Adenomyosis and junctional zone changes in patients with endometriosis.

OBJECTIVES: To evaluate image findings in the junctional zone (JZ) in patients with endometriosis and correlate with image findings of adenomyosis. To attempt a correlation of the degree of adenomyotic infiltration with the degree of infiltration and stage of endometriosis. STUDY DESIGN: Magnetic resonance imaging (MRI) of the uterus was performed in 153 women with suspected deeply infiltrating endometriosis and planned surgery, and in a reference group of 129 women without endometriosis, verified during hysterectomy. Changes in the JZ and endometriosis in the pelvis were described in detail. Diagnosis of adenomyosis at MRI was based on optimal criteria derived from the hysterectomy control group. The stage of endometriosis (AFS stage) was determined during surgery. RESULTS: In the group of women with endometriosis 34.6% had adenomyosis compared with 19.4% in the reference group (p<0.05). More women with endometriosis (39.9%) had an irregular JZ compared to 22.5% in the reference group (p<0.01). Among women with severe endometriosis (AFS stage IV) 42.8% had adenomyosis compared to 29.4% in the women with other stages of endometriosis (AFS stages I+II+III) (p=0.10). More women with severe endometriosis (AFS stage IV) had deeper wall invasion of adenomyosis (p>0.05) but the presence of deep infiltrative rectovaginal endometriosis and the size of infiltration were not correlated to adenomyosis or depth of infiltration of adenomyosis. CONCLUSIONS: In a group of young women with severe symptomatic endometriosis and planned surgery a systematic evaluation of the JZ revealed that one third had uterine adenomyosis, but the invasive potential of endometrial cells in the uterus and in the peritoneum corresponded only to a limited degree.

Response, relapse and mucosal immune regulation after infliximab treatment in fistulating Crohn's disease.

BACKGROUND: Infliximab reduces mucosal inflammation in some, but not all, patients with Crohn's disease. AIM: To monitor clinical data and changes in mucosal cytokine levels after infliximab treatment to identify differences between responders and non-responders. METHODS: Twenty-six patients with fistulating Crohn's disease received three infliximab infusions at weeks 0, 2 and 6. Follow-up was for 1 year and included clinical examination, colonoscopy, ano-rectal ultrasound and magnetic resonance imaging. Biopsies were taken at weeks 0, 8, 26 and 52. Cell cultures were established and analysed for tumour necrosis factor-alpha, interferon-gamma and interleukin-10 levels, and related to clinical status and fistula healing. RESULTS: Eleven of 15 patients (73%) with active disease (Crohn's disease activity index > 150) obtained remission (Crohn's disease activity index < 150) at 8 weeks. In in vitro cell cultures, there was reduced tumour necrosis factor-alpha and interleukin-10 production at week 26, with the latter persistent throughout the study period. When the disease deteriorated or relapsed, there was increased interferon-gamma production in in vitro cell cultures. Fistula healing was associated with reduced production of interferon-gamma, tumour necrosis factor-alpha and interleukin-10. CONCLUSIONS: Infliximab down-regulates mucosal immune activation in Crohn's disease. Monitoring of mucosal cytokine levels after infliximab treatment by whole biopsy cultures may be useful as interleukin-10, tumour necrosis factor-alpha and interferon-gamma production are different in responders and at relapse.

Peripheral vascular surgery and magnetic resonance arteriography--a review.

OBJECTIVES: to review the current status of lower limb MRA. DESIGN: a literature review based predominantly on a MEDLINE database search of English-language publications from January 1991 to October 2000. MATERIALS AND METHODS: twenty-eight articles, concerning non-enhanced MRA (13), gadolinium-enhanced MRA (14) or both (1), met the predefined requirement for quality. Results gadolinium-enhanced MRA (CE-MRA) seems to be more accurate, quicker and associated with fewer problems than non-enhanced (TOF) MRA. TOF-MRA has a sensitivity and specificity of 93% (range 64-100%) and 88% (range 57-100%) respectively, and CE-MRA presents values of 96% (range 71-100%) and 96% (63-100%), respectively, using conventional arteriography as the gold standard. Some articles report a substantial incidence of runoff vessels suitable for distal bypass visible on MRA but invisible on conventional arteriography. Gadolinium contrast is given intravenously and is generally well tolerated and has no known nephrotoxicity. CONCLUSION: CE-MRA is accurate compared to conventional arteriography, has the potential to increase the limb salvage rate for selected patients, is non-invasive and well tolerated.

Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis.

OBJECTIVE: To compare the diagnostic potential of magnetic resonance imaging (MRI) and transvaginal ultrasonography (TVS) in the diagnosis of adenomyosis. DESIGN: Double blind set-up. SETTING: University medical school. PATIENT(S): We studied 106 consecutive premenopausal women who underwent hysterectomy for benign reasons. INTERVENTION(S): Transvaginal ultrasonography and MRI were compared with histopathologic examination as the golden standard. MAIN OUTCOME MEASURE(S): Adenomyosis. RESULT(S): Twenty-two (21%) patients had adenomyosis. The sensitivity and specificity were as follows: sensitivity: MRI 0.70 (0.46-0.87) and TVS 0.68 (0.44-0.86) (P=.66); specificity: MRI 0.86 (0.76-0.93) and TVS 0.65 (0.50-0.77) (P=.03). The combination of MRI and TVS was most sensitive (0.89 [0.64-0.98]), but produced the lowest specificity (0.60 [0.44-0.73]). Adenomyosis was not detected by either MRI or TVS at uterine volumes >400 mL. Exclusion of uteri >400 mL from the analysis improved the diagnostic precision of MRI, but not that of TVS. The diagnostic accuracy at MRI was improved by calculating the maximum difference between the thinnest and thickest junctional zone (JZdif) (i.e., > or =5-7 mm). CONCLUSION(S): Magnetic resonance imaging was superior to TVS for the diagnosis of adenomyosis. Magnetic resonance imaging had a higher specificity than TVS, but their sensitivities were in line. The diagnostic accuracy of MRI, as that of TVS, was at an intermediate level, but the diagnostic accuracy of the former improved by exclusion of uteri >400 mL. The combination of MRI and TVS produced the highest level of accuracy for exclusion of adenomyosis, but the low specificity may necessitate further investigation of positive findings. Measurement of the difference in junctional zone thickness may optimize the diagnosis of adenomyosis at MRI.

Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy.

OBJECTIVE: To evaluate and compare the diagnostic accuracy of magnetic resonance imaging (MRI), transvaginal ultrasonography (TVS), hysterosonographic examination (HSE), and hysteroscopy in the evaluation of the uterine cavity. DESIGN: Independent double-blind study. SETTING: University medical hospital. PATIENT(S): One hundred six consecutive premenopausal women who underwent hysterectomy for benign diseases. INTERVENTION(S): Results of MRI, TVS, HSE, and hysteroscopy were compared with the results of histopathologic examination at hysterectomy (the gold standard). RESULT(S): The overall sensitivity was MRI 0.76, TVS 0.69, HSE 0.83, and hysteroscopy 0.84. The specificity was MRI 0.92, TVS 0.83, HSE 0.90, and hysteroscopy 0.88 (MRI, HSE, hysteroscopy vs. TVS <0.05). Polyps were missed in 9 of 12 cases at MRI, 7 at TVS, 4 at HSE, and 2 at hysteroscopy (MRI vs. hysteroscopy, and TVS vs. hysteroscopy <0.05). The sensitivity for identification of submucous myomas was MRI 1.0, TVS 0.83, HSE 0.90, and hysteroscopy 0.82; the specificity was MRI 0.91, TVS 0.90, HSE 0.89, and hysteroscopy 0.87 (MRI vs. TVS, and MRI vs. hysteroscopy). Magnetic resonance imaging was significantly more precise than TVS, HSE, and hysteroscopy in determining submucous myoma in-growth (2-way ANOVA <0.05). CONCLUSION(S): For exclusion of abnormalities in the uterine cavity, MRI, HSE, and hysteroscopy were equally effective and slightly superior to TVS. Magnetic resonance imaging and TVS missed endometrial abnormalities such as polyps, but MRI and HSE were most accurate for the evaluation of submucous myomas, and MRI was superior in evaluation of exact submucous myoma in-growth.

Diagnostic importance of magnetic resonance angiography in arterial reconstructive surgery.

Magnetic resonance angiography (MRA) permits the non-invasive visualisation of blood flow in arteries and veins. It has an enormous potential in imaging of various vascular pathologies and it has been establishing itself as a reliable alternative to widespread contrast X-ray methods explaining morphology of vascular system. This advanced and safe diagnostic method is very rarely used in the clinical practice of vascular surgeons in Slovak republic. The aim of this report is to outline a clinical importance of MRA for arterial reconstructive surgery, its advantages, limitation as an imagine technique and its practical application in different anatomical areas of the human body which are related to operative activity of vascular surgeons. It is intended for briefly comparing MRA with other vascular imagine techniques more common used in clinical practice of our surgical and vascular surgery departments and outpatient clinics.

Incidence and growth pattern of vestibular schwannomas in a Danish county, 1977-98.

During a period of 21 years 162 acoustic neuromas or vestibular schwannomas (VS) were diagnosed in the county of Aarhus. During this period the incidence increased gradually, probably due to improvement of the quality of computed tomography imaging (CTI), and more widely available access to magnetic resonance imaging (MRI). Sixty-four patients were followed up by repeated CTI or MRI, whereas the remaining patients were referred for immediate operation. Six of the observed patients had their tumours removed after demonstration of continuous tumour growth. The observation of 64 tumours over periods between 5 months and 15 years provided useful information on the natural history of sporadic VS. Our results showed that 14 VS (22%) regressed, 35 VS (55%) did not grow or had only minimal growth (growth rate up to 1 mm/year), whereas 15 VS (23%) grew > 1 mm/year. All VS with positive growth had regular growth patterns.

[Magnetic resonance imaging of patients with perianal fistulas]. / Magnetisk resonans-scanning ved udredning af patienter med perianale fistler.

Magnetic resonance imaging (MRI) of the anal canal was retrospectively evaluated during a three year period in 67 patients with suspected perianal fistulae. In six cases the surgeon, who knew the results of the MRI, found a fistula not seen on MRI while MRI showed a fistula in one patient which could not be found at surgery. We recommend MRI in cases where an experienced surgeon has difficulties mapping the fistula tract.

Investigations into the natural history of vestibular schwannomas.

In the period from 1977 to 1996 143 vestibular schwannomas were diagnosed in 138 patients in the County of Aarhus, Denmark. The natural history of vestibular schwannomas was observed in 50 patients with 52 tumours who did not undergo immediate surgical removal of their tumour due to small tumour size, advanced age, poor general health and the patients' refusal of surgery. The management included serial CT- or MR-imaging and complete otoneurological evaluation. The imaging interval was between 6 months and 2 years and depended on the recorded growth rate. Thirty-three (64%) of the tumours showed continuous growth with a mean growth rate of 1.6 mm/year. In 11 (21%) of the tumours the size was unchanged and eight (15%) remitted. The last group consisted mainly of the largest tumours. Among the tumours with positive growth, 15 (45%) had a growth rate of 1 mm/year or less. Generally, our findings showed that approximately two-thirds of all the tumours did not grow, were getting smaller or had a growth rate sufficiently small to be simply watched. Additionally, our results suggest that some symptomatic tumours will grow to a certain point whereupon stagnation or remission occurs.

Is supraspinatus pathology as defined by magnetic resonance imaging associated with clinical sign of shoulder impingement?

To examine the association between supraspinatus pathology and clinical sign of impingement, 42 workers with and 31 age-matched workers without signs of subacromial impingement had their shoulder examined by magnetic resonance imaging. All subjects were selected from an epidemiologic study evaluating the risk of shoulder impingement syndrome in relation to ergonomic exposure. Physical examination was conducted according to the same protocol and included assessment of shoulder function. Magnetic resonance images were evaluated in a blinded manner with regard to clinical status and age. Twenty-two (55%) subjects in the impingement group and 16 (52%) subjects in the control group had a pathologic supraspinatus tendon (odds ratio 1.13 [95% confidence interval 0.45 to 2.88]). The prevalence of supraspinatus pathology increased from 32% in the youngest to 48% in the middle and 72% in the oldest age group. The results of this study indicate that supraspinatus pathology is related to age rather than to clinical sign of impingement.

Clinical magnetic resonance imaging and arthroscopic findings in knees: a comparative prospective study of meniscus anterior cruciate ligament and cartilage lesions.

We compared the diagnostic and predictive value of magnetic resonance imaging (MRI) and clinical findings with arthroscopy in 61 knees in a prospective study. In meniscal tears, the accuracy and positive predictive value of MRI was found to be nearly twice that of clinical examination. The sensitivity, specificity, and negative predictive value of MRI were comparable to the figures found in other studies. We recommend MRI as a clarifying diagnostic tool when a clinical examination indicates a lesion of the meniscus. In our study, the clinical relevance of MRI in anterior cruciate ligament lesions and especially in cartilage lesions was more doubtful. The combination of clinical and MRI findings would reduce the number of blank arthroscopies to 5%. MRI is a valuable diagnostic tool in planning the type of anesthesia and treatment, and could significantly reduce the need for a second arthroscopy.

The size of acoustic neuromas: CT and MRI.

The growth rate of acoustic neuromas is very variable: some tumours grow rapidly, some do not grow and some even get smaller. When making treatment decisions, it may be important to have an idea of the growth rate of the individual tumour, and this is only possible when there are comparable examinations. We performed both CT and MRI on 15 patients. Two radiologists estimated the size of their acoustic neuromas. There was a significant difference between the two examiners' calculations of tumour volumes on CT and between the first examiner's CT and MRI volume calculations. No difference was found between the two MRI volume estimations or the second examiner's estimation of volumes on CT and MRI. Measurements of the maximal tumour diameter along the pyramid showed good concordance. We conclude that measurement the size of acoustic neuromas is reproducible with MRI and the measurement of the maximal tumour diameter is in practice a better parameter for comparison than calculation of real volume.

Tumour oxygenation assessed by polarographic needle electrodes and bioenergetic status measured by 31P magnetic resonance spectroscopy in human soft tissue tumours.

The purpose of this study was to evaluate the feasibility of polarographic oxygen electrode measurements and phosphorus magnetic resonance spectroscopy (31P-MRS) in extravisceral soft tissue tumours, designated to receive preoperative radiotherapy. Pretreatment tumour oxygenation was determined in 41 cases and 31P-MRS was amenable to lesions in 34 patients. Biopsies were characterized histopathologically as 25 primary soft tissue sarcomas (STS), 2 recurrent STS, 9 benign and 5 other malignancies. Evaluation of phosphorus (31P) spectra was possible in 11 cases. The oxygenation status of normal tissue was higher than that of tumours, whereas no difference was found between oxygenation status of benign lesions and that of STS. There was substantial variation between tumours in the median pO2 and the bioenergetic status (beta-NTP/Pi). No correlation was found between tumour pO2 and volume (n = 25). Moreover, there was no correlation between beta-NTP/Pi and the median tumour pO2, the fraction of pO2 values < or =2.5 mmHg or tumour volume (n = 10), respectively. In conclusion, oxygen electrode assessment was found to be a clinically applicable and feasible technique for measuring tumour oxygenation status, whereas the success of 31P-MRS in human neoplasms was limited by a very poor resolution in the phosphorus signal that allowed analysis of 31P spectra in 11 tumours out of 34 cases.

[Intracranial lipomas]. / Intrakranielle lipomer.

Intracranial lipomas are rare lesions that should be regarded as congenital malformations. They are usually asymptomatic and incidental findings during neuroradiological investigations. Other brain malformations are often seen in association with intracranial lipomas. The most common is hypoplasia of the corpus callosum. An attempt at surgical removal is not advisable. Lipomas are strongly adherent to the surroundings and typically enclose both vessels and nerves. Magnetic resonance imaging is capable of differentiating lipomas from dermoid cysts and teratomas, making this the diagnostic method of choice.

The pituitary gland in nocturnal enuresis: MR findings.

Nocturnal enuresis is considered a benign condition partially explained by a defect circadian rhythm of vasopressin. An organic cause may be responsible for an abnormal pituitary function, when enuresis persists into adulthood. In the present study the pituitary gland and surroundings of 8 adults suffering from primary monosymptomatic nocturnal enuresis were studied by magnetic resonance imaging. The pituitary gland appeared normal in all, except from a Rathke's cleft cyst observed in one patient. This cleft cyst was not considered to be clinically important. It was concluded, that severe nocturnal enuresis persisting into adulthood is not likely to be combined with detectable pathology on magnetic resonance imaging of the pituitary gland.

[Can magnetic resonance imaging differentiate between benign and malignant conditions in patients with skeletal or soft tissue tumors?]. / Kan magnetisk resonans-undersøgelse adskille benigne tilstande fra maligne hos patienter med skelet- eller bløddelstumorer?

The records of 437 patients referred preoperatively for magnetic resonance imaging (MRI) due to clinical or radiological suspicion of a bone or soft-tissue malignancy were examined retrospectively in order to evaluate how good MRI is at distinguishing malignant from benign lesions. The MR-examination tends to overestimate malignancy. In all cases, the preoperative MR-examination correctly identified all malignant tumours as malignant, but also estimated a number of benign lesions as malignant. Sensitivity, specificity and predictive value was 100%, 71.2% and 76.4% respectively. In case of bursa/ganglion and pseudotumour, MR was able to correctly identify these lesions as benign. MR could not differentiate between the different types of sarcomas.

[Size of acoustic neurinomas assessed by CT and magnetic resonance scanning]. / Størrelsen af acusticusneurinomer bedømt ved CT og magnetisk resonansskanning.

Some acoustic neuromas do not grow or grow very slowly. It is therefore of value to compare the results of measuring the size of acoustic neuromas by either CT or Magnetic Resonance Imaging (MRI) scanning with a view to being able to observe the growth rate of these tumours. Fifteen patients with acoustic neuromas had both CT- and MRI-scans performed. Two trained radiologists evaluated the size of the tumours in a blinded fashion. There was a significant difference between one observer's calculations from the CT- and the MRI-scans, and also a significant difference between the two observers' calculations from the CT-scans. No difference in calculating tumour size was found between the two observers' calculations from the MRI-scans. It is concluded that the size of acoustic neuromas i evaluated more equally by two observers using MRI-scans than when using CT-scans. By the use of repeated MRI-scanning it is possible to keep patients with acoustic nouromas under observation and avoid operation in those patients where the tumour does not grow.

Imaging of chondrosarcoma with histopathological and prognostic correlation. An analysis of 49 cases mainly based on plain film radiography.

PURPOSE: To investigate the course of chondrosarcoma in relation to radiographic and histopathologic findings. MATERIAL AND METHODS: 49 consecutive patients seen during an 11-year-period were analysed, including re-evaluation of their radiographic and histopathologic material. RESULTS: Forty-two patients had radiographic changes typical for cartilaginous tumours, in 37 with malignant stigmata. Seven patients had malignant changes not typical for chondrosarcoma. By histopathologic grading 16 patients had grade I, 17 grade II and 16 grade III tumours. Six of the grade II-III tumours were histopathologic variants (mesenchymal, dedifferentiated or myxoid chondrosarcomas). Surgical removal of the tumour was performed in 42 patients, 41 of whom were followed up for 0.4-11.4 years (median 3.8 years). Local recurrence occurred in 7 patients, and 11 patients developed metastases. Ten patients, 4 with local recurrence and metastases, and 6 with metastases only were dead at the end of the follow-up. The actuarial 5-year overall survival rate was 64%. The occurrence of local recurrence, metastases and death was found to be related to the histopathologic grades II and III. Atypical radiographic features only occurred in grade II-III tumours and were related to metastases and death, but not to local recurrence. CONCLUSION: Atypical radiographic findings were related to high-grade malignancy and poor prognosis.

Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases.

The purpose of our study was to evaluate the use of static magnetic resonance imaging (MRI) as a preoperative diagnostic tool in young patients with a traumatic primary anterior shoulder dislocation. Twenty-five patients who had acute primary traumatic anterior shoulder dislocation were examined with MRI and arthroscopy. The patients (18 male and 7 female) were between 16 and 39 years old (mean age, 27 years). They had no previous shoulder dislocations. The dislocations were confirmed radiographically. Examination with MRI and arthroscopy was performed within 10 days after the trauma. The MRI evaluation was performed before the arthroscopic examination, and the images were interpreted by an experienced magnetic resonance radiologist. No information from the MRI examination was available to the orthopedic surgeons before arthroscopy. The standard of reference for comparison was arthroscopy. Subacute MRI evaluation identified 15 labral tears, 12 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff lesion, and 1 partial rupture of the biceps tendon. Arthroscopic examination revealed 22 labral tears, 15 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff tear, 1 partial rupture of the biceps tendon, and 1 osseous Bankart lesion. Anterior capsulolabral tears and Hill-Sachs lesions appeared with a high incidence after acute anterior primary shoulder dislocation. Conventional MRI was only moderately reliable in the preoperative evaluation of labral tears and Hill-Sachs lesions, and it failed to give an accurate, differentiated preoperative diagnosis of the capsulolabral lesions.