Anna S. Lev-Toaff

Spectrum of imaging findings on MRI and CT after uterine artery embolization

Uterine artery embolization (UAE) is an effective treatment for symptomatic uterine 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 require urgent medical or surgical intervention.

Diagnostic imaging modalities for Müllerian anomalies: the case for a new gold standard.

Female reproductive tract anomalies are difficult to number in the general population but are often discovered in evaluations of menstrual complications or fertility disorders. Traditionally, assessment of the reproductive tract entailed hysterosalpingography to image the uterine cavity with the final diagnosis provided by combined hysteroscopy/laparoscopy. These approaches, while providing important information, were uncomfortable and invasive and for HSG, involved radiation exposure. Magnetic resonance imaging (MIR) allowed for the avoidance of these issues while offering accuracy, thus becoming the gold standard diagnostic imaging modality but entailing cost, patient discomfort, and inconvenience. Current advances in ultrasound technology, specifically 3-dimensional ultrasound, achieve the same benefits of MRI in being accurate and noninvasive but also offer the following advantages: they are available in the office, they are cost-effective, and they provide immediate results. As 3-dimensional technology continues to become more accessible and more providers become proficient in using it, ultrasound may replace MRI as the new gold imaging standard in diagnosing müllerian anomalies.

Comparison of small bowel follow through and abdominal CT for detecting recurrent Crohn's disease in neoterminal ileum

PURPOSE To assess the findings of recurrent Crohns disease in the neoterminal ileum on small bowel follow through (SBFT) and computed tomography (CT) as well as the overall diagnostic performance of these imaging tests. METHODS Our radiology database yielded 52 patients with an ileocolic anastomosis for Crohns disease who underwent SBFT and CT. The images were reviewed to determine the sensitivity, specificity, PPV, and NPV for individual findings of recurrent Crohns disease in the neoterminal ileum. The overall sensitivity, specificity, PPV, and NPV of these tests for recurrent Crohns disease were determined by comparing imaging reports to endoscopic and surgical findings in 45 patients (87%) and clinical response to treatment in seven (13%). RESULTS SBFT had a sensitivity of 90%, specificity of 85%, PPV of 95%, and NPV of 73% for detecting recurrent Crohns disease, and CT had a sensitivity of 77%, specificity of 69%, PPV of 88%, and NPV of 50%. These tests combined had a sensitivity of 95%, specificity of 69%, PPV of 90%, and NPV of 82%. The most common findings were luminal narrowing, thickened folds, and ulcers (especially aphthoid lesions) on SBFT and bowel wall thickening on CT. CT also revealed extraenteric collections not visualized on SBFT in three patients (8%). CONCLUSIONS Our experience suggests that SBFT is more sensitive and specific than CT for detecting recurrent Crohns disease in the neoterminal ileum, mainly because of the ability of barium studies to depict aphthoid lesions not visualized on CT. Conversely, CT is better for detecting extraenteric findings such as abscesses. When combined, these tests have a higher sensitivity for detecting recurrent Crohns disease than either test alone.

Differences between genders in colorectal morphology on CT colonography using a quantitative approach: a pilot study

PURPOSE To explore quantitative differences between genders in morphologic colonic metrics and determine metric reproducibility. METHODS Quantitative colonic metrics from 20 male and 20 female CTC datasets were evaluated twice by two readers; all exams were performed after incomplete optical colonoscopy. Intra-/inter-reader reliability was measured with intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC). RESULTS Women had overall decreased colonic volume, increased tortuosity and compactness and lower sigmoid apex height on CTC compared to men (p<0.0001,all). Quantitative measurements in colonic metrics were highly reproducible (ICC=0.9989 and 0.9970; CCC=0.9945). CONCLUSION Quantitative morphologic differences between genders can be reproducibility measured.