Accuracy of magnetic resonance imaging in diagnosis of deeply infiltrating endometriosis

Objective: To determine the accuracy of MRI and diffusion weighted images in the diagnosis of deep infiltrating endometriosis (DIE). Patients and methods: This study included 72 patients (mean age, 28 years; range, 17–41 years). Inclusion criteria were patients who: (a) had a history of symptoms consistent with endometriosis, such as pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and infertility; (b) had a pelvic examination revealing thickening of the posterior cul-de-sac and/or nodules; (c) had transvaginal ultrasound showing ovarian cysts with thickened low amplitude echoes. Exclusion criteria were the common contraindications to MRI (pacemaker, metallic foreign bodies, and claustrophobia). MRI was performed using a GE Signa 1.5 T MRI system and no contrast medium was used for imaging. Results: In 70/72 patients, DIE was confirmed at surgery and histopathologic examination. 36/72 (50%) patients had endometriotic nodules infiltrating the rectouterine pouch and rectum, 24/72 (33%) the vesicouterine pouch, 6/72 (8.3%) the urinary bladder and 6/72 (8.3%) the anterior abdominal wall. 20/72 patients (27%) had endometrioma correlating with DIE and another 8/72 (11%) had also adenomyosis. Conclusion: In conclusion, preoperative MRI is an excellent tool to provide a reasonably accurate mapping of multiple sites of pelvic endometriosis with high accuracy

Added values of diffusion weighted imaging, Dynamic contrast enhancement and opposed phase MRI in evaluation of bony lesions around the knee & ankle joints

Background: Magnetic resonance imaging (MRI) represents the most advanced imaging technique in diagnosis of bone tumors being more sensitive in assessing bone marrow changes and extent of tumors compared to CT and plain X-ray. The distinction between malignant and benign neoplasms is mandatory for appropriate therapeutic choices and planning. MRI has the upper hand in the assessment of such tumors due to its brilliant soft tissue discrimination. The use of multiparametric MRI techniques increase accuracy of discrimination between malignant and benign lesions. Results: This prospective study included 34 patients; 16 males and 18 females with musculoskeletal complaint around the knee & ankle joints. Their age ranged from 10 to 65 years (mean age was 26.65 ± 17.23 years). The cut off value of ADC for bony lesions (by ROC curve) was ≤ 1 to be considered malignant. At this cut off point; the sensitivity of ADC to detect malignant and to exclude benign lesions was 83.3 % and the specificity was 86.4 %. The cut off value for SIR for bony lesions (by ROC curve) was ≥ 0.89 to be considered malignant.&nbsp

Magnetic resonance imaging for diagnosis of pelvic lesions associated with female infertility

Objective: To study the mandatory indications and accuracy of magnetic resonance (MR) imaging for diagnosis of pelvic lesions associated with female infertility. Design: Prospective cross-sectional study. Main outcome measures: Indications and accuracy of MR imaging for diagnosis of pelvic lesions. Uterovaginal lesions were excluded as they were studied in a previous article (under publication). Materials and methods: 423 infertile women were investigated by hysterosalpingography (HSG), transabdominal and transvaginal ultrasonography after thorough clinical examination. Hundred and thirty (30.95%) patients were associated with pelvic lesions not conclusively diagnosed by HSG or/and ultrasonography and were examined by MR imaging to confirm the diagnosis. Fifty-four patients (41.53%) had uterovaginal lesions. They were discussed in a previous article. Seventy-six (58.46%) patients had other pelvic lesions. The present study concerned with these lesions. Results: The diagnosis by MR imaging was conclusive for 11 cases of pyosalpinx, 3 cases of hematosalpinx, 25 cases of hydrosalpinx, 24 cases of ovarian endometriomas, deep endometriosis of the of rectosigmoid (3 cases), urinary bladder (3 cases), one case of endometriosis of the abdominal wall after repeated cesarean sections and six ovarian tumors, 5 cases of benign cystic teratoma and 1 case of serous cystadenocarcinoma. The diagnosis of these lesions was confirmed by laparoscopy or laparotomy and histopathological examination. Magnetic resonance imaging failed to diagnose peritubal adhesions in 22 out of 39 cases (56.41%) of tubal lesions and peritoneal implants of endometriosis in 12 out of 31cases (38.70%) of pelvic endometriotic lesions. They were discovered during the surgical treatment of the tubal and ovarian lesions through laparoscopy or laparotomy. Conclusion: The following pelvic lesions associated with female infertility were not conclusively diagnosed by HSG or/ and US but were precisely diagnosed by MR imaging with 100% accuracy: Pyosalpinx, hydrosalpinx and hematosalpinx, ovarian and deep infiltrating endometriosis and benign and malignant ovarian tumors as benign cystic teratoma and serous cystadenocarcinoma

Magnetic resonance imaging of uterovaginal lesions associated with female infertility

Objective: To study the mandatory indications and accuracy of magnetic resonance (MR) imaging for the diagnosis of uterovaginal lesions associated with female infertility. Design: Prospective cross sectional study. Main outcome measures: Indications and accuracy of MR imaging for the diagnosis of uterovaginal lesions. Materials and methods: 423 infertile women were investigated by hysterosalpingography (HSG) and transvaginal ultrasonography (TVUS). In 54 women having uterovaginal lesions and 76 women with tubo-ovarian lesions, the diagnosis was not conclusive by HSG and TVUS and consequently they were examined by MR imaging. The present study was devoted for infertile women suffering from uterovaginal lesions. Results: MR imaging confirmed the diagnosis of agenesis of the uterus and the vagina (1 case), unicornuate uterus (2 cases, functioning rudimentary horn connected to the dominant horn in 1 case), uterus didelphys (1 case), bicornuate uterus (5 cases), septate and subseptate uteri (10 cases). Eighteen patients had multiple corporeal leiomyomas, 8 subserous and 10 intramural, diffuse adenomyosis, 14 cases and localized adenomyoma, 3 cases. Intramural leiomyomas showed enhancement on T2-weighted imaging suggesting a good response to uterine artery embolization (UAE). The size, number and location of myomas were precisely demonstrated on MR imaging, information necessary for myomectomy and UAE. The findings of MR imaging were compared with the final diagnosis after laparoscopy or surgical intervention and histopathological study. The accuracy, sensitivity, specificity, and positive and negative predictive values of MR imaging for diagnosing uterovaginal lesions associated with infertility were 100%. Conclusion: The present study proved that MR imaging was the method of choice for precise diagnosis of uterovaginal lesions associated with infertility, when the diagnosis was not conclusive on HSG and TVUS. MR imaging was mandatory for conclusive diagnosis of mullerian duct anomalies, adenomyosis uteri and multiple uterine leiomyomas destined to myomectomy or uterine artery embolization. The accuracy, sensitivity, specificity and positive and negative predictive values of MR imaging for diagnosis of these lesions were 100%

Uterine leiomyomas embolization with magnetic resonance imaging follow up

Introduction: Uterine artery embolization (UAE) has been used to treat symptomatic uterine leiomyomas, as women choose to preserve their uterus, uterus sparing techniques such as UAE have been developed. Magnetic resonance imaging (MRI) sequence signal characteristics and the degree of leiomyoma enhancement may be used to predict the response of leiomyoma to UAE.  Objective: to investigate role of UAE in different uterine myomas with follow up by MRI. Materials and methods: This prospective observational study was included 40 females with clinical criteria of symptomatic fibroid who weren’t suitable or refuse the other modalities of treatment and underwent UAE. All patients were undergone pre-procedure pelvic ultrasound and pelvic MRI, and post-procedure pelvic MRI.  Results: There was a significant decrease in the uterine volume post embolization in all patients with infarction more than 50% occurred in 38 (95%) patients. Bleeding and anemia in patients who had improved were significantly higher than those who were unchanged/recurrent (P value <0.05). Post embolization syndrome occurred in 10 patients (25%), only one patient (2.5%) had puncture site hematoma, two patients (5%) complained with pelvic infection and re-bleeding occurred in 5 (12.55%) patients.&nbsp