T2-hypointense adnexal lesions: an imaging algorithm.

T2-weighted sequences are an integral part of magnetic resonance (MR) imaging performed for the characterization of adnexal lesions. A relatively small number of these lesions demonstrate low signal intensity on T2-weighted MR images. In the majority of cases, a specific diagnosis can be made by interpreting the signal intensity of the lesion with respect to certain pathologic correlates, including blood products, smooth muscle, fibrous tissue, and calcification, as well as high lesion cellularity. For example, lesions that are at least as dark as skeletal muscle are almost always benign, whereas those whose T2 signal intensity is higher than that of skeletal muscle constitute a more heterogeneous group composed of benign, borderline, and malignant disease entities. The authors propose a diagnostic algorithm that takes these features into account, as well as the appearances of the lesion with additional pulse sequences, to aid in the correct interpretation of T2-hypointense adnexal lesions. Knowledge of the anatomy, the T1-weighted imaging features, and the enhancement characteristics of adnexal lesions allows accurate characterization of these lesions, resulting in appropriate patient management.

Revisiting Middle East Respiratory Coronavirus (MERS-CoV) Outbreak Chest Radiographic Initial Findings, Temporal Progression, and Correlation to Outcomes: A Multicenter Study.

Objectives Accounts of initial and follow-up chest X-rays (CXRs) of the Middle East respiratory coronavirus (MERS-CoV) patients, and correlation with outcomes, are sparse. We retrospectively evaluated MERS-CoV CXRs initial findings, temporal progression, and outcomes correlation. Materials and methods Fifty-three real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR)-confirmed MERS-CoV patients with CXRs were retrospectively identified from November 2013 to October 2014. Initial and follow-up CXR imaging findings and distribution were evaluated over 75 days. Findings were correlated with outcomes. Results Twenty-two of 53 (42%) initial CXRs were normal. In 31 (68%) abnormal initial CXRs, 15 (48%) showed bilateral non-diffuse involvement, 16 (52%) had ground-glass opacities (GGO), and 13 (42%) had peripheral distribution. On follow-up CXRs, mixed airspace opacities prevailed, seen in 16 (73%) of 22 patients 21-30 days after the initial CXRs. Bilateral non-diffuse involvement was the commonest finding throughout follow-up, affecting 16 (59%) of 27 patients 11-20 days after the initial CXRs. Bilateral diffuse involvement was seen in five (63%) of eight patients 31-40 days after the initial CXRs. A bilateral diffuse CXR pattern had an odds ratio for mortality of 13 (95% CI=2-78) on worst and 18 (95% CI=3-119) on final CXRs (P-value <0.05). Conclusion Initially, normal CXRs are common in MERS-CoV patients. Peripherally located ground-glass and mixed opacities are common on initial and follow-up imaging. The risk of mortality is higher when bilateral diffuse radiographic abnormalities are detected.