Utility of structural MRI and DWI in evaluation of uterine and adnexal lesions

Background: In females, uterine and adnexal pathologies have been the common cause of morbidity. Accurate diagnosis is of utmost importance for timely intervention, which can be done with good accuracy by Magnetic Resonance Imaging (MRI).Diffusion weighted imaging (DWI) is a functional imaging sequence which works on the principle of random mobility of water molecules within the tissues. MRI with DW Imaging emerged as an optimistic tool in detection and characterization of various uterine and adnexal lesions, their anatomical extension, understanding the pathophysiology by ADC values which further helps in differentiation of benign from malignant lesions. Methods: This was a prospective, observational study conducted at a tertiary center for over a period of 2 years with 100 patients of all age groups suspected of uterine and adnexal lesions, examined under Siemens Avanto Magnetic Resonance Imaging (1.5 Tesla). The mean differences in ADC between benign and malignant were compared using a student t-test. Accuracy of ADC Cut off value to differentiate benign from malignant lesions were assessed by Kappa statistic. Results: The mean ADC value for benign uterine lesions was 1.33 + 0.18 ×10-3 mm2/s and for malignant lesions was 0.77 + 0.08 ×10-3 mm2/s with an ADC cut off value of 0.92×10-3mm2/s was suggested for differentiating benign from malignant uterine lesions. The mean ADC value for benign adnexal lesions was 1.35 +78 ×10-3 mm2/s and for malignant lesions was 0.91 + 0.03 ×10-3 mm2/s. Few benign lesions showed ADC values lower than malignant lesions. The mean ADC value for endometriomas was 0.69 + 0.03 ×10-3 mm2/s and the mean ADC value for tubo-ovarian abscess was 0.46+ 0.06 x×10-3 mm2/s. Hence statistically, ADC cut off value of 0.96×10-3mm2/s was not significant in differentiating benign from malignant adnexal lesions with a kappa value of 0.3 and p-value of 0.37.From our study, the sensitivity, specificity, positive predictive, negative predictive value and accuracy of MRI in detecting and differentiating benign and malignant uterine and adnexal lesions was 95%, 100%, 100%, 98.72% and 99% respectively with a strong kappa value. Conclusion: From our study we have concluded that diffusion weighted imaging has a notable role in differentiating benign from malignant uterine lesions rather than adnexal lesions. However, irrespective of ADC values, a complete analysis of the lesions utilizing all sequences we had observed that MRI had a sensitivity, specificity and accuracy in detecting uterine and adnexal lesions

Static MR urography in obstructive uropathy and congenital anomalies in adults and paediatric age

Background: Magnetic Resonance Urography (MRU) provides anatomical imaging of the renal system and urinary tract and is useful in both adults and paediatric patients. Functional MR urography enables differential renal function to be determined and allows the measurement of renal excretion into the collecting systems. The utility of MRU in adult patients who had obstructive uropathy was evaluated in this study to determine the extent and cause of obstruction. Paediatric patients were assessed for anatomical imaging and obstruction thresholds for possible congenital abnormalities.Method: This was a prospective, observational study conducted at a tertiary centre for over a period of 2 years. Total of 62 cases, both adult and paediatric patients were examined under Siemens Avanto Magnetic Resonance Imaging (1.5 Tesla). Data was collected on a pretested proforma, entered in excel sheet and quantitative data was summarised with MEAN and SD.Results: Age: Mean age of the subjects was 39.17. The majority were males at 59.67% (37) and females constituted 40.33% (25). The mean duration of symptoms was 16.52 days. Flank pain was most common presenting complaint in 53.23%. 32.26% of the lesions were observed in kidney, 12.90% in renal pelvis, 6.45% each in upper and mid ureter, 16.13% in distal ureter, 19.35% at PUJ, 4.84% in urinary bladder, 9.68% in urethra. 5 patients had bilateral lesions, 38 had right sided involvement and 13 had left sided involvement. Significant number of paediatric patients had congenital lesions and lesser number of acquired lesions when compared to adults with a P value of 0.000249.Conclusion: Static MR-Urography was useful in detecting the exact aetiology of obstructing lesions presenting in varied aged groups including congenital and acquired lesions. Most common reasons for obstructive uropathy was noted to be lesions in kidney followed by those in pelvis and the ureters. Significant number of paediatric patients presented with congenital lesions compared to the adults who had higher number of acquired lesions. We suggest static MR-Urography is one of the ideal diagnostic tests in diagnosis of cases with obstructive uropathy