B. Op de Beeck

The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma

The aim of this study was to compare the preoperative findings of abdominal/pelvic CT and MRI with the preoperative clinical International Federation of Obstetrics and Gynecology (FIGO) staging and postoperative pathology report in patients with primary cancer of the cervix. Thirty-six patients with surgical–pathological proven primary cancer of the cervix were retrospectively studied for preoperative staging by clinical examination, CT, and MR imaging. Studied parameters for preoperative staging were the presence of tumor, tumor extension into the parametrial tissue, pelvic wall, adjacent organs, and lymph nodes. The CT was performed in 32 patients and MRI (T1- and T2-weighted images) in 29 patients. The CT and MR staging were based on the FIGO staging system. Results were compared with histological findings. The group is consisted of stage 0 (in situ):1, Ia:1, Ib:8, IIa:2, IIb:12, IIIa:4, IVa:6, and IVb:2 patients. The overall accuracy of staging for clinical examination, CT, and MRI was 47, 53, and 86%, respectively. The MRI incorrectly staged 2 patients and did not visualize only two tumors; one was an in situ (stage-0) and one stage-Ia (microscopic) disease. The MRI is more accurate than CT and they are both superior to clinical examination in evaluating the locoregional extension and preoperative staging of primary cancer of the cervix.

Inverted Meckel's diverticulum as a leading point for ileoileal intussusception in an adult: case report

Intussusception due to an inverted Meckels diverticulum is considered a rare occurrence. We present a case of a 37-year-old male with anemia and melena due to an inverted Meckels diverticulum at the base of an ileoileal intussusception. To our knowledge, this is the first case in which small bowel enema, computed tomography, and magnetic resonance imaging showed the pathology.

Vascular pathology of the spleen, part II.

Quite often, the spleen is regarded as the ‘‘silent and forgotten’’ organ of the abdomen. Although primary splenic diseases are rare, the spleen is a frequent site of secondary manifestations in a wide range of hematologic, immunologic, oncologic, infectious, vascular, and systemic disorders. Despite this broad spectrum of splenic diseases, the radiologic literature on splenic pathology is rather sparse. The introduction of cross-sectional imaging modalities opened up new diagnostic horizons. Ultrasound (US) rapidly became a suitable method for screening abdominal pathology. Despite a low specificity, US provides a high sensitivity for the identification of focal splenic lesions. During the 1980s, due to its superior contrast resolution, computed tomography (CT) became the gold standard for splenic imaging. Currently, helical, volumetric CT scanning with bolus injection of contrast material is considered the state-of-the-art imaging modality for evaluation of the spleen. Magnetic resonance imaging (MRI) has shown great promise due to its superior tissue-characterization ability in selected cases. The spleen is surrounded by a capsule that sends out trabeculae that divide the parenchyma or splenic pulp into incomplete compartments. The white pulp contains arterioles surrounded by a sheath of densely packed, small lymphocytes that are subdivided into central, intermediate, and peripheral marginal zone that form a lattice for the red pulp, which consists of large, thinwalled sinusoids lined by fenestrated endothelium that are filled with blood and separated by thin plates of cords of lymphoid tissue, the cords of Billroth. The structure of the spleen is built around its blood supply. There are two models of circulation within the spleen, open and closed. In the closed circulation model, central arteries supply the white pulp, blood runs through a system of marginal zone sinuses that drain directly into the venous sinuses. In the open circulation model, central arteries supply the red pulp and form sheathed capillaries that drain into the splenic parenchyma, which consists of a stellate network of the splenic cords. Venous sinuses flow together to become trabecular veins that unite at the hilus to form the splenic vein. The closed circulatory system consists of a small (10%) fast flow compartment, Whereas the open system consists of a large (90%) slow flow compartment. The mixture of the two circulation models is most likely the reason for the nonhomogeneous, flamelike enhancement of the spleen on the early arterial phase of CT or MRI (Fig. 1), whereas the spleen will enhance homogeneously on the late arterial and venous phases. This pictorial essay refers to lesions involving the splenic vessels and to the consequent splenic parenchymal pathology of such lesions. The spleen also plays a major role in portal hypertension, and splenic vessels are involved in the development of collateral pathways.

Paraperitoneal indirect inguinal bladder hernia: MR demonstration

Inguinal or inguinoscrotal herniation of the bladder is not uncommon and has been estimated to comprise 1% to 3% of all inguinal hernias. The appearance of hernias on ultrasonography, intravenous pyelography, cystography, and computed tomography has been described previously but no instance of correlation with magnetic resonance (MR) imaging has been documented. Nevertheless, herniated bladders can be encountered fortuitously during abdominal MR imaging, and the radiologist should be familiar with their appearance. We present a case of unsuspected paraperitoneal indirect inguinal bladder herniation demonstrated by MR. Appearance on MR is characteristic, and this modality may be useful for differentiating the several types of inguinal hernias of the bladder because of its superior soft tissue contrast. In addition, MR imaging can be used to perform imaging in any plane and dynamic examinations during straining.

Septic Thrombophlebitis of the Right Ovarian Vein

BACKGROUND A 26-year-old woman presented at the emergency department with a painful abdomen and fever up to 39°C, despite antibiotics. She had given prematurely birth by caesarian section to a twin 8 days earlier. On clinical examination she had a diffuse painful and tender abdomen, especially on the right side and suprapubic region. Laboratory findings showed an increased c-reactive protein of 24 mg/dL (normal < 0,3) and increased white blood cell count of 13 Å~ 10E9/L (normal 4,3-10 Å~ 10E9/L). There was also a decreased hemoglobin level of 8,4 g/dL (normal 12-15 g/dL). An ultrasonography was performed by the gynecologist and revealed a large heterogeneous fluid collection anteriorly of the uterus.