Alessandra Tomei

Feasibility of 3.0 T pelvic MR imaging in the evaluation of endometriosis

INTRODUCTION Endometriosis represents an important clinical problem in women of reproductive age with high impact on quality of life, work productivity and health care management. The aim of this study is to define the role of 3T magnetom system MRI in the evaluation of endometriosis. MATERIALS AND METHODS Forty-six women, with transvaginal (TV) ultrasound examination positive for endometriosis, with pelvic pain, or infertile underwent an MR 3.0T examination with the following protocol: T2 weighted FRFSE HR sequences, T2 weighted FRFSE HR CUBE 3D sequences, T1 w FSE sequences, LAVA-flex sequences. Pelvic anatomy, macroscopic endometriosis implants, deep endometriosis implants, fallopian tube involvement, adhesions presence, fluid effusion in Douglas pouch, uterus and kidney pathologies or anomalies associated and sacral nervous routes were considered by two radiologists in consensus. Laparoscopy was considered the gold standard. RESULTS MRI imaging diagnosed deep endometriosis in 22/46 patients, endometriomas not associated to deep implants in 9/46 patients, 15/46 patients resulted negative for endometriosis, 11 of 22 patients with deep endometriosis reported ovarian endometriosis cyst. We obtained high percentages of sensibility (96.97%), specificity (100.00%), VPP (100.00%), VPN (92.86%). CONCLUSION Pelvic MRI performed with 3T system guarantees high spatial and contrast resolution, providing accurate information about endometriosis implants, with a good pre-surgery mapping of the lesions involving both bowels and bladder surface and recto-uterine ligaments.

Fetal MRI as a complement to US in the evaluation of cleft lip and palate

PurposeThe aim of our study was to investigate the role of fetal magnetic resonance imaging (MRI) as a complement to ultrasound (US) in the evaluation of cleft lip and palate (CLP), whether isolated or in association with syndromic conditions.Materials and methodsWe enrolled 24 pregnant women (27 fetuses) (mean gestational age 23.7 weeks) with a level-two US diagnosis of cleft lip (CL) or CLP with or without associated central nervous system (CNS) or facial-bone anomalies. All individuals underwent a fetal MRI examination to study the facial skeleton, CNS and fetal body. For each fetus, the main anatomical facial landmarks and biometric parameters [anteroposterior diameter (APD), biparietal diameter (BPD), inferior facial angle (IFA), frontomaxillary angle (FMA), bi-orbital diameter (BOD), intraorbital diameter (IOD)] were measured.ResultsTwenty-five of 27 fetuses had a US diagnosis of CL or CLP. MRI confirmed the diagnosis in 16/25 fetuses and added information about the extent of the cleft and the degree of involvement of the anterior and posterior palate in 8/25 fetuses. MRI ruled out the diagnosis in 1/25 fetuses and identified an alteration of the parameters IFA, FMA and IOD in 6/24 fetuses.ConclusionsIn the study of CLP fetal, MRI is able to define the degree of involvement of the posterior palate and the lateral extent of the cleft with higher diagnostic accuracy than US. Furthermore, MRI provides a complete study of the fetal head and biometric development of the facial bones, thus enabling early detection of potential syndromic conditions.RiassuntoObiettivoLo scopo del nostro studio è valutare il ruolo complementare, rispetto all’esame ecografico, della risonanza magnetica (RM) fetale nell’inquadramento delle labioschisi (LBS) o labio-palatoschisi (LPS) isolate e associate a quadri sindromici.Materiali e metodiAbbiamo prospettivamente arruolato 24 donne in gravidanza (27 feti; età gestazionale media 23,7 settimane) con diagnosi ecografica di II livello di LBS o LPS, associata o meno ad anomalie cranio-encefaliche o del massiccio facciale; le pazienti sono state sottoposte a RM fetale per lo studio del massiccio facciale, oltre che del sistema nervoso centrale (SNC) e del body fetale. Per ogni feto abbiamo valutato i principali reperi anatomici del massiccio facciale e calcolato i seguenti parametri riguardanti il suo normale sviluppo: diametro anteroposteriore della mandibola (DAPM), diametro biparietale della mandibola (DBPM), angolo facciale inferiore (IFA), angolo fronto-mascellare (FMA), diametro bisorbitario (DBO), diametro interorbitario (DIO).RisultatiVenticinque/27 feti avevano diagnosi ecografica di LBS-LPS. La RM ha confermato la diagnosi ecografica in 16/25 feti ed ha aggiunto informazioni riguardo l’estensione della schisi ed il coinvolgimento del palato in 8/25 feti; ha smentito la diagnosi in 1/25 feti. Inoltre abbiamo evidenziato in 6/24 feti un’alterazione dei parametri IFA, FMA, DIO.ConclusioniLo studio RM fetale del massiccio facciale nelle LBS-LPS definisce con maggiore accuratezza il grado di coinvolgimento del palato posteriore e la lateralità; consente, inoltre, una valutazione del distretto cranioencefalico e dello sviluppo biometrico del massiccio facciale al fine di identificare precocemente eventuali condizioni sindromiche.

Role of fetal MRI in the diagnosis of cerebral ventriculomegaly assessed by ultrasonography

PurposeTo evaluate the additional diagnostic value of fetal MRI to evaluate cerebral ventriculomegaly assessed by ultrasonography (US) for the possibility to change the diagnosis, the counseling and the management of pregnancy.Materials and MethodsFrom february 2006 to october 2008, we studied 55 pregnant women by fetal MRI (mean age 28 years), 4 with twin pregnancy, for a total of 59 fetuses with mean gestational age of 27 weeks. The number of fetuses affected by ventriculomegaly assessed by US was 55. All fetuses had a US diagnosis of ventriculomegaly: 29 fetuses with isolated ventriculomegaly and 26 fetuses with ventriculomegaly associated with CNS (central nervous system) abnormalities (18) and with no CNS abnormalities (8).ResultsThe findings showed that the two techniques are substantially in agreement in defining the degree of VM, with the exception of some cases in which the disagreement could be attributed to the possible progression of the dilatation between the US and MRI examinations, which sway between two days and two weeks. We proved a low correlation between US and MRI in the evaluation of ventriculomegaly associated either with CNS or non-CNS anomalies: in fact while fetal MRI detected 26/55 (47,3%) VM associated with CNS anomalies, US demonstrated only 18/55(32,7%). Referring to VM associated with non-CNS anomalies, MRI diagnosed 10/55 cases (18,2%) compared to 8/55 fetuses (14,5%) showed by US.ConclusionsOur experience demonstrated that fetal MRI has an important role as adjunctive tool to sonography in the evaluation of cerebral ventriculomegaly for the additional informations given to parents and for the possibility to change the diagnosis, the counseling and the management of pregnancy.RiassuntoObiettivoLo scopo del nostro studio è valutare il ruolo della risonanza magnetica nell’inquadramento diagnostico delle ventricolomegalie per le conseguenze che un cambiamento della diagnosi può avere sul counselling materno, sul management della gravidanza e sulla pianificazione di eventuali interventi pre e postnatali, nell’ottica di una gestione multidisciplinare.Materiali e metodiNel periodo compreso fra febbraio 2006 ed ottobre 2008, abbiamo sottoposto a risonanza magnetica 55 donne in stato di gravidanza (età media 28 aa), 4 delle quali con gravidanze gemellari, per un totale di 59 feti di età gestazionale con età gestazionale media di 27 settimane. Il numero di feti interessati da ventricolomegalia secondo l’indicazione ecografica era di 55. Tutti i feti avevano diagnosi ecografica di ventricolomegalia: 29 feti con ventricolomegalia isolata e 26 feti con ventricolomegalia associata; in particolare in quest’ultimo gruppo 18 feti riportavano associazioni con anomalie del SNC ed 8 feti con anomalie di altri distretti.RisultatiÈ emerso così che le due metodiche sono sostanzialmente in accordo nel definire l’entità della ventricolomegalia, fatta eccezione per alcuni casi nei quali la discordanza potrebbe attribuirsi alla possibile progressione della dilatazione nell’arco di tempo intercorso fra ecografia e risonanza magnetica, variabile fra 2 giorni e 2 settimane. Minor grado di accordo è invece emerso dal confronto rispetto alla associazione delle ventricolomegalie con ulteriori anomalie sia del SNC fetale che di altri organi e apparati. Infatti la RM ha evidenziato 26/55 (47,3%) VM associate ad anomalie del SNC, versus 18/55 (32,7%) diagnosi di associazione con ulteriori anomalie encefaliche poste con l’ecografia; quanto alle associazioni con anomalie di altri distretti la RM ne ha posto diagnosi in 10/55 casi (18,2%) e l’ecografia in 8/55 feti (14,5%).ConclusioniIn base ai nostri risultati concludiamo che qualora si riscontri una ventricolomegalia vadano sempre informati i genitori circa il rischio di ulteriori anomalie associate e di conseguenti possibili ripercussioni sullo sviluppo psicomotorio del nascituro rispetto alla popolazione normale, consigliandone l’approfondimento diagnostico con i mezzi diagnostici disponibili.

Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration

OBJECTIVES Endometriosis is the ectopic localization of endometrial glands. Symptoms include a wide variety of chronic pelvic pain. Ovarian endometriosis represents the most frequent site of implantation followed by the Douglas pouch which is undepicted unless peritoneal fluid is present. Pelvic exams may be reported as normal in 40% of evaluations, although multiple nodularities are located in this region. Nowadays, laparoscopy represents the standard technique for endometriosis evaluation. However, magnetic resonance imaging (MRI) remains the best noninvasive technique for the evaluation of pelvic lesions. According to the importance of a precise preoperative diagnosis of deep infiltrative endometriosis involving the Douglas pouch, we evaluated feasibility of a 3-T system in the evaluation of this particular region. METHODS We enrolled 19 women coming with either ultrasound or anamnestic suspicion of endometriosis. Pelvic MRI examination was performed on the 3-T system. We applied a standard exam protocol including pulse sequences [single-shot fast spin echo (FSE)] and high-resolution T2W and T1W FSE sequences with and without FS. RESULTS MRI diagnosed posterior cul-de-sac obliteration in 15/19 patients. MRI findings were compared with laparoscopy, thus obtaining the following statistical values: mean sensitivity, specificity, positive predictive value and negative predictive value, respectively, of 93%, 75%, 93% and 75%. Moreover, we calculated an interobserver agreement k value of 0.72 with a substantial degree of agreement between two radiologists of a sensitivity value of 93% and specificity value of 75%. CONCLUSIONS Precise preoperative mapping of posterior cul-de-sac region is essential for a preoperative planning. In our work, the 3-T MRI was shown to be excellent in the evaluation of posterior cul-de-sac obliteration associated to an optimal evaluation of the uterosacral ligaments due to the higher contrast spatial resolution.

Diffusion-weighted MR imaging and apparent diffusion coefficient of the normal fetal lung: preliminary experience.

To assess if a correlation is present between apparent diffusion coefficient (ADC) values and normal lung maturation during gestation to define potential reference values as indicators of the lung development.

MRI and DWI: feasibility of DWI and ADC maps in the evaluation of placental changes during gestation.

To establish if a correlation exists between apparent diffusion coefficient (ADC) values, obtained by diffusion‐weighted imaging (DWI), and placental aging.

Fetal MRI with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) assessment in the evaluation of renal development: preliminary experience in normal kidneys

PurposeThe study aimed to investigate the correlation between apparent diffusion coefficient (ADC) and gestational age by applying diffusion-weighted imaging (DWI) in the study of normal fetal kidneys.Materials and methodsWe performed magnetic resonance (MR) imaging on 88 fetuses (gestational age range 17–40 weeks) after ultrasound had ruled out urinary system malformations. A multiplanar study of the urinary system was obtained by using conventional T2-weighted sequences and echoplanar imaging (EPI). DW sequences with ADC maps were subsequently acquired, and kidney ADC values were correlated with gestational age by diving the fetuses into six groups according to age.ResultsWe found a correlation between ADC values and gestational age. The ADC values, ranging from 0.99 to 1.62×10−3 mm2/s [mean 1.22; 95% confidence interval (CI) 1.19–1.25, standard deviation (SD) 0.147], showed a tendency to decrease with increasing gestational age. The relationship between ADC values and gestational age was expressed by a linear regression equation: ADC (mm2/s)=1.69–0.0169 (GA) (R2=37.7%, R2 ADJ=37.0%, p<0.005, Pearson correlation=−0.614).ConclusionsDWI with ADC mapping provides functional information on fetal renal parenchyma development and may thus become a useful tool in the management of pregnancy and treatment of the newborn child.RiassuntoObiettivoApplicare le sequenze pesate in diffusione (DWI) nello studio dei reni fetali, per valutare l’esistenza di una correlazione fra coefficiente di diffusione apparente (ADC) ed età gestazionale nei feti sani.Materiali e metodiAbbiamo studiato con esame RM 88 feti (età gestazionale 17–40 settimane), già valutati con esame ecografico che escludeva malformazioni del tratto urinario. L’apparato urinario fetale è stato studiato con sequenze T2 pesate ultraveloci; successivamente sono state acquisite sui reni fetali sequenze DWI (con calcolo automatico delle mappe di ADC) ed i valori di ADC messi in relazione con l’età gestazionale, suddividendo i feti in sei gruppi in base all’età gestazionale. La normale funzionalità renale è stata confermata dopo la nascita attraverso dati clinico-laboratoristici ed ecografia renale.RisultatiAbbiamo riscontrato che i valori di ADC, compresi fra 0,99 e 1,62×10−3 mm2/s (media 1,22; 95% CI 1,19–1,25; deviazione standard 0,147) tendono a decrescere con l’aumentare delle settimane di gestazione. La migliore correlazione è stata espressa dall’equazione di regressione lineare: ADC (mm2/s)=1,69–0,0169 (GA) (R2=37,7%, R2 ADJ=37,0%, p<0,005, correlazione di Pearson=–0,614). Conclusioni. Le sequenze DWI ed le mappe di ADC, fornendo informazioni funzionali sullo sviluppo del parenchima renale fetale, risultano di grande utilità soprattutto nella gestione della gravidanza e nel management post-natale.

Role of foetal MRI in the evaluation of ischaemic-haemorrhagic lesions of the foetal brain

Abstract Objective: The purpose of this study is to define the role of foetal magnetic resonance imaging (MRI) in evaluating cerebral ischaemic-haemorrhagic lesions and the extension of parenchymal injuries. Study design: From September 2006 to September 2010, 271 foetal MRI have been performed on cases referred to us for ultrasound suspect of brain abnormalities or cytomegalovirus infection and Toxoplasma serum conversion. Foetal MRI was performed with a 1.5-T magnet system without mother sedation. Results: Foetal MRI detected ischaemic-haemorrhagic lesions in 14 of 271 foetuses, consisting of 5% incidence. MRI confirmed the diagnosis in three of 14 cases with ultrasonography (US) suspect of ischaemic-haemorrhagic lesions associated with ventriculomegaly. In one of 14 cases with US findings of cerebellar haemorrhage, MRI confirmed the diagnosis and provided additional information regarding the parenchymal ischaemic injury. In eight of 14 cases with US suspect of ventriculomegaly (3), corpus callosum agenesis (2), hypoplasia of cerebellar vermis (1), holoprosencephaly (1) and spina bifida (1), MRI detected ischaemic and haemorrhagic lesions unidentified at US examination. In two of 14 foetuses with US suspect of intracerebral space-occupying lesion, MRI modified the diagnosis to extra-axial haematoma associated with dural sinus malformation. Results were compared with post-mortem findings or afterbirth imaging follow-up. Conclusions: Foetal MRI is an additional imaging modality in the diagnosis of cerebral ischemic-haemorrhagic lesions, and it is useful in providing further information on the extension of the parenchymal injury and associated abnormalities, thus improving delivery management.

Patologia malformativa dell’addome fetale

Le malformazioni congenite dell’addome e del tratto gastrointestinale fetali sono piuttosto frequenti e multiformi: comprendono sia difetti di parete (difetti diaframmatici, difetti della parete addominale anteriore) che anomalie intraddominali degli organi contenuti in sede peritoneale e retroperitoneale (fegato, colecisti, stomaco, intestino, pancreas, surreni, reni, vasi, vescica, ureteri, genitali, vasi del cordone ombelicale).

Malformazioni congenite dell’apparato genitale femminile

Le malformazioni congenite dell’apparato genitale femminile rappresentano un gruppo piuttosto eterogeneo di patologie che possono interessare variamente utero, vagina, genitali esterni, tube e ovaie. Sebbene il riscontro di una malformazione dell’apparato genitale possa essere occasionale, le pazienti manifestano un’ampia gamma di sintomi, quali sterilita, amenorrea primaria, poliabortivita, dismenorrea grave, comparsa di crisi dolorose addominali, impossibilita ad avere rapporti sessuali.