Primary Cystic Lesions of the Retrorectal Space: MRI Evaluation and Clinical Assessment.

OBJECTIVE: The purpose of this study was to assess the a priori chance that primary cystic lesions of the retrorectal space are malignant and to investigate MRI characteristics that indicate malignancy. MATERIALS AND METHODS: Patients referred to a center for colorectal surgery were recruited from 2000 to 2014. Lesions were proven by clinical assessment and histopathology. MRI was performed at 1.5 T with examinations evaluated by two radiologists. Interobserver agreement was assessed (Cohen kappa) and differences between malignant and benign lesions calculated (Fisher exact test). RESULTS: Twenty-eight patients (22 women, six men; age range, 18-70 years) with 31 lesions were included. Lesions were categorized as tailgut cysts (n = 16, 52%), teratomas (n = 9, 29%), lesions of colorectal origin (n = 4, 13%), or neurogenic lesions (n = 2, 6%). Five patients (18%) had malignant lesions. Colorectal lesions had the highest percentage of malignancy (3/4, 75%). A solid tissue component was found in all five (100%) malignant lesions and two (8%) of the benign lesions, which were both teratomas (p < 0.05). Sensitivity and specificity for malignancy according to the presence of a solid tissue component was 100% (5/5) and 92% (24/26). For unilocularity, multilocularity, debris, septa, and wall thickening, differences were not significant. Interobserver agreement was excellent (κ = 1) for all characteristics except debris (κ = 0.795). CONCLUSION: The majority of retrorectal cystic lesions are benign. The presence of a solid tissue component should raise suspicion for malignancy.

Pitfalls in susceptibility-weighted imaging of the pediatric brain.

Susceptibility-weighted imaging (SWI) is a recently developed high resolution 3-dimensional gradient-echo pulse sequence that accentuates the magnetic susceptibility of blood, calcium, and nonheme iron. The clinical applications of SWI in pediatric neuroimaging have significantly expanded recently. Potential pitfalls related to blood oxygenation, blood flow, magnetic field strength, and misinterpretation of localization as well as possible mimickers may be misleading and affect the correct interpretation of SWI images. Familiarity with these potential diagnostic pitfalls is important to prevent misdiagnosis and will further enhance the ability of SWI in becoming a robust and reliable technique.

Chronic lower urinary tract symptoms in women: classification of abnormalities and value of dedicated MRI for diagnosis.

OBJECTIVE: Chronic lower urinary tract symptoms are common in women. We present a classification of abnormalities that can be considered in the differential diagnosis for lower urinary tract symptoms and can show the value of dedicated state-of-the art MRI in the workup of patients. CONCLUSION: Dedicated MRI tailored to patient symptoms and clinical findings has the potential to map out morphologic causes and categorize dysfunctional conditions from those that are truly nonmorphologic.

Optimal treatment of premature ovarian failure after treatment for Hodgkin's lymphoma is often withheld.

BACKGROUND: The purpose of this study is to determine: 1. the effect of treatment for Hodgkin's lymphoma on ovarian function, and 2. the interventions to relieve postmenopausal symptoms. METHODS: Seventy-seven consecutive patients treated between 1989 and 2003 in the Rotterdam region for Hodgkin's lymphoma stages I and II were approached for this study. A questionnaire consisting of 45 questions was carried out to evaluate premature menopausal symptoms, hormonal replacement therapy and use of contraception, menstrual cycle, and subsequent pregnancies. RESULTS: After informed consent 67 patients were willing to participate in the study and 66 patients filled in a questionnaire. After antitumor treatment 13 patients developed treatment-related premature ovarian failure, 35 patients had a spontaneous cycle, and 18 patients could not be classified as they used hormonal contraception. Women who developed treatment-related premature ovarian failure had a significantly higher mean age at the start of treatment for Hodgkin's lymphoma than women who remained premenopausal (p < 0.002). Only 6 of these 13 women (46%) received hormonal substitution. In all, 21 women conceived after antitumor treatment, and 28 children were born. All pregnancies were the result of spontaneous conception. CONCLUSIONS: The effect of antitumor treatment for Hodgkin's lymphoma on ovarian function is age dependent (odds ratio of 1.18 per year). There is a striking inconsistency regarding the management of ovarian protection before and during antitumor treatment. Premenopausal women who undergo therapy for Hodgkin's lymphoma should be offered hormonal substitution therapy after loss of ovarian function.