Magnetic resonance imaging of uterine fibroids: a preliminary investigation into the usefulness of 3D-rendered images for surgical planning.

PURPOSE: This study aimed to assess the efficacy of 3D surface-rendered (SR) magnetic resonance (MR) images for surgical planning of uterine fibroids. METHODS: Ten patients with uterine fibroids underwent 3D volume isotropic turbo spin-echo acquisition (VISTA) sequences in sagittal planes. SR images showing the uterine body, endometrium, and fibroids were extracted from the raw MR data. The preoperative assessment for fertility-preserving fibroid enucleation was independently performed by two gynecologists using 2D sagittal and 3D SR images separately. RESULTS: The required interpretation times [second] for sagittal versus SR images were 19.7 ± 9.5 versus 10.4 ± 5.1 for observer 1 (p < 0.05) and 47.5 ± 12.3 versus 19.7 ± 9.5 for observer 2 (p < 0.01). The accuracy rates of the planned surgical procedures from sagittal versus SR images were 50 versus 70% for observer 1 and 70 versus 70% for observer 2. The accuracy rates of the numbers of fibroids to be removed from sagittal versus SR images were 70 versus 80% for observer 1 and 70 versus 80% for observer 2. CONCLUSION: Compared with sagittal images, SR images could significantly reduce the time required for surgical planning of uterine fibroids without sacrificing the accuracy of the preoperative assessment.

Exploratory study of pre-surgical medications with dienogest or leuprorelin in laparoscopic cystectomy of endometrial cysts.

AIM: The aim of this study was to compare the effects of pre-surgical medication with dienogest or leuprorelin on post-surgical ovarian function. MATERIAL AND METHODS: We conducted an exploratory study in two centers in Japan that comprised 30 patients with ovarian endometrial cysts for whom surgical excision was planned. Patients were enrolled and divided into pre-surgical medication groups with dienogest or leuprorelin for 12 weeks. Thereafter, patients were treated by laparoscopic cystectomy. The primary outcome was ovarian function post-surgery, as assessed by serum anti-Müllerian hormone (AMH) level, antral follicle count (AFC) and resumption of menses. Secondary outcome was the effect of pre-surgical medication, as assessed by the size of endometrial cysts and visual analog scale (VAS) score. Serum AMH, AFC, size of endometrial cysts, and VAS scores were measured at baseline (before medication), after medication (1 day before surgery), and at 4 and 12 weeks post-surgery. RESULTS: Serum AMH levels did not change after pre-surgical medication with either dienogest or leuprorelin. Although AMH decreased after surgery, it recovered by 12 weeks post-surgery in both groups with no statistically significant difference. Mean AFC did not change after surgery in either group. Menses returned by 12 weeks post-surgery in all patients except for those who were pregnant. The rate of reduction of endometrial cyst volume did not differ between the groups. Both dienogest and leuprorelin were associated with substantial reductions in VAS scores. CONCLUSION: There were no statistically significant differences between pre-surgical medication with dienogest and leuprorelin in post-surgical ovarian function. Both medications were effective in reducing endometrial cyst volume and VAS score.

Diffusion-weighted imaging of ovarian torsion: usefulness of apparent diffusion coefficient (ADC) values for the detection of hemorrhagic infarction.

PURPOSE: We undertook this study to evaluate the need for diffusion-weighted (DW) magnetic resonance (MR) imaging in detecting hemorrhagic infarction following ovarian torsion. METHODS: The study included 14 consecutive patients aged 12 to 74 years (average age, 36 years) with surgical confirmation of ovarian torsion who underwent 1.5-tesla MR imaging. Pathologically, hemorrhagic infarction was found in 7 patients. We retrospectively reviewed signal intensity on T1-, T2-, and diffusion-weighted images and apparent diffusion coefficients (ADCs) in swollen ovarian stroma. RESULTS: Fallopian tube thickening was seen in all patients. In patients with ovarian cystic lesion, maximum cyst wall thickness was significantly higher in patients with hemorrhagic infarction (mean, 13.5 ± 4.1 mm) than those without (mean, 5.0 ± 1.0 mm) (P < .05). Signal intensity did not differ significantly on T1-weighted, T2-weighted, and DW images between patients with and without hemorrhagic infarction. ADCs were significantly lower in patients with hemorrhagic infarction (1.20 ± 0.50 [× 10(-3) mm(2)/s]) than those without (2.04 ± 0.26 [× 10(-3) mm(2)/s]) (P < .01). With an ADC threshold of 1.80 [× 10(-3) mm(2)/s], sensitivity for hemorrhagic infarction was 0.88 (7 of 8), and specificity was 1.00 (6 of 6). CONCLUSION: ADC measurements were useful for detecting hemorrhagic infarction in patients with ovarian torsion.

Ovarian fibromas: MR imaging findings with emphasis on intratumoral cyst formation.

PURPOSE: The purpose of this study was to assess MR imaging findings of ovarian fibromas with emphasis on intratumoral cyst formation. MATERIALS AND METHODS: MR images with a 1.5-T unit obtained in 17 consecutive patients (age range, 18-87 years; mean age, 58 years) with 17 histologically proven ovarian fibromas were retrospectively reviewed for the size, configuration, signal intensity of solid components, and presence of cystic degeneration and edema within tumor. Size, number, and location of intratumoral cysts were also assessed. RESULTS: The maximum diameter of tumors ranged from 3.3 to 19.1cm (mean, 10.9 cm). Seven (41%) tumors were multinodular. On T2-weighted images, solid components of tumors were heterogeneously mixed hypo- and hyperintensity in 16 (94%) tumors. Nine (53%) tumors demonstrated cysts and 16 (94%) demonstrated edema within tumor. The maximum diameter of the largest cysts ranged from 1.0 to 13.2 cm (mean, 6.4 cm), and the number of cysts per tumor ranged from 1 to 60 (mean, 15.6). Of the nine tumors with cystic formation, the predominant location of the cysts was peripheral in five (56%), exophytic in two (22%), central (11%) in one, and diffuse in one (11%). CONCLUSION: Peripheral or exophytic cyst formation may be characteristic MR imaging features with ovarian fibromas.

Anatomic variation of the celiac trunk with special reference to hepatic artery patterns.

Based on a large homogeneous sample from a Japanese population, anatomic variations in the celiac trunk (CT) and the hepatic artery were studied. Previously we analyzed the branching mode of the CT in 450 Japanese cadavers. In order to maximize the database on the CT and hepatic artery, we examined the anatomy of these arteries in 524 cadavers, a total of 974 cases. A total of 89.8% of cases showed the classical trifurcation of the CT. The typical normal pattern of the CT and the hepatic artery was confirmed in 66.6% and 72.4% of the cadavers, respectively. Variant left and right hepatic arteries were observed in 11.0% and 4.9%, respectively. A variant anatomy involving both the left and right hepatic arteries was found in 1.5%. A common hepatosplenic trunk and a gastrohepatic trunk were seen in 4.4% and 0.3%, respectively. A common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) or directly from the aorta was present in 3.5% or 0.5%, respectively. A hepatosplenomesenteric trunk and a celiomesenteric trunk were encountered in 0.7%, respectively. This anatomical update of the CT and the hepatic artery can be useful for transplantation and general surgeons, as well as vascular radiologists in this area.

Comparative effects of milk and soymilk on bone loss in adult ovariectomized osteoporosis rat.

The present study was designed to investigate the comparative effects of milk and soymilk on the bone morphology of ovariectomized rat model with postmenopausal osteoporosis. Fourty 12-week-old female Spraque-Dawley rats were randomly divided into the following 5 groups: intact control (control), sham-operated (sham), ovariectomized (OVX), ovariectomized and fed milk (milk), ovariectomized and fed soymilk (soymilk) groups. Rats of OVX, milk and soymilk groups were bilaterally ovariectomized. Milk or soymilk of 3 ml was administered by gavage via an intragastric tube per day for 6 weeks. The distal femoral metaphysis was studied morphologically, together with bone mineral density (BMD), serum parathyroid hormone (PTH) and estradiol levels. In the OVX group, the trabecular bone volume was significantly reduced. The percentage area of resorbing surface was high. In the soymilk group, the trabecular bone volume was 68% higher and the percentage area of resorbing surface was 18% lower as compared with the OVX group. The serum estradiol level rose 48% and the serum PTH level fell 26% in the soymilk group. In the milk group, the trabecular bone volume had the tendency to be high, but there was no significant change of the bone morphology. The present study provides certain evidence that the soymilk has beneficial effects in preventing bone loss in rats induced by ovarian hormone deficiency.