Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis.

Although endometriosis is a common gynecological condition in women of reproductive age, a complication of endometriosis is rarely considered as the differential diagnosis of acute abdominal pain in that context. However, acute events in women with endometriosis can represent life-threatening conditions, which require emergent treatment and often surgical management. Mass effect of endometriotic implants can give rise to obstructive complications, specifically occurring in the bowel or in the urinary tract, while inflammatory mediators released by ectopic endometrial tissue can lead to inflammation of the surrounding tissues or to superinfection of the endometriotic implants. Magnetic resonance imaging is the best imaging modality to reach the diagnosis of endometriosis, but an accurate diagnosis is possible on computed tomography, especially in the presence of stellar, mildly enhanced, infiltrative lesions in suggestive areas. The aim of this pictorial review is to provide an image-based overview of key findings for the diagnosis of acute abdominal complications of endometriosis.

Recognizing the features of Isolated Fallopian Tube Torsion on CT and MRI and interobserver agreement: A cross-sectional study.

PURPOSE: Isolated Fallopian tube torsion (IFTT) is a rare cause of acute pelvic pain in women of reproductive age. Preoperative diagnosis is rarely made, even though an early surgery is necessary to preserve women's fertility. This study aims to identify simple and reproductible imaging features for the diagnosis of IFTT on sectional imaging. METHODS: We conducted a retrospective, cross-sectional study on patients diagnosed with IFTT in our center between January 2008 and December 2021. The CTs and MRIs of 16 patients with surgically proven IFTT were retrospectively and independently reviewed by two radiologists to identify the relevant findings for the diagnosis. RESULTS: The median patient age was 29 years (range: 13-63 years). Only four patients (25 %) had a conservatory treatment. Two patterns of IFTT were identified on CT and MRI. The first pattern (n = 6, 37 %) consisted of a thin-walled hydrosalpinx, U- or C-shaped, with a median diameter of 3 cm. The second pattern (n = 10, 63 %) consisted of an extra-ovarian cyst adjacent to a soft tissue mass containing the twisted tube and vessels. In 15 patients (94 %), the ipsilateral ovary was of normal size. Hematosalpinx was observed in 3 patients with necrosis of the tube on pathological reports (19 %). Interobserver agreement was substantial or good for all criteria. CONCLUSIONS: An association of simple and reproductible features can support the diagnosis of IFTT on sectional imaging in an emergency context: the identification of these features may avoid a delayed surgical treatment, which could otherwise compromise women's fertility.

Fertility-sparing management of a suspicion of leiomyosarcoma: avoiding hysterectomy by performing transcervical myoma biopsy.

OBJECTIVE: To describe the fertility-sparing management of an atypical uterine myoma. DESIGN: Step-by-step video explanation of transcervical biopsy using transabdominal ultrasound guidance, highlighting tips and tricks. Patient consent was obtained before the publication of the case. SETTING: University hospital. PATIENT(S): A 32-year-old nulliparous woman with a history of dysmenorrhea was found to have an atypical myoma FIGO 6, with suspicion of leiomyosarcoma on magnetic resonance imaging. INTERVENTION(S): A transcervical biopsy of an atypical myoma was done under transabdominal ultrasound guidance. A myomectomy by a minimally invasive approach was performed without morcellation. MAIN OUTCOME MEASURE(S): Feasibility of transcervical biopsy and correlation with definitive anatomopathological diagnosis. RESULT(S): The patient was under general anesthesia. A hysteroscopy confirmed the normal appearance of the uterine cavity with no direct access to the myoma. Four core biopsies were performed with a 16-gauge needle transcervically under ultrasound guidance. The preliminary diagnosis of cellular leiomyoma allowed a fertility-sparing surgery. Myomectomy and surgical treatment of endometriosis were performed secondarily. This patient had a successful recovery, and the diagnosis of benign cellular leiomyoma was confirmed on the surgical specimen. CONCLUSION(S): The current video highlights the safety and feasibility of transcervical ultrasound-guided core biopsy in patients with atypical uterine fibroids.

Reader performances in breast lesion characterization via DBT: One or two views and which view?

PURPOSE: To compare the performance in breast lesion characterization of one-view mediolateral (MLO) digital mammography plus digital breast tomosynthesis (DM-DBT) versus one-view craniocaudal (CC) DM-DBT versus two-view DM-DBT. MATERIALS AND METHODS: The institutional review board approved this retrospective study conducted on 138 women from the population of a previous prospective multicenter study, with 69 consecutive patients with benign or high-risk lesions and 69 randomized patients with breast cancer, all confirmed at pathology. Four radiologists (two senior and two junior) blinded to the clinical, mammographic and pathological data independently reviewed the MLO DM-DBT views, the CC DM-DBT views and the MLO + CC DM-DBT views using the American College of Radiology Breast Imaging-Reporting and Data System criteria for index lesion characterization. Areas under the receiver were calculated and compared for each reader and imaging protocol. RESULTS: No significant differences in breast cancer characterization were observed between single MLO and CC views for all the readers. The added value of a second view was statistically significant for characterization in pooled data and for junior readers but not for senior readers (p ranging from 0.15 to 0.57 depending on the view and the senior reader). Finally, in 4 breast cancer cases, lesions were only detectable on the CC DM-DBT view in two cases and on the MLO DM-DBT view in the two other cases. CONCLUSION: Our results support the use of two-view DM-DBT for breast lesion characterization when the readers are inexperienced. There is no significant difference between CC and MLO views when diagnosis is performed with one view.

Imaging of appendicitis: Tips and tricks.

Acute appendicitis is one of the most common surgical emergencies worldwide. Over the past 30 years, imaging has become central to the diagnosis of appendicitis, reducing both negative appendicectomy rate and healthcare expenses. Appendicitis can be challenging in many ways for radiologists with various clinical presentations, complications and differential diagnoses. The aim of this review is to present a step-by-step reasoning with key findings, tips and tricks leading to the diagnosis of appendicitis and its complications. The first steps are with the use of the appropriate imaging modality (US, CT and MRI) to locate the appendix in abdominal cavity and to identify the features of appendicitis and its complications through specific imaging signs. The next steps are to eliminate an unusual morphology of the appendix that may simulate acute appendicitis and to recognize an unusual imaging presentation of appendicitis. Then, to corroborate the diagnosis of appendicitis, the last step is to rule out any differential diagnoses mainly from the genitourinary and gastrointestinal tracts. Following these steps can help to accurately diagnose appendicitis and its complications.

Diagnostic performance of CT signs for predicting adnexal torsion in women presenting with an adnexal mass and abdominal pain: A case-control study.

PURPOSE: To determine which CT findings or combinations of CT findings could accurately identify adnexal torsion in a cohort of women admitted for abdominal pain and presenting with an adnexal mass. MATERIALS AND METHODS: The local institutional review board approved this retrospective case-control study involving adults-the informed consent requirement was waived. Enhanced computed tomography (CT) findings of 32 consecutive adnexal torsion and 32 control patients admitted for abdominal pain and presenting with an adnexal mass were independently reviewed by two radiologists, with consensus by a third one, for all CT findings commonly assessed in adnexal torsion. All twisted and untwisted adnexa were confirmed by surgery. Univariate and multivariate analyses were performed for adnexal torsion prediction. RESULTS: The median patient age was 41 years (interquartile range, 30.5-62 years). Only benign masses were encountered in the torsion group. Five CT features were significantly associated with adnexal torsion: a large ovary with a threshold at 80mm (p=0.005), median or contralateral displacement of the adnexa (p=0.00014), asymmetric wall thickening of the mass (p<0.0001), inter-utero-ovarian mass (p<0.0001) and whirlpool sign (p=0.0006). In the multivariate analysis, only the inter-utero-ovarian mass was independently associated with adnexal torsion (odds ratio=130 (CI95%: 15-infinite), p<0.0001) with an excellent overall diagnostic performance (AUC=0.89; CI95%: 0.81-0.97). It was a sensitive (Se=97%, CI95%: 84-100) and specific feature (Sp=81%, CI95%: 64-93). CONCLUSION: An inter-utero-ovarian mass is an accurate and reliable CT finding for diagnosing adnexal torsion in patients with acute abdominal pain and an adnexal mass.