Thoracic endometriosis syndrome: CT and MRI features.

Thoracic endometriosis is considered to be rare, but is the most frequent form of extra-abdominopelvic endometriosis. Thoracic endometriosis syndrome affects women of reproductive age. Diagnosis is mainly based on clinical findings, which can include catamenial pneumothorax and haemothorax, non-catamenial endometriosis-related pneumothorax, catamenial haemoptysis, lung nodules, and isolated catamenial chest pain. Symptoms are typically cyclical and recurrent, with a right-sided predominance. Computed tomography (CT) is the first-line imaging method, but is poorly specific; therefore, its main role is to rule out other pulmonary diseases. However, in women with a typical clinical history, some key CT findings may help to confirm this often under-diagnosed syndrome. MRI can also assist with the diagnosis, by showing signal changes typical of haemorrhage within diaphragmatic or pleural lesions.

Ultrasonography and MRI features of the Mayer-Rokitansky-Küster-Hauser syndrome.

Although Mayer-Rokitansky-Küster-Hauser syndrome is a rare condition with a reported incidence of 1/4500 female live births, it represents the second most common cause of primary amenorrhea and has psychologically devastating consequences. The radiologist plays a pivotal role in both making the accurate initial diagnosis of this condition and assessing findings that may contribute to treatment planning. The purpose of this article is to provide an overview of the capabilities of ultrasound and magnetic resonance imaging (MRI) for the diagnosis and management of this syndrome with emphasis on the relevant clinical and surgical findings and to describe potential associated abnormalities and differential diagnosis.

Ovarian hyperthecosis on grayscale and color Doppler ultrasound.

OBJECTIVES: To describe the grayscale and color Doppler ultrasound findings in women with ovarian hyperthecosis. METHODS: In a retrospective study, we reviewed the findings on ultrasound examination of the ovaries in 10 patients with proven hyperthecosis. Clinical features had been recorded and testosterone levels measured in all cases. The ovaries had been examined using grayscale ultrasound in all patients and color Doppler in six patients. Bilateral stromal hyperthecosis had been pathologically confirmed in all patients. RESULTS: The clinical features were polymorphic, with symptoms of virilization in four patients. Type 2 diabetes was present in four patients. Testosterone levels were greater than 2 ng/mL in four patients. On grayscale ultrasound examination, the ovaries were normal in two patients but showed bilateral abnormalities in eight; both ovaries were increased in size in seven patients and had a round shape in two patients, the ovary being both increased in size and round in shape in one of these patients. A very peculiar nodular stromal pattern was observed in two out of 10 patients, while a homogeneous stromal pattern was observed in eight patients. On color Doppler, performed in six patients, no areas of hypervascularization were observed. CONCLUSION: Findings on grayscale ultrasonography and on color Doppler examination, in association with clinical and biological findings, are useful in the diagnosis of ovarian hyperthecosis and in ruling out the presence of an androgen-secreting tumor.

Solitary fibrous tumor of the pleura: Can computed tomography features help predict malignancy? A series of 56 patients with histopathological correlates.

OBJECTIVE: To identify computed tomography (CT) predictors of malignancy, from a retrospective study of preoperative CT scans of patients with solitary fibrous tumors (SFT) of the pleura. PATIENTS AND METHODS: The CT scans of 56 patients with histopathologically confirmed SFT (33 women and 23 men; mean age, 60years) who underwent surgery between December 2004 and November 2012 were retrospectively analyzed by three radiologists working in consensus, blinded to the final histological diagnosis. RESULTS: SFT was asymptomatic and incidentally discovered in 22 patients (45.8%). Resection specimen analysis (R0 resection in all cases) revealed that 23 tumors (41%) were malignant. The CT features, which significantly differed between malignant and benign SFTs were tumor size (P=0.002) with a discriminative threshold value of 10cm, tumor heterogeneity before (P=0.02) and after (P=0.03) intravenous administration of iodinated contrast material, presence of intratumoral hydric attenuation areas (P=0.01), pleural effusion (P=0.01), measurable intratumoral vessels (P=0.02), hypervascularization with visible intratumoral vessels and/or marked enhancement (P=0.001). Presence of intratumoral calcifications (P=0.2) and maximum post-contrast enhancement value (P=0.6) were not significantly different between the two groups. CONCLUSION: A size greater than or equal to 10cm, hypervascularization, attenuation heterogeneity and association with pleural effusion are individual variables that suggest malignant SFT on CT.

[Value of sonography and MR imaging for the evaluation of deep pelvic endometriosis]. / Valeurs diagnostiques de l'echographie et de l'IRM pour l'evaluation de l'endométriose pelvienne profonde.

Deep pelvic endometriosis may involve the uterosacral ligaments, cul-de-sac of Douglas, vagina, rectum, and occasionally the bladder. Evaluation by physical examination is difficult, and imaging techniques are needed to evaluate the location and extent of endometriosis. In this review, we review the transvaginal and transrectal sonographic and MR imaging features suggestive of deep pelvic endometriosis and their diagnostic value.

Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer.

Nineteen patients with middle and lower rectal carcinomas were operated on, with abdominoperineal resection in 10 patients, lower anterior resection with coloanal anastomosis in 6 patients, and colorectal anastomosis in 3 patients. The distance of the lower margin of the tumor to insertion of the levator ani on the rectal wall was correctly evaluated by computed tomography in 12 (63%) of 19 patients and by magnetic resonance imaging in 13 (68%) of 19 patients, while digital examination correctly assessed the distance in 15 (79%) of 19 patients. Computed tomography and magnetic resonance imaging were unable to assess extension through the rectal wall. No significant difference was observed between computed tomography and magnetic resonance imaging in assessing extension to the perivesical fat, adjacent organs, pelvic side wall, or lymph nodes. According to the TNM classification, magnetic resonance imaging correctly staged 74% (14/19) of carcinomas, while computed tomography correctly staged 68% (13/19).

Idiopathic thrombocytopenic purpura as the presenting feature of a primary bilateral adrenal non Hodgkin's lymphoma.

Primary lymphomas arising in the adrenal gland are extremely rare. The presenting symptoms are nonspecific and may be related to lymphoma or to associated adrenal insufficiency. In this report we describe the case of a 61 year old woman with idiopathic thrombocytopenic purpura and primary bilateral non Hodgkin's lymphoma of the adrenals.

Magnetic resonance imaging of pseudomyxoma peritonei.

MRI findings in three cases of pseudomyxoma peritonei, in two cases associated with visceral invasion, are described. MR imaging using the same morphologic criteria as described in ultrasonography and CT suggested the diagnosis in all three cases. In T 1 weighted images (SE 400/28 ms) the hypointensity of signals of both implants and mucoid ascites was found to approach that of muscle tissue. In T 2 weighted images (SE 1600/40, 80, 120 ms), however, there was general hyperintensity of signals, which was more pronounced in mucoid ascites than in implants, and which approached signal intensities of water. Invasion of the viscera was very well depicted in all cases.

Fat suppression techniques in MR imaging of mature ovarian teratomas: comparison with CT.

OBJECTIVE: The aim of this study is to analyze the ability of MR fat suppression techniques to characterize fat components of ovarian mature cystic teratomas (MCT) shown by CT. SUBJECTS AND METHODS: MR images of eight MCTs of the ovary were obtained using standard sequences followed by a SPIR (spectral presaturation with inversion recovery) sequence in six cases and by Dixon sequences in two cases. In all cases correlation with CT and pathologic findings was achieved. RESULTS: MR fat suppression sequences showed to be as accurate as CT in detecting fat inside the cystic part of the teratomas (8/8). CONCLUSION: MR fat suppression sequences should be performed when presence of fat is suspected on images of ovarian tumors produced by standard MR sequences.

Mature cystic teratomas of the ovary: CT and MR findings.

OBJECTIVE: To correlate CT and MR patterns of ovarian mature cystic teratomas (MCT). SUBJECTS AND METHODS: CT and MR findings in 25 histologically proven ovarian MCT were retrospectively reviewed. MCT characterization at CT and MR was based on detection of fat and/or a Rokitansky protuberance. MR signal intensity and CT density numbers of fat were correlated. RESULTS: At pathology, 24/25 tumors contained fat, 1/25 a water content, and 23/25 a Rokitansky protuberance. Twenty one MCT contained fat with a density number less than-20 HU (mean density: -95 HU) and a signal intensity superior or equal to sub-cutaneous fat on T1 images, however, only six of these had a signal intensity equal to sub-cutaneous fat on T1 and T2 images and 12 had a reversed chemical shift artifact. Three contained fat with a density number ranging from -13 to +8 HU and a signal intensity inferior to subcutaneous fat on T1 images. CT showed a Rokitansky protuberance in 21/23, containing adipose tissue in 16 and calcified structures in 21. Standard MR showed a Rokitansky protuberance in 14/23 and characterized adipose tissue in eight cases, and calcified material in six cases. Finally, CT characterized 24/25 (96%) MCT. Standard MR characterized 22/25 (88%) MCT, and standard MR with fat-suppression sequences characterized 23/25 (92%) MCT. CONCLUSION: Standard MR is less effective than CT in characterizing fat and has the same difficulty as CT in characterizing fat mixed with hair when its density is high. When fat cannot be identified by either technique, diagnosis of a Rokitansky protuberance is more easily made at CT than at MR.

Localized fibrous pleural mesothelioma: CT findings.

The CT findings in 16 patients (20 examinations) with proven localized fibrous mesothelioma are described. These lesions proved to be large, uninvasive, sometimes heterogeneous, and enhancing solitary masses. These morphologic findings in an asymptomatic patient should be suggestive of this lesion.

[Bladder endometriosis. Apropos of 4 cases and review of the literature]. / Endométriose vésicale. A propos de quatre cas et revue de la littérature.

The aim of our study is to evaluate the diagnostic and therapeutic attitude toward endometriosis of the bladder. We have analysed four observations treated in the gynecologic service of Hotel-Dieu in Paris between January 1989 and January 1998, which represents 1.3% of all endometriosis operated during this period. Every patient underwent echography, RMN, UIV and cystoscopy. In all for cases a surgical treatment by laparotomy was realised. The choice of this way is explained by the multiple localisations of endometriosis in three cases and the impossibility of a coelioscopic treatment in the forth. The anatomopathologic exam found endometriosis in all of the cases.

[Pelvic endometriosis]. / Endométriose pelvienne.

Endometriosis is a common disease that affects about 20% of women of childbearing age. At transabdominal and endovaginal ultrasound, in 90% of cases, ovarian endometriosis appears as a homogeneous lesion with low level echoes most often associated with clots. However this modality is insufficient to detect associated lesions. MRI is as accurate as ultrasound to detect ovarian endometriosis which most often appears with a signal higher than that of adipose tissue on T1W images and a bright signal area on fat suppressed images. The main advantage of this examination is not only to detect small ovarian implants but to also detect associated subperitoneal implants. These lesions involving the bladder as well as posterior structures such as the uterosacral ligaments, rectovaginal septum, and rectum appear as fibromuscular masses containing hyperintense signal areas on T1W images, or as purely fibrotic lesions that can be quite difficult to diagnose. Laparoscopy remains the procedure of choice to detect peritoneal implants.

[Malignant tumors of the ovaries: role of imaging]. / Tumeurs malignes de l'ovaire. Rôle de la radiologie.

Malignant ovarian tumors are developed in more than 95% in the epithelium surface of the ovary. In the mainly cystic forms, vegetations greater than 2cm, with an irregular surface, with a broad base on implantation, containing vessels on color Doppler are very suggestive of malignancy. Ultrasound is highly accurate in these forms. In most of the mixed forms on mainly solid forms, the irregular solid portions with degenerative changes containing tumoral vessels are very suggestive of malignancy. CT scan or MR imaging are usually more indicative of showing malignancy than ultrasound. In the multilocular forms, diagnosis of malignancy or benignity is often difficult. Extension to the pelvis, peritoneum and lymph nodes is easier to define on CT scan.

[X-ray computed tomography of endometrioid cancers of the ovary. Apropos of 4 cases]. / Tomodensitométrie des cancers endométrioïdes de l'ovaire. A propos de 4 cas.

The preoperative CT scan of 4 patients who had surgery for endometrioid adenocarcinoma of the ovaries were studied retrospectively and the results correlated to operative and pathological findings. 1) All tumors were bilateral. 2) Uterine involvement was diagnosed in 1 out of 3 cases. 3) Fallopian tubes involvement was present in 3 cases but was never seen on CT scan. 4) Ascites and peritoneal metastasis were correctly diagnosed in 2 out of 3 cases.

[Magnetic resonance imaging of the pelvic area. Preliminary results]. / Imagerie par résonance magnétique (IRM) de la région pelvienne. Résultats préliminaires.

Magnetic Resonance Imaging (MRI) is chiefly characterized by its natural contrast and by its capability of producing images in the three spatial directions. Although nearly all pathological tumors have prolonged T1 and T2 relaxation times and therefore it seems to be difficult to distinguish them one from another, significant pathological particularities can be obtained by comparing T1 and T2 weighted images. MRI is of particular interest to provide morphologic data and to demonstrate the relationship of tumors to vascular axes. Furthermore information in three dimensions (scans along transaxial, sagittal and coronal planes) is compared to produce a detailed morphological analysis of the tumor and of the adjacent structures. 0,5 T imaging was performed in 25 patients with pathologic pelvis and in 5 normal volunteers.

[Castleman's disease. X-ray computed tomographic aspect. Apropos of 2 mediastinal forms and a multicentric form]. / La maladie de Castleman. Aspect TDM. A propos de deux formes médiastinales et d'une forme multicentrique.

A multicentric form of Castleman's disease is described, this being a rare affection for which CT image characteristics have not, to our knowledge, been reported. Two cases of localized and one case of multicentric Castleman's disease are reported, and differential characters of these two forms with common histology: angio-follicular lymphoid hyperplasia, outlined. The localized form is found mainly in the mediastinum in young patients and follows a favorable course with recovery after exeresis. The diffuse form develops in later life and presents with severe systemic signs and a marked biological inflammatory syndrome Glands and viscera are affected and its course is grave, with mostly fatal relapses. Angiography suggests diagnosis when images show hypervascular lesions in lymph glands. CT scan imaging with contrast is very suggestive when glandular lesions are present that take up contrast strongly. This appearance should always raise the possibility of Castleman's disease.

[Magnetic resonance imaging of the pelvis. Methodological aspects]. / L'imagerie par résonance magnétique du pelvis. Aspects méthodologiques.

Multiparametric choice is needed in Magnetic Resonance Imaging (MRI). In addition to matrix definition, section thickness, accumulation number, the repetition time TR, the echo time TE (for the spin echo technique) and the plane selection are of great importance. In pelvic examination, information supplied by T1 and by T2 weighted images is complementary. So, comparison between the three dimensional sections is of great interest. Although long acquisition times could, in theory, provide better images and therefore more clinical information, the patient comfort must be considered in choosing a reasonable examination time. We believe that it is possible, without great loss of information, not to make inversion recovery sequences. Using a 0.5 T superconducting magnet, sequences were done with TR of 1,200 ms for T2 weighted images and two echoes with TE of 40 or 50 ms. Twice repeated sequences (for averaging purpose) and 256(2) matrix (with a 42 cm field diameter) seem to be well adapted to MRI clinical applications.

[Comparative study of MRI and x-ray computed tomography in the preoperative evaluation of rectal carcinoma]. / Etude comparative de l'IRM et de la TDM dans le bilan préopératoire des carcinomes du rectum.

Twenty-one patients with middle and low rectal carcinomas have been operated by abdominoperineal resection (APR) in 11 patients, and low anterior resection (LAR) with coloanal anastomosis in 7 and colorectal anastomosis in 3. The distance of the lower margin of the tumor to insertion of the levator ani on the rectal wall was correctly evaluated by CT in 15 of 21 cases (71%) and by MR in 14 of 21 (67%) while digital examination correctly assessed the distance in 17 of 21 (81%). CT and MR were unable to assess extension through the rectal wall. No significant discordance was observed between CT and MR in assessing extension to the perivesical fat, adjacent organs, pelvic side wall or lymphnodes. According to the TNM classification, MR correctly staged 76% (16 of 21) of patients while CT correctly staged 71% (15 of 21).

[Value and limitations of puncture guided by x-ray computed tomography in hematology]. / Intérêt et limites de la ponction guidée par tomodensitométrie en hématologie.

Interpretable cytologic data were obtained in 63% of a series of 68 punctures, for biopsy of hematologic affections, guided by CT scanning. The frequency of puncture of post-therapy residual masses (44 cases) explains the high incidence of non-significant examination results after lymph node puncture. The technique was most effective (78% of punctures exploitable) when used for thoracic masses and visceral localizations. The method is very safe: lack of serious incidents and minor reactions, mainly during thoracic puncture, in only 4.4%. The method is simple in use and should be employed, within certain limits that should be recognized, very widely in hematologic diseases.