Placental magnetic resonance imaging: normal appearance, anatomical variations, and pathological findings.

Placental magnetic resonance imaging (MRI) has been increasingly requested, especially for the evaluation of suspected cases of placental adhesive disorders, generally known as placenta accreta. Abdominal radiologists need to become familiar with normal placental anatomy, anatomical variations, the current terminology, and major placental diseases that, although rare, are important causes of maternal and fetal morbidity and mortality. The aim of this didactic pictorial essay is to illustrate various findings on placental MRI, as well as to emphasize the importance of communication between radiologists and obstetricians in the search for best practices in the management of the affected patients.

A ressonância magnética placentária tem sido cada vez mais solicitada, sobretudo na avaliação de casos suspeitos de acretismo. Os radiologistas abdominais precisam se familiarizar com a anatomia placentária normal, variações anatômicas, terminologias atuais e principais doenças placentárias que, embora raras, são causas importantes de morbimortalidade materno-fetal. O objetivo deste ensaio é ilustrar, de maneira didática, diferentes achados placentários e enfatizar a importância da comunicação entre radiologistas e obstetras na busca da melhor conduta para as pacientes.

Placental magnetic resonance imaging: normal appearance, anatomical variations, and pathological findings / Ressonância magnética placentária: aspecto normal, variações anatômicas e achados patológicos

Abstract Placental magnetic resonance imaging (MRI) has been increasingly requested, especially for the evaluation of suspected cases of placental adhesive disorders, generally known as placenta accreta. Abdominal radiologists need to become familiar with normal placental anatomy, anatomical variations, the current terminology, and major placental diseases that, although rare, are important causes of maternal and fetal morbidity and mortality. The aim of this didactic pictorial essay is to illustrate various findings on placental MRI, as well as to emphasize the importance of communication between radiologists and obstetricians in the search for best practices in the management of the affected patients.

Resumo A ressonância magnética placentária tem sido cada vez mais solicitada, sobretudo na avaliação de casos suspeitos de acretismo. Os radiologistas abdominais precisam se familiarizar com a anatomia placentária normal, variações anatômicas, terminologias atuais e principais doenças placentárias que, embora raras, são causas importantes de morbimortalidade materno-fetal. O objetivo deste ensaio é ilustrar, de maneira didática, diferentes achados placentários e enfatizar a importância da comunicação entre radiologistas e obstetras na busca da melhor conduta para as pacientes.

Performance of imaging interpretation, intra- and inter-reader agreement for diagnosis of pelvic endometriosis: comparison between an abbreviated and full MRI protocol.

PURPOSE: To compare the performance of imaging interpretation, intra- and inter-reader agreement between an abbreviated (aMRI) and full (fMRI) MRI protocol for diagnosis of pelvic endometriosis. METHODS: Seventy consecutive fMRI exams performed under suspicion of pelvic endometriosis were selected. Four radiologists (Rd) (1-10 years experience) independently evaluated presence/absence of endometriosis at 9 anatomic sites (AS). The readers evaluated aMRI (coronal T2 TSE volumetric images and axial T1 GRE fat-sat without contrast, extracted from fMRI) and fMRI protocols randomly, with at least 4 weeks interval between readings. The degree of confidence for diagnosis at each AS was evaluated with a 1-3 Likert Scale (1: low; 3: high). Intra- and inter-reader agreement between protocols were evaluated by kappa statistics and took reading experience into account. The gold standard for assessing the performance of imaging interpretation (sensitivity, specificity and accuracy) used a consensus reading of two other Rd (> 15 years experience). RESULTS: There was no significant difference in the accuracy of imaging interpretation between the abbreviated (0.83-0.86) and full (0.83-0.87) protocols (p = 0.15). Intra-reader agreement between protocols ranged from substantial to almost perfect (0.74-0.96). A substantial inter-reader agreement was found for both protocols for readers with similar levels of experience (0.67-0.69) and in the global analysis (0.66 for both protocols). No difference was found in terms of degree of confidence between protocols, for all readers. CONCLUSION: An abbreviated MRI protocol for pelvic endometriosis provided an accuracy of interpretation comparable to that of a complete protocol, with similar degrees of confidence and reproducibility, regardless the level of experience.

Placental adhesion disorder: magnetic resonance imaging features and a proposal for a structured report.

Placental adhesion disorder encompasses the various types of abnormal placentation that occur when the chorionic villi penetrate the uterine wall. Placenta accreta has become more common, mainly because of the increasing rates of cesarean section. Although ultrasound is the first-line imaging modality for evaluation of the placenta, it plays a limited role in cases of posterior placenta accreta and inconclusive findings. In such cases, magnetic resonance imaging (MRI) is indicated, mainly because it is a more accurate means of identifying placental invasion of extrauterine structures in high-risk pregnant women. In this review article, we present the ten major and minor MRI features of placental adhesion disorder, as described in the international literature. In addition, we propose a template for structured reports of MRI examinations of the placenta. We have also devised a guided questionnaire in order to identify risk factors in patients scheduled to undergo such examinations, with the objective of facilitating the multidisciplinary treatment planning needed in order to minimize maternal morbidity and mortality.

A desordem de adesão placentária é um tipo de placentação anormal que ocorre quando há penetração das vilosidades coriônicas na parede uterina. O acretismo placentário tornou-se mais frequente, principalmente devido às taxas crescentes de cesarianas. A ultrassonografia é a modalidade de imagem de primeira linha para avaliação placentária, apresentando papel limitado nos casos de placenta posterior e achados duvidosos. Nesses casos, a ressonância magnética (RM) está indicada e é bastante eficaz, principalmente para identificar a disseminação extrauterina da placenta em gestantes de alto risco. Neste artigo de revisão apresentamos os dez principais sinais de desordem de adesão placentária pela RM descritos na literatura. Junto a isso, propomos um modelo de relatório estruturado e um questionário direcionado com o intuito de identificar os possíveis fatores de risco da paciente a ser submetida ao exame de RM da placenta, atendendo às expectativas dos especialistas envolvidos no planejamento do tratamento multidisciplinar necessário para minimizar a morbimortalidade materna.

Placental adhesion disorder: magnetic resonance imaging features and a proposal for a structured report / Desordem de adesão placentária: sinais na ressonância magnética e proposta de laudo estruturado

Abstract Placental adhesion disorder encompasses the various types of abnormal placentation that occur when the chorionic villi penetrate the uterine wall. Placenta accreta has become more common, mainly because of the increasing rates of cesarean section. Although ultrasound is the first-line imaging modality for evaluation of the placenta, it plays a limited role in cases of posterior placenta accreta and inconclusive findings. In such cases, magnetic resonance imaging (MRI) is indicated, mainly because it is a more accurate means of identifying placental invasion of extrauterine structures in high-risk pregnant women. In this review article, we present the ten major and minor MRI features of placental adhesion disorder, as described in the international literature. In addition, we propose a template for structured reports of MRI examinations of the placenta. We have also devised a guided questionnaire in order to identify risk factors in patients scheduled to undergo such examinations, with the objective of facilitating the multidisciplinary treatment planning needed in order to minimize maternal morbidity and mortality.

Resumo A desordem de adesão placentária é um tipo de placentação anormal que ocorre quando há penetração das vilosidades coriônicas na parede uterina. O acretismo placentário tornou-se mais frequente, principalmente devido às taxas crescentes de cesarianas. A ultrassonografia é a modalidade de imagem de primeira linha para avaliação placentária, apresentando papel limitado nos casos de placenta posterior e achados duvidosos. Nesses casos, a ressonância magnética (RM) está indicada e é bastante eficaz, principalmente para identificar a disseminação extrauterina da placenta em gestantes de alto risco. Neste artigo de revisão apresentamos os dez principais sinais de desordem de adesão placentária pela RM descritos na literatura. Junto a isso, propomos um modelo de relatório estruturado e um questionário direcionado com o intuito de identificar os possíveis fatores de risco da paciente a ser submetida ao exame de RM da placenta, atendendo às expectativas dos especialistas envolvidos no planejamento do tratamento multidisciplinar necessário para minimizar a morbimortalidade materna.

Common and Uncommon Benign Pancreatic Lesions Mimicking Malignancy: Imaging Update and Review.

There is a broad range of inflammatory, pseudotumoral, and benign lesions that may masquerade as pancreatic malignancies, often representing a challenge to the radiologist. Unawareness of these entities can lead to inadequate differential diagnoses or misdiagnosis, with important prognostic and therapeutic consequences. The purpose of this article is to revisit a spectrum of lesions, varying from common to exceedingly rare nonmalignant, that may mimic malignant pancreatic neoplasms on imaging, identifying relevant features that may contribute to reaching the correct diagnosis. Representative cases include focal fatty replacement, intrapancreatic accessory spleen, pancreatic lobulation, lipoma, autoimmune pancreatitis, focal pancreatitis, eosinophilic pancreatitis, groove pancreatitis, hemangioma, intrapancreatic aneurysm, tuberculosis, and Castleman's disease.

Translabial US and Dynamic MR Imaging of the Pelvic Floor: Normal Anatomy and Dysfunction.

Pelvic floor dysfunction (PFD) is a common condition that typically affects women older than 50 years and decreases the quality of life. Weakening of support structures can involve all three pelvic compartments and cause a combination of symptoms, including constipation, urinary and fecal incontinence, obstructed defecation, pelvic pain, perineal bulging, and sexual dysfunction. The causes of PFD are complex and multifactorial; however, vaginal delivery is considered a major predisposing factor. Physical examination alone is limited in the evaluation of PFD; it frequently leads to an underestimation of the involved compartments. Imaging has an important role in the clinical evaluation, yielding invaluable information for patient counseling and surgical planning. Three- and four-dimensional translabial ultrasonography (US) is a relatively new imaging modality with high accuracy in the evaluation of PFD such as urinary incontinence, pelvic organ prolapse, and puborectalis avulsion. Evaluation of mesh implants is another important indication for this modality. Dynamic magnetic resonance (MR) imaging of the pelvic floor is a well-established modality for pelvic floor evaluation, with high-resolution images yielding detailed anatomic information and dynamic sequences yielding functional data. Specific protocols and dedicated image interpretation are required with both of these imaging methods. In this article, the authors review the normal anatomy of the female pelvic floor by using a practical approach, discuss the roles of translabial US and MR imaging in the investigation of PFD, describe the most appropriate imaging protocols, and illustrate the most common imaging findings of PFD in the anterior, middle, and posterior compartments of the pelvis. Online supplemental material is available for this article. ©RSNA, 2018.

Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy.

Endometriosis is a common multifocal gynecologic disease that manifests during the reproductive years, often causing chronic pelvic pain and infertility. It may occur as invasive peritoneal fibrotic nodules and adhesions or as ovarian cysts with hemorrhagic content. Although findings at physical examination may be suggestive, imaging is necessary for definitive diagnosis, patient counseling, and treatment planning. The imaging techniques that are most useful for preoperative disease mapping are transvaginal ultrasonography (US) after bowel preparation, and magnetic resonance (MR) imaging. Initial transvaginal US is a reliable technique for detecting rectosigmoid endometriotic lesions. MR imaging is indicated as a complementary examination in complex cases of endometriosis with extensive adhesions and ureteral involvement. Peritoneal endometriotic implants are typically hypoechoic on transvaginal US images and demonstrate low signal intensity on T2-weighted MR images. Endometriotic implants most commonly are found in retrocervical and rectosigmoid sites, followed by the vagina, bladder, and ureters. Cysts with low-level internal echoes and echogenic peripheral foci at transvaginal US are suggestive of endometriomas. MR imaging has high specificity for identifying endometriomas, which are characterized by high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Correlation of the radiologic imaging features of endometriotic lesions with their laparoscopic appearances may help improve individual proficiency in the radiologic diagnosis of endometriosis.

Helminthic diseases in the abdomen: an epidemiologic and radiologic overview.

Helminthic diseases have a worldwide distribution. They affect billions of people in endemic areas and can result in serious clinical complications. Some parasites have a human gastrointestinal life cycle with resultant abdominal manifestations. However, the symptoms of helminthic diseases are usually nonspecific. Radiologic imaging, along with the identification of risk factors, may help narrow the differential diagnosis. To avoid diagnostic delays, radiologists should be familiar with the geographic distribution, transmission cycle, and characteristic and atypical manifestations of common helminthic diseases at abdominal imaging with radiography, computed tomography, magnetic resonance imaging, and ultrasonography. Awareness of the clinical, epidemiologic, and pathogenic characteristics of these diseases also may be helpful for narrowing the diagnosis when imaging features are nonspecific.

Contribuição da ressonância magnética na avaliação de doadores do lobo direito ao transplante hepático / Contribution of magnetic resonance in the evaluation of donors for right lobe living liver transplantation

Este estudo teve, por finalidade, estabelecer o valor da ressonância magnética em 30 doadores potenciais do lobo direito do fígado, na determinação dos seguintes fatores: esteatose hepática; anatomia biliar; anatomias arterial hepática, venosas portal e hepática, e volume hepático lobar, comparando-os, respectivamente, com os achados anatomopatológicos da biópsia hepática, da colangiografia intraoperatória, da angiografia digital e/ou com os achados cirúrgicos, e com o peso real do enxerto. A RM subestimou a infiltração gordurosa hepática; permitiu identificar a anatomia biliar, com concordância em 83 por cento dos casos; apresentou 100 por cento de concordância na avaliação das anatomias arterial e venosas portal e hepática, e superestimou, em pequeno grau, o volume hepático lobar /The purpose of this study was to establish the value of the magnetic resonance in 30 potential donors for right lobe living liver transplantation. The main goal was to determine the following factors: steatosis; biliar anatomy; hepatic arterial anatomy; portal and hepatic venous anatomy, and lobar liver volume, comparing them to liver biopsy results, to intraoperative colangiography, to digital angiography and/or surgical findings, and to the real graft weight, respectively. The MR has underestimated liver steatosis; it has identified biliar anatomy with 83 per cent of agreement; it has had 100 per cent of agreement in the evaluation of arterial and portal and hepatic venous anatomy, and it has overestimated with small degree the lobar liver volume...

Preoperative imaging of donor patients for adult right-lobe liver transplantation.

A major discrepency exists between the number of available cadaveric livers and patients requiring liver transplants, which has resulted in the innovative procurement of liver segments taken from healthy donors being implanted into cirrhotic patients. Most recently, liver surgeons have started resecting the entire right lobe (segments V-VIII) from healthy adult donor livers, and implanting these segments into recipients where the graft is able to sustain and maintain metabolic function and fully regenerate.

Analise dos fatores de risco para o desenvolvimento de infeccao puerperal / Risk factors for puerperal infection

Os autores procuraram determinar os fatores de risco para o desenvolvimento de infeccao puerperal em um hospital geral de atendimento regionalizado. Durante o periodo de julho de 1989 a dezembro de 1990 foram registrados 145 casos de infeccao puerperal em 5234 partos realizados. Os dados destas pacientes, bem como de um grupo composto de 145 pacientes foram analisados retrospectivamente. O parto cesarea, primiparidade, rotura prematura de membranas ovulares e o tempo de rotura de membranas encontravam-se significativamente aumentados nas pacientes que desenvolveram infeccao puerperal...

Criterios diagnosticos de infeccao puerperal em pacientes submetidas a antibioticoterapia profilatica / Diagnostic criteria of puerperal infections in patients submited to profilatic antibiotictherapy

Os autores avaliaram retrospectivamente a sensibilidade e especificidade dos criterios clinicos e laboratoriais utilizados no diagnostico de infeccao puerperal em 145 pacientes, bem como as intercorrencias durante o puerperio em um grupo controle composto por 145 puerperas que nao desenvolveram infeccao puerperal. Dados sugestivos de infeccao puerperal ao exame fisico foram observados em 92,4 por cento das pacientes que desenvolveram infeccao, sendo que nas pacientes com endometrite e infeccao do trato urinario o exame fisico apresentou menos elementos do que o habitualmente descrito...

Avaliacao de uma nova classificacao do risco de contaminacao em procedimentos obstetricos / Evaluation of a new classification of contamination risk for obstetric procedures

Foram comparadas duas formas de administracao de antibioticos, orientadas por duas classificacoes distintas do risco de contaminacao em procedimentos obstetricos. O estudo inclui 3347 pacientes submetidas a procedimentos obstetricos durante o ano de 1990. Observou-se uma reducao significativa do indice de infeccao puerperal de 6,72 para 2,59 por cento com a introducao de uma classificacao mais rigorosa do risco de contaminacao e de antibioticoterapia profilatica. Os autores concluem que a utilizacao profilatica de antibioticos orientada por uma classificacao rigorosa do risco de contaminacao em procedimentos obstetricos foi eficiente na reducao do indice de infeccao puerperal.