 1-3 mm and drains into the inferior vena cava and left renal vein on the right and left sides, respectively. They can be seen in most patients during MDCT studies. Curved planar and volume-rendered images can be used to display testicular veins. We aim to demonstrate MDCT findings of normal testicular vein and its pathologies including varicocele, varices, the testicular vascular pedicle sign, and phlebolith. The testicular vein can be dilated owing to varicocele or portal hypertension and in patients with intraabdominal seminomas arising from undescended testis. The testicular vein can also cause ureteral compression at the crossing point. Understanding MDCT findings of the normal testicular vein and its various pathologies can allow a correct diagnosis, thereby avoiding further diagnostic tests.
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Affiliation(s)
- Musturay Karcaaltincaba
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100, Turkey.
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17
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Galant Herrero J, Martí-Bonmatí L, Roca V, Calbo J, Picazo N, Puerta A. Visualización por resonancia magnética del drenaje venoso en las masas pélvicas: una ayuda para filiar su origen. RADIOLOGIA 2009; 51:171-5. [DOI: 10.1016/j.rx.2008.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 02/19/2008] [Indexed: 10/21/2022]
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18
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Hemorrhagic mesenteric cystic lymphangioma presenting with acute lower abdominal pain: the diagnostic clues on MR Imaging. Emerg Radiol 2008; 16:327-30. [DOI: 10.1007/s10140-008-0747-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 06/11/2008] [Indexed: 11/26/2022]
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19
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Kin Y, Katsumori T, Kasahara T, Nozaki T, Ito H, Nishimura T. Hemodynamics of ovarian veins: MR angiography in women with uterine leiomyomata. Eur J Radiol 2007; 63:408-13. [PMID: 17349763 DOI: 10.1016/j.ejrad.2007.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 01/22/2007] [Accepted: 02/01/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE The passive reflux into ovarian veins (OVs) is well known as a common finding in normal asymptomatic women. The purpose of this study was to investigate the hemodynamics of OVs in women with myomatous uterus. MATERIALS AND METHODS Thirty-two women with symptomatic uterine leiomyomata underwent time-of-flight MR (TOF-MR) angiography, including venography and arteriography, and contrast-enhanced MRI. The frequency of reflux into OVs on TOF-MR angiography was retrospectively assessed with uterine volume, and compared to that of normal women in previous publication. The statistical evaluation was performed using Fisher's exact test. RESULTS The mean uterine volume was 932 +/- 612 ml (range, 301-2627 ml). The reflux into left OVs was observed in 4 of 32 women (13%) and that into right OVs was noted in 0 of 32 women (0%). These rates were significantly lower than those of normal asyptomatic women in the previous publication (p<0.05). The reflux into OVs was observed in 0 of 19 women (0%) with 600 ml or larger myomatous uterus, whereas it was noted in 4 of the remaining 13 women (31%) with less than 600 ml myomatous uterus, with significant difference between the two groups (p=0.02). CONCLUSIONS We found that reflux into OVs was infrequent in the vast majority of women with myomatous uterus, especially those with larger uterus due to leiomyomata on the basis of TOF-MR angiography. These findings suggested myomatous uterus could affect the flow direction of OVs, and passive reflux into OVs might be prevented due to the influence of antegrade flow of OVs.
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Affiliation(s)
- Yoko Kin
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga 520-3046, Japan.
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Hirakawa M, Yoshimitsu K, Kakihara D, Irie H, Asayayama Y, Ishigami K, Honda H. Detection of the gonadal veins in the diagnosis of transposed ovaries in patients with cervical carcinoma: a useful sign on MDCT. AJR Am J Roentgenol 2007; 188:1564-7. [PMID: 17515377 DOI: 10.2214/ajr.05.2032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the detectability of the gonadal vein of transposed ovaries in patients with uterine cervical cancer on MDCT. CONCLUSION Gonadal veins and surgical clips of transposed ovaries can be shown with high consistency on MDCT. Tracking the gonadal veins and detecting the surgical clips may prevent the transposed ovaries from being misinterpreted as peritoneal implants.
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Affiliation(s)
- Masakazu Hirakawa
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Okamoto D, Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M, Ushijima Y, Nishihara Y, Amada S, Kobayashi H, Honda H. Gliomatosis Peritonei Associated With Immature Ovarian Teratoma. J Comput Assist Tomogr 2007; 31:317-9. [PMID: 17414772 DOI: 10.1097/01.rct.0000250111.87585.55] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A rare case of gliomatosis peritonei associated with immature ovarian teratoma was reported. The computed tomographic findings of gliomatosis peritonei were similar to the classic findings of peritoneal dissemination of malignant tumors. To avoid overestimating the clinical stage of ovarian tumors, radiologists should be aware of this rare condition related to teratomas.
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Affiliation(s)
- Daisuke Okamoto
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
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