Recognition of the ovaries and ovarian origin of pelvic masses with CT.

Knowledge of the morphologic features and ligamentous attachments of the ovaries, the relationship of the ovary to the ureter, and the course of the ovarian vein and artery is necessary for confident recognition of the ovaries and differentiation between ovarian and nonovarian masses with computed tomography (CT). The suspensory ligament attaches the ovary to the pelvic sidewall and transmits the ovarian vein and artery. This ligament may be seen at CT as a linear or fan-shaped soft-tissue band leading to the ovary. The utero-ovarian ligament is occasionally visualized with CT as a soft-tissue band between the uterus and ovary. The ovaries are usually located anterior or anteromedial to the pelvic ureters, whereas iliac lymph nodes are lateral or posterolateral to the ureters. Therefore, an ovarian mass displaces the ureter posteriorly or posterolaterally, whereas a large lymph node mass displaces the ureter medially or anteromedially. An ovarian mass may be draped by ovarian parenchyma, thus revealing the origin of the mass. Tracking the ovarian vein from near the level of the renal vessels caudally to the pelvis leads to the suspensory ligament region and is often helpful in identifying the ovary and differentiating ovarian and nonovarian masses.

Ultrasound diagnosis of fatty liver in patients with chronic liver disease: a retrospective observational study.

OBJECTIVES: Hepatic ultrasound (US) is readily available and physicians usually trust the results of an US report suggesting fatty liver, but there are conflicting reports on its accuracy, especially in patients with chronic liver disease (CLD). Therefore, we retrospectively examined liver biopsies in patients with CLD and compared the histologic results to the hepatic US findings. METHODS: Liver biopsies were graded for fat (grades 0 to 3), inflammation (grades 0 to 4), and fibrosis (stages 0 to 4) in 131 patients with CLD (89% had chronic hepatitis C). Hepatic US interpretations were grouped into 3 categories-"normal," "fatty liver," and "nonspecific." A secondary analysis was performed using 3 sonographic categories based on the echogenicity: normal, "increased echogenicity," and "heterogenous." The US results were then compared with the liver biopsy results. RESULTS: A normal US report was associated with many false negatives, as 25% of these patients had fat (grades 1 to 3) on biopsy; furthermore, 46% had "significant fibrosis" (stages 2 to 4) or "significant inflammation" (grades 2 to 4). A "fatty liver" interpretation correctly identified fat on biopsy in 36.4% and "significant fat" (grades 2 to 3) in 11.4%, but 66% had significant fibrosis or significant inflammation. An US with increased echogenicity correctly identified fat in 43.5% and significant fat in 19.4%, but 69.4% had significant fibrosis or significant inflammation. The sensitivity of an US ranged from 11.4% to 88.2% and the specificity ranged from 40.4% to 86.2%, depending on the degree of steatosis on biopsy and the sonographic interpretation being considered. CONCLUSIONS: US is inaccurate for diagnosing hepatic steatosis in patients with CLD. Echogenic abnormalities are more likely to be the result of fibrosis or inflammation in this setting.