A survey of pelvic types on computed tomography images.

BACKGROUND: In the medical literature several classifications of the pelvis according to its shape can be found. The most common classification distinguishes four general pelvis types: gynecoid, android, anthropoid and platypelloid. Natural childbirth may be significantly prolonged, difficult or even impossible if the pelvis shape is not in proportion to the size of the fetus. The objectives of our study were to calculate major diameters and conjugate diameters of the female bony pelvic ring and to determine the major pelvic types according to their shape. Based on the parameters obtained, we aimed to establish a relationship between some pelvic types and difficult childbirth. METHODS: The study was prospective in design and included 54 female subjects of various ages who had been referred for computed tomography of the pelvis, as part of the diagnosis of an underlying condition. In each patient, five most important parameters in two planes were measured and the pelvic type was determined by using the brim index and a special formula for android type. All measurements were performed using the Vue PACS v 12.1.6.1005 program. The description of the pelvic inlet was used to confirm all pelvic types. Data on previous births were taken from the questionnaire filled out by the subjects during the radiological examination. RESULTS: Gynecoid pelvic type was the most common in our sample (28 pelvises - 52%), followed by platypelloid type (11 pelvises - 20%), anthropoid type (8 pelvises - 15%) and finally android type (7 pelvises - 13%). There was a statistically significant difference in the diameter bispinous length (p < 0.05) between the platypelloid and anthropoid pelvic types. Pathological degree of stenosis was present in seven pelvises (the first degree in six pelvises and the second degree in one pelvis). The frequency of cesarean section was 31.82% and this technique was most frequently used in the subjects with a gynecoid pelvic type. The duration of natural labor ranged from 4 to 18 h. There was no statistically significant difference in the duration of labor between subjects with different pelvic types. CONCLUSIONS: Gynecoid pelvic type was present in more than half of our subjects. Although this type is considered ideal for labor, we have not established that it has a great influence on whether the labor will be performed naturally or by cesarean section, neither that it significantly affects the length of birth. The gross narrowing of the pelvic ring is present in non-gynecoid pelvic types. The data obtained will certainly be useful to the obstetrician when planning the labor and considering all the factors that may affect the course of birth.

Vulvar cancer staging: guidelines of the European Society of Urogenital Radiology (ESUR).

OBJECTIVE: The aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging staging guidelines for vulvar cancer and to propose standardised MRI protocols and reporting. METHODS: The guidelines recommended from the ESUR in this article resulted from a questionnaire analysis regarding imaging staging of vulvar cancer that was answered by all members of the Female Pelvic Imaging Working Group. Only the answers with an agreement equal to or more than 80% were considered. Additionally, the literature was reviewed to complement and further support our conclusions. RESULTS: The critical review of the literature and consensus obtained among experts allows for recommendations regarding imaging staging guidelines, patient preparation, MRI protocol, and a structured MRI report. CONCLUSIONS: Standardising image acquisition techniques and MRI interpretation reduces ambiguity and ultimately improves the contribution of radiology to the staging and management of patients with vulvar cancer. Moreover, structured reporting assists with the communication of clinically relevant information to the referring physician.

Multislice computed tomography urography in the diagnosis of urinary tract diseases.

BACKGROUND/AIM: . Multislice computed tomography (MSCT) has triggered considerable changes in uroradiological imaging. The aim of this study was to establish the place of MSCT urography (MSCTU) in comparison with intravenous urography (IVU) and to determine the sensitivity and specificity of MSCT in the evaluation of urothelial abnormalities. METHODS: This prospective study included 120 patients with a high clinical suspicion of urinary tract diseases divided into two groups. The group I consisted of 60 patients with macroscopic hematuria, bladder carcinoma and malignant pelvic tumors after radiotherapy or operation. They underwent both IVU and MSCTU. The group II included 60 patients (> or = 40 years old) with retroperitoneal and malignant pelvic tumors, complicated pyelonephritis, microscopic hematuria, acute urinary tract obstruction (without visible calculi on unenhanced scans), and they were submitted to computed tomography with additional scan phase enabling MSCTU. RESULTS: Compared with IVU, MSCTU is more sensitive for the detection of urinary tract diseases (parenchymal changes, renal tumors, urolithiasis, fibrosis) and extraurinary processes. MSCTU is more specific than IVU for renal parenchymal abnormalities, tumors of the excretory system, urolithiasis, bladder tumors, fibrosis and extraurinary diseases. MSCTU is equally sensitive, but more specific for hydronephrosis compared to MSCT. The diagnosis made by the use of MSCTU in patients with macroscopic and microscopic hematuria and with obstruction not caused by stones, perfectly comply with operative findings and histological diagnosis. CONCLUSION: The obtained results support MSCTU to be the modality of choice in the diagnostic algorithm of patients with macroscopic hematuria and in the evaluation of microscopic hematuria and unexplained obstruction of the urinary tract. The only remaining role for IVU in our institution is imaging of the upper urinary tract in patients with hematuria under the age of 40.