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Bo J, Sun M, Wei C, Wei L, Fu B, Shi B, Fang X, Dong J. MRI combined with clinical features to differentiate ovarian thecoma-fibroma with cystic degeneration from ovary adenofibroma. Br J Radiol 2024; 97:1057-1065. [PMID: 38402483 DOI: 10.1093/bjr/tqae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE To explore the value of magnetic resonance imaging (MRI) and clinical features in identifying ovarian thecoma-fibroma (OTF) with cystic degeneration and ovary adenofibroma (OAF). METHODS A total of 40 patients with OTF (OTF group) and 28 patients with OAF (OAF group) were included in this retrospective study. Univariable and multivariable analyses were performed on clinical features and MRI between the two groups, and the receiver operating characteristic (ROC) curve was plotted to estimate the optimal threshold and predictive performance. RESULTS The OTF group had smaller cyst degeneration degree (P < .001), fewer black sponge sign (20% vs. 53.6%, P = .004), lower minimum apparent diffusion coefficient value (ADCmin) (0.986 (0.152) vs. 1.255 (0.370), P < .001), higher age (57.4 ± 14.2 vs. 44.1 ± 15.9, P = .001) and more postmenopausal women (72.5% vs. 28.6%, P < .001) than OAF. The area under the curve of MRI, clinical features and MRI combined with clinical features was 0.870, 0.841, and 0.954, respectively, and MRI combined with clinical features was significantly higher than the other two (P < .05). CONCLUSION The cyst degeneration degree, black sponge sign, ADCmin, age and menopause were independent factors in identifying OTF with cystic degeneration and OAF. The combination of MRI and clinical features has a good effect on the identification of the two. ADVANCES IN KNOWLEDGE This is the first time to distinguish OTF with cystic degeneration from OAF by combining MRI and clinical features. It shows the diagnostic performance of MRI, clinical features, and combination of the two. This will facilitate the discriminability and awareness of these two diseases among radiologists and gynaecologists.
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Affiliation(s)
- Juan Bo
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
| | - Mingjie Sun
- Faculty of Graduate Studies, Wannan Medical College, Wuhu, Anhui 241002, China
| | - Chao Wei
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Longyu Wei
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Baoyue Fu
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Bin Shi
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Xin Fang
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Jiangning Dong
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
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Gu Z, Li X, Dai Y, Shi J, Wu Y, Zhang C, Li Q, Yan H, Leng J. Clinical features of patients with previous spontaneous rupture of ovarian endometrioma operated electively: a case-control study. Reprod Health 2023; 20:156. [PMID: 37865796 PMCID: PMC10589996 DOI: 10.1186/s12978-023-01702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND The aim of the study is to investigate the proportion and clinical features of previous spontaneously ruptured ovarian endometrioma among women who underwent elective surgery for endometrioma. METHODS This retrospective study was based on a cohort of elective surgeries for endometrioma performed by the same gynecologic team at Peking Union Medical College Hospital from January 2017 to October 2022. Patients diagnosed with previous spontaneously ruptured endometrioma during elective surgery were enrolled in the ruptured group. In the same cohort, patients with unruptured endometrioma treated during the same period were selected as the unruptured group by 1:2 matching according to age. Demographic and clinical information were collected and compared between two groups. RESULTS A total of 422 patients in the cohort were diagnosed with endometrioma. There were 38 patients (9.0%) in ruptured group and 76 patients in unruptured group. All enrolled participants were treated by laparoscopic surgery. In ruptured group, 86.8% patients had a history of acute abdominal pain, which was only 13.2% in unruptured group (P < 0.001). Compared to unruptured group, patients diagnosed with ruptured endometrioma had a lower BMI (P = 0.021), larger maximum diameter of endometrioma (P = 0.040), higher proportion of cul-de-sac partial obliteration rather than complete obliteration (P = 0.003). CONCLUSIONS Spontaneous rupture of endometrioma is not rare. The proportion of spontaneous rupture of endometrioma in our study was higher than that reported in the literatures. In women with endometrioma, the onset of acute abdominal pain should be considered a rupture of cyst, especially in patients with big cysts.
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Affiliation(s)
- Zhiyue Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jinghua Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yushi Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Chenyu Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Qiutong Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Hailan Yan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
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Keum J, Lee WM, Choi JS, Bae J, Cho S, Kang BK. Diagnostic Clues for Women with Acute Surgical Abdomen Associated with Ruptured Endometrioma. J Pers Med 2023; 13:1226. [PMID: 37623476 PMCID: PMC10455920 DOI: 10.3390/jpm13081226] [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: 06/28/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: An investigation of the preoperative diagnostic clues used to identify ruptured endometrioma by comparing the ruptured and unruptured states in patients who underwent laparoscopic operations due to endometrioma. (2) Methods: Patients with ruptured endometriomas (14 patients) and unruptured endometriomas (60 patients) were included, and clinical symptoms, laboratory findings, and radiological findings were analyzed. (3) Results: There were no significant differences in age, parity, last menstrual cycle days, or median size of endometrioma between two groups (group A: ruptured; group B: unruptured). The median serum level of CA 125 was 345.1 U/mL in group A and 49.8 U/mL in group B (p = 0.000). The median serum levels of CA 19-9 in group A and B were 46.0 U/mL and 19.1 U/mL, respectively (p = 0.005). The median serum level of CRP in group A was 1.2 g/dL, whereas it was 0.3 in group B (p = 0.000). ROC analysis showed that the optimal CA 125 cutoff value was 100.9 U/mL; the optimal CA 19-9 cutoff value was 27.7 U/mL; and the optimal CRP cutoff value was 1.0 g/dL. (4) Conclusions: Ruptured endometrioma can be diagnosed preoperatively using a combination of clinical symptoms, laboratory findings, and radiological findings. If a physician suspects a ruptured endometrioma, surgery should be performed to ensure optimal prognosis.
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Affiliation(s)
- Jihyun Keum
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (J.K.); (J.S.C.); (J.B.); (S.C.)
| | - Won Moo Lee
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (J.K.); (J.S.C.); (J.B.); (S.C.)
| | - Joong Sub Choi
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (J.K.); (J.S.C.); (J.B.); (S.C.)
| | - Jaeman Bae
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (J.K.); (J.S.C.); (J.B.); (S.C.)
| | - Seongsil Cho
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea; (J.K.); (J.S.C.); (J.B.); (S.C.)
| | - Bo Kyeong Kang
- Department of Radiology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea;
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Coutureau J, Mandoul C, Verheyden C, Millet I, Taourel P. Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis. Insights Imaging 2023; 14:94. [PMID: 37222834 DOI: 10.1186/s13244-023-01433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 05/25/2023] Open
Abstract
Although endometriosis is a common gynecological condition in women of reproductive age, a complication of endometriosis is rarely considered as the differential diagnosis of acute abdominal pain in that context. However, acute events in women with endometriosis can represent life-threatening conditions, which require emergent treatment and often surgical management. Mass effect of endometriotic implants can give rise to obstructive complications, specifically occurring in the bowel or in the urinary tract, while inflammatory mediators released by ectopic endometrial tissue can lead to inflammation of the surrounding tissues or to superinfection of the endometriotic implants. Magnetic resonance imaging is the best imaging modality to reach the diagnosis of endometriosis, but an accurate diagnosis is possible on computed tomography, especially in the presence of stellar, mildly enhanced, infiltrative lesions in suggestive areas. The aim of this pictorial review is to provide an image-based overview of key findings for the diagnosis of acute abdominal complications of endometriosis.
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Affiliation(s)
- Juliette Coutureau
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Caroline Mandoul
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Cecile Verheyden
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Ingrid Millet
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Patrice Taourel
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
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5
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Brookmeyer C, Fishman EK, Sheth S. Emergent and unusual presentations of endometriosis: pearls and pitfalls. Emerg Radiol 2023; 30:377-385. [DOI: 10.1007/s10140-023-02128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
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Ballesta M, Piqueras R, Brugger S, Estellés Lerga P. Non-traumatic spontaneous abdominal haemorrhage. RADIOLOGIA 2023; 65 Suppl 1:S73-S80. [PMID: 37024233 DOI: 10.1016/j.rxeng.2022.11.004] [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: 07/06/2022] [Accepted: 11/11/2022] [Indexed: 04/08/2023]
Abstract
Spontaneous abdominal hemorrhage is defined as intra-abdominal hemorrhage from a non-traumatic cause. It is a challenging clinical situation and in most cases the diagnosis is made on the basis of imaging findings. CT is the technique of choice for the detection, localization and extension of bleeding. Objective is to review the main imaging findings expected in spontaneous abdominal hemorrhage as well as its main etiologies.
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Affiliation(s)
- M Ballesta
- Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - R Piqueras
- Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Brugger
- Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - P Estellés Lerga
- Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
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7
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Hemorragia abdominal espontánea no traumática. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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8
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Arslan S, Sarıkaya Y, Akata D, Özmen MN, Karçaaltıncaba M, Karaosmanoğlu AD. Imaging findings of spontaneous intraabdominal hemorrhage: neoplastic and non-neoplastic causes. Abdom Radiol (NY) 2022; 47:1473-1502. [PMID: 35230499 DOI: 10.1007/s00261-022-03462-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 02/07/2023]
Abstract
Contrary to traumatic and iatrogenic intraabdominal hemorrhages, spontaneous intraabdominal hemorrhage is a challenging clinical situation. A variety of neoplastic and non-neoplastic conditions may cause spontaneous intraabdominal bleeding. Imaging findings vary depending on the source of bleeding and the underlying cause. In this article, we aim to increase the awareness of imagers to the most common causes of spontaneous intraabdominal hemorrhage by using representative cases.
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Affiliation(s)
- Sevtap Arslan
- Department of Radiology, Suhut State Hospital, 03800, Afyon, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Afyonkarahisar Health Sciences University, 03217, Afyon, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey
| | - Mustafa Nasuh Özmen
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey
| | - Muşturay Karçaaltıncaba
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey
| | - Ali Devrim Karaosmanoğlu
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06230, Ankara, Turkey.
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9
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Bulut E, Peker M, Kupeli A, Danisan G, Bulut AC. The efficiency of susceptibility-weighted MRI in the differentiation of endometriomas from haemorrhagic ovarian cysts. Abdom Radiol (NY) 2021; 46:5337-5343. [PMID: 34313828 DOI: 10.1007/s00261-021-03196-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the efficiency of susceptibility-weighted magnetic resonance (MR) imaging (SWIs) in differentiating endometriomas from haemorrhagic ovarian cysts. MATERIALS AND METHODS Between July 2017 and January 2019, 89 ovarian cystic lesions (57 endometriomas and 32 haemorrhagic cysts) that were identified as complicated cystic lesions on ultrasonography (US) and underwent lower abdominal MRI with susceptibility weighting were retrospectively evaluated. Final diagnoses were obtained with surgical pathological correlation and radiological-clinical follow-up. Two radiologists blinded to the final diagnoses retrospectively reviewed the images in consensus. The signal intensity on T1- and T2-weighted images and curved linear or punctate signal void areas on SWI were noted for the presence of lesions. RESULTS Forty of the 57 endometriomas demonstrated the defined MRI criteria, including a cystic hyperintensity on T1-weighted images and hypointensity on T2-weighted images. The remaining 17 lesions did not demonstrate these criteria on conventional MR images. SWI showed punctate or curved linear signal void areas in 53 of 57 endometriomas (92.9%) and none of the haemorrhagic cysts. The sensitivity, specificity and accuracy of SWI in differentiating endometrioma from haemorrhagic cyst were 92.9%, 100.0%, and 95.5%, respectively. CONCLUSIONS The addition of the SWI sequence to conventional MRI can help distinguish endometriomas from haemorrhagic ovarian cysts.
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Tran-Harding K, Nair RT, Dawkins A, Ayoob A, Owen J, Deraney S, Lee JT, Stevens S, Ganesh H. Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation. Clin Imaging 2018; 52:163-171. [DOI: 10.1016/j.clinimag.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 01/06/2023]
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Iraha Y, Okada M, Iraha R, Azama K, Yamashiro T, Tsubakimoto M, Aoki Y, Murayama S. CT and MR Imaging of Gynecologic Emergencies. Radiographics 2017; 37:1569-1586. [DOI: 10.1148/rg.2017160170] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Yuko Iraha
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Masahiro Okada
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Rin Iraha
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Kimei Azama
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Tsuneo Yamashiro
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Maho Tsubakimoto
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Yoichi Aoki
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Sadayuki Murayama
- From the Department of Radiology (Y.I., M.O., R.I., K.A., T.Y., M.T., S.M.) and Department of Obstetrics and Gynecology (Y.A.), Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
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Bourgioti C, Preza O, Panourgias E, Chatoupis K, Antoniou A, Nikolaidou ME, Moulopoulos LA. MR imaging of endometriosis: Spectrum of disease. Diagn Interv Imaging 2017; 98:751-767. [PMID: 28652096 DOI: 10.1016/j.diii.2017.05.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 02/07/2023]
Abstract
Endometriosis is a common gynecological disorder defined by the presence of endometrial tissue outside the uterus. It is the most common cause of chronic pelvic pain and typically affects the ovaries, uterine ligaments, peritoneum, tubes, rectovaginal septum and bladder. It may, however, be found at various extrapelvic sites, including the perineum, liver, pancreas, lung or even the central nervous system, and in such cases, diagnosis may be quite challenging. Even though definitive diagnosis requires laparoscopy, preoperative identification of endometriosis is important not only to differentiate it from other diseases with similar clinical presentations but also, for accurate presurgical mapping, since complete removal of all endometriotic foci is critical for the effective treatment of the patient's symptoms. Ultrasound is performed initially, but magnetic resonance imaging (MRI) is increasingly being used, particularly when sonographic findings are unclear, when deep pelvic endometriosis is suspected or when surgery is planned, as it provides better contrast resolution and a larger field of view compared to ultrasound. In this article, we will discuss distinctive MRI appearances of endometriotic foci and we will review common and uncommon locations of endometriosis within the body, in an attempt to familiarize radiologists with its wide spectrum of manifestations.
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Affiliation(s)
- C Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - O Preza
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - E Panourgias
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - K Chatoupis
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - A Antoniou
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - M E Nikolaidou
- Department of Gynaecology and Obstetrics, Rea maternity hospital, 383, Sygrou Ave., 17564 Athens, Greece.
| | - L A Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
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13
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Lee NK, Kim S, Kim KH, Suh DS, Kim TU, Han GJ, Lee JW, Kim JY. Diffusion-weighted magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts in the ovary. Acta Radiol 2016; 57:998-1005. [PMID: 26543051 DOI: 10.1177/0284185115609805] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/02/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The classic magnetic resonance imaging (MRI) feature of endometriomas is the shading sign, which is characterized by T2-shortening in ovarian cystic lesions that are hyperintense on T1-weighted images. The shading sign is infrequently observed in hemorrhagic ovarian cysts. PURPOSE To investigate the value of MRI with diffusion-weighted imaging (DWI) for distinguishing endometriomas from hemorrhagic cysts in the ovary. MATERIAL AND METHODS This retrospective study included 91 patients with 98 ovarian endometriomas and 21 hemorrhagic ovarian cysts that were confirmed pathologically, who had undergone MRI with DWI. Two radiologists compared MRI features, including size, bilaterality, multilocularity, the shading sign, the ovarian lesion/muscle signal intensity ratio at T2-weighted images, and T2 dark spots, between endometriomas and hemorrhagic cysts. We also compared the mean ADC value between endometriomas and hemorrhagic cysts, and determined the optimal cutoff ADC value for differentiating endometriomas from hemorrhagic cysts. RESULTS The size and mean ADC values were significantly different between endometriomas and hemorrhagic cysts. The mean ADC values of endometriomas and hemorrhagic cysts were 1.06 ± 0.38 × 10 (-3) mm(2)/s and 0.73 ± 0.29 × 10(-3) mm(2)/s, respectively (P < 0.002). The optimal cutoff ADC value for differentiating endometriomas from hemorrhagic cysts was 0.849 × 10(-3) mm(2)/s (sensitivity, 77.6%; specificity, 76.2%). CONCLUSION The addition of DWI could help in differentiating endometriomas from hemorrhagic cysts in the ovary, when conventional MRI is challenging.
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Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Ga Jin Han
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
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14
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Katz DS, Khalid M, Coronel EE, Mazzie JP. Computed Tomography Imaging of the Acute Pelvis in Females. Can Assoc Radiol J 2013; 64:108-18. [DOI: 10.1016/j.carj.2012.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 12/30/2022] Open
Abstract
Sonography is the primary imaging modality for the evaluation of pelvic pain in female patients, especially if gynaecological pathology is suspected. However, computed tomography (CT) is frequently used in patients who present to emergency departments (and elsewhere) with otherwise nonspecific abdominal and pelvic pain and may be the first imaging modality to demonstrate an acute gynaecological abnormality. Computed tomography can also be used prospectively in selected patients to further evaluate findings initially identified on sonography, although to reduce radiation exposure, magnetic resonance imaging is being used more frequently in this situation. The purpose of this article is to discuss the spectrum of gynaecological findings of the acute female pelvis that may be identified on CT by the emergency radiologist and by the general radiologist, with a brief review of the imaging literature of each specific diagnosis.
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Affiliation(s)
- Douglas S. Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Maria Khalid
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Esther E. Coronel
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Joseph P. Mazzie
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
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15
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Roche O, Chavan N, Aquilina J, Rockall A. Radiological appearances of gynaecological emergencies. Insights Imaging 2012; 3:265-75. [PMID: 22696088 PMCID: PMC3369119 DOI: 10.1007/s13244-012-0157-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/26/2012] [Accepted: 02/21/2012] [Indexed: 12/22/2022] Open
Abstract
Background The role of various gynaecological imaging modalities is vital in aiding clinicians to diagnose acute gynaecological disease, and can help to direct medical and surgical treatment where appropriate. It is important to interpret the imaging findings in the context of the clinical signs and patient's pregnancy status. Methods Ultrasound and Doppler are readily available in the emergency department, and demonstrate features of haemorrhagic follicular cysts, ovarian cyst rupture, endometriotic cysts and pyosalpinx. Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone. Computed tomography (CT) is not routinely employed in diagnosing acute gynaecological complications. However due to similar symptoms and signs with gastrointestinal and urinary tract pathologies, it is frequently used as the initial imaging modality and recognition of features of gynaecological complications on CT is important. Results Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT. Conclusion MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion. In this article, we review the imaging appearances of gynaecological emergencies in non-pregnant patients. Teaching points • Ultrasonography is easily accessible and can identify life-threatening gynaecological complications. • Tomography scanners and computed radiography are not routinely used but are important to recognise key features. • MRI is used for the characterisation of acute gynaecological complications. • Recognition of the overlap in symptoms between gastrointestinal and gynaecological conditions is essential.
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Affiliation(s)
- Oran Roche
- St Barts & The London NHS trust, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK,
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16
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Affiliation(s)
- Casey A Boyd
- University of Texas Medical Branch, Galveston, Texas, USA
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