Pregnancy in a rudimentary horn: multicenter's MRI features of a rare condition.

PURPOSE: To describe the MRI features of rudimentary horn pregnancy (RHP) with surgical correlations. METHODS: Nine women with a RHP underwent preoperative pelvic MRI. MRI protocol included T2- (n = 9), T1- (n = 7), and fat-suppressed contrast-enhanced T1-weighted sequences (n = 4). Two pelvic radiologists retrospectively analyzed MR images to assess the following MRI features: presence of a myometrium around the gestational sac (GS) and characteristics of its wall, GS surrounded by myometrium in contact with the round ligament, communication of the GS with the endometrial cavity of the main horn, continuity of the GS with the cervix, fibrous or muscular GS attachment to the main horn, lateral deviation, and endometrial thickness of the main horn. Ovaries and tubes were also assessed. MRI features were correlated with surgical findings. RESULTS: Seven of the nine women [29 ± 6 SD years (range 16-37 years)] underwent surgical management. The first US diagnosed RHP in only 1/9 patients. All pregnancies were diagnosed using MRI. RHP was all located in the rudimentary horn of a unicornuate uterus. All the GS was surrounded by myometrium in contact with the round ligament. None of the RHP displayed communication with the endometrial cavity of the main horn nor with the cervix. An attachment between the RHP and the main horn was seen in 3/9 patients. All the main horns were lateralized and empty. CONCLUSION: MRI diagnosed RHP in all patients by identifying the GS surrounded by myometrium in contact with the round ligament and the absence of continuity between the GS and the cervix. LEVEL OF EVIDENCE: IV-retrospective study.

How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings.

PURPOSE: To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated. RESULTS: The median patient age was 28 years (interquartile range, 22-39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96-99.4). CONCLUSION: Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA. KEY POINTS: • Appendiceal diameter and marked left tubal thickening allow differentiating PID from AA. • PID should be considered if appendiceal diameter is < 7 mm. • Marked left tubal diameter indicates PID rather than AA when enlarged appendix. • No pathological CT findings were identified in 5 % of PID patients.

Assessment of Strangulation in Adhesive Small Bowel Obstruction on the Basis of Combined CT Findings: Implications for Clinical Care.

Purpose To determine which computed tomography (CT) findings or combinations of findings can help to accurately identify strangulation in adhesive small bowel obstruction (SBO). Materials and Methods Contrast agent-enhanced CT findings in a cohort of 256 patients consecutively admitted for adhesive SBO, with a delay of less than 24 hours between CT and surgery for the operated patients, were reviewed independently by two radiologists, with consensus by a third, to assess CT findings commonly associated with strangulation. The reference standard for strangulation was surgery. Univariate and multivariate analyses were performed to identify predictors of strangulation in the entire cohort and to identify predictors of the need for surgical resection in the subgroup of patients with strangulation. A CT score was obtained and diagnostic performances of different combined CT findings were calculated. Results In this study, 105 patients (41.0%; 105 of 256) underwent a surgical procedure, 62 of whom were found to have strangulation (59.0%; 62 of 105), whereas 151 patients (59.0%; 151 of 256) improved with medical care. Three CT findings were significantly associated with strangulation in the multivariate analysis: reduced bowel wall enhancement (odds ratio, 7.8; 95% confidence interval [CI]: 2.6, 23.5), diffuse mesenteric haziness (odds ratio, 6.1; 95% CI: 2.5, 15.2), and a closed-loop mechanism (odds ratio, 6.5; 95% CI: 2.8, 15.5). The model combining these three features had an area under the curve of 0.91 (95% CI: 0.86, 0.96) and a high negative predictive value (97%; 95% CI: 93%, 99%). Positive likelihood ratios were high when two or three of these CT findings were combined (positive likelihood ratios, 14.7 [95% CI: 7.1, 30.4] and 43.8 (95% CI: 14.2, 135.2], respectively). Among the strangulated cases, reduced bowel wall enhancement (odds ratio, 3.9; 95% CI: 1.3, 12) and mesenteric fluid (odds ratio, 3.6; 95% CI: 1.0, 12.8) were predictive of resection. Conclusion A score that combines three CT findings (reduced bowel wall enhancement, a closed-loop mechanism, and diffuse mesenteric haziness) can accurately predict strangulation in adhesive SBO. © RSNA, 2017 Online supplemental material is available for this article.