CT and MRI features following Uterine Fibroid Embolization

Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE associated common and uncommon MRI and CT appearances and discuss post UAE complications that requires urgent medical or surgical intervention Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE associated common and uncommon MRI and CT appearances and discuss post UAE complications that requires urgent medical or surgical intervention

Legal Aspects of Obstetric Sonography.

PIP:The combination of rapid innovation and high risk obstetric sonography has resulted in increased potential for litigation: 80% of suits in sonography are obstetric-related. These suits come under the category of tort law, where damages are sought to compensate those whose interests have been harmed. To win a claim the plaintiff must prove that a legal duty has been breached, that damages have been incurred, and that the breach was the legal as well as the actual cause of the damage. Although it is not possible to claim that the radiologist caused the damage, damages to a living being, the fetus, are being awarded for several types of claims. Wrongful pregnancy claims are being awarded costs of the pregnancy and childbirth in cases of failed sterilization or abortion. Wrongful birth suits arise from negligent genetic counseling when the infant is born defective, and the anomalies are diagnosable but overlooked. Wrongful life suits, brought by the defective individual, are controversial for their large monetary awards, as well as the ethical question whether impaired life is better than no life at all. Only 4 states recognize these claims. Wrongful death suits are applicable where therapy under sonographic guidance causes death of the fetus. Agency law applies where an error is committed by a technologist in a radiologist\u27s employ. It is recommended that the radiologist follow American College of Radiology guidelines for fetal surveys; obtain follow-up or a 2nd opinion in case of an abnormality; keep written notes of normal fetal structures; keep abreast of local case law and legislation; rescan patients after the technologist\u27s exam; and document and report promptly all normal and abnormal findings