Multimodality Imaging of Pelvic Inflammatory Disease Complicated with Tubo-Ovarian Abscess

Teaching Point: Pelvic inflammatory disease (PID) is the most frequent gynecologic cause of emergency visits. Because of its prevalence and non-specific symptoms, the radiologist may encounter this pathology and its complications on all imaging modalities and should carefully assess PID signs to avoid delay in management, late complications, and unnecessary surgery

Prolapsed Uterine Fibroid: Value of MRI in Case of Massive Bleeding

Teaching Point: In case of acute bleeding caused by a mass located in the vagina, it may be difficult to assess the origin of the mass and determine whether it is benign or malignant; MRI is a useful tool for mass detection, diagnosis, and treatment decision

Échographie et seins denses : où en est-on ? [US and dense breasts: where do we stand?].

The use of ultrasonography in dense breast remains a controversial topic. It is acknowledged that ultrasound as an adjunct to mammography increases the detection rate of breast cancers. However, the main limitation of US, in addition to its operator dependent nature, is its low specificity, leading to a high rate of false positive results. Several techniques can be used to improve the performance of US and cost/effectiveness ratio, such as Doppler imaging, harmonic imaging, spatial and frequency compound imaging, all of which are routinely available, and elastosonography, contrast US and 3D US which are still in development

Imagerie des cancers du sein inflammatoires

Inflammatory breast carcinomas are rare (1-5%), their prognosis is poor, requiring prompt multidisciplinary management. Clinically, they show rapid onset of inflammatory signs (erythema, edema, warmth, and tenderness) often associated with a palpable breast mass or axillary node involvement. Mammography is frequently abnormal, with malignant signs in more than 86%. Ultrasonography best allows detection of masses masked by the densified parenchyma and therefore is helpful for biopsies. CT and MRI enable a better analysis of the extension of disease and response to therapy. © 2006. Elsevier Masson SAS

Uterine fibroid management: Today and tomorrow.

Current treatments for fibroids are mainly surgical and expensive, so alternatives need to be found. It is, therefore, vital to develop and evaluate alternatives to surgical procedures, especially when fertility preservation is the goal. Selective progesterone receptor modulators (SPRMs) are synthetic compounds that have either an agonistic or antagonistic impact on target tissues determined by their binding to progesterone receptors. Their mixed activity depends on recruitment of cofactors that regulate transcription along so-called genomic pathways, as well as nongenomic interactions with other signaling pathways. There is no doubt that surgery remains indicated in some instances, but we must now establish whether use of SPRMs (notably ulipristal acetate) allows less invasive surgery or even complete avoidance of surgery. Long-term intermittent administration of ulipristal acetate will undoubtedly change our approach to the management of uterine fibroids according to the International Federation of Gynecology and Obstetrics classification, which provides a comprehensive basis for different treatment options. When considering less invasive techniques (uterus-sparing options like myomectomy), the choice is guided by the size, number and location of fibroids, as well as the personal experience of the gynecologist and available equipment. There is now a growing body of evidence pointing to the crucial role of progesterone pathways in the pathophysiology of uterine fibroids. SPRMs should, therefore, be considered an alternative to surgical therapy, or at least an adjunct to surgery, as illustrated in the algorithms. © 2019 Japan Society of Obstetrics and Gynecology