Courtney A. Woodfield

Diffusion-Weighted MRI of Peripheral Zone Prostate Cancer: Comparison of Tumor Apparent Diffusion Coefficient With Gleason Score and Percentage of Tumor on Core Biopsy

OBJECTIVEnThe objective of our study was to determine the relationship between the apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI) and Gleason score of prostate cancer and percentage of tumor involvement on prostate core biopsy.nnnMATERIALS AND METHODSnWe performed a retrospective study of 57 patients with biopsy-proven prostate cancer who underwent endorectal MRI with DWI between July 2007 and March 2008. Regions of interest (ROIs) were drawn on ADC maps at sites of visible tumor on DW images and ADC maps. A hierarchic mixed linear model was used to compare the ADC value of prostate cancer with the Gleason score and the percentage of tumor on core biopsy.nnnRESULTSnEighty-one sites of biopsy-proven prostate cancer were visible on DW images and ADC maps. The least-squares mean ADC for disease with a Gleason score of 6 was 0.860 x 10(-3) mm(2)/s (standard error of the mean [SEM], 0.036); Gleason score of 7, 0.702 x 10(-3) mm(2)/s (SEM, 0.030); Gleason score of 8, 0.672 x 10(-3) mm(2)/s (SEM, 0.057); and Gleason score of 9, 0.686 x 10(-3) mm(2)/s (SEM, 0.067). Differences between the mean ADC values for a prostate tumor with a Gleason score of 6 and one with a Gleason score of 7 (p = 0.0096) and for a prostate tumor with a Gleason score of 6 and one with a Gleason score of 8 (p = 0.0460) were significant. Comparison between the ADC and percentage of tumor on core biopsy showed a mean ADC decrease of 0.006 (range, 0.004-0.008 x 10(-3) mm(2)/s) for every 1% increase in tumor in the core biopsy specimen.nnnCONCLUSIONnDWI may help differentiate between low-risk (Gleason score, 6) and intermediate-risk (Gleason score, 7) prostate cancer and between low-risk (Gleason score, 6) and high-risk (Gleason score > 7) prostate cancer. There is an inverse relationship between the ADC and the percentage of tumor involvement on prostate core biopsies.

Female Infertility: A Systematic Approach to Radiologic Imaging and Diagnosis

Imaging plays a key role in the diagnostic evaluation of women for infertility. The pelvic causes of female infertility are varied and range from tubal and peritubal abnormalities to uterine, cervical, and ovarian disorders. In most cases, the imaging work-up begins with hysterosalpingography to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at hysterosalpingography but typically require further characterization with hysterographic or pelvic ultrasonography (US) or pelvic magnetic resonance (MR) imaging. Hysterographic US helps differentiate among uterine synechiae, endometrial polyps, and submucosal leiomyomas. Pelvic US and MR imaging help further differentiate among uterine leiomyomas, adenomyosis, and the various müllerian duct anomalies, with MR imaging being the most sensitive modality for detecting endometriosis. The presence of cervical disease may be inferred initially on the basis of difficulty or failure of cervical cannulation at hysterosalpingography. Ovarian abnormalities are usually detected at US. The appropriate selection of imaging modalities and accurate characterization of the various pelvic causes of infertility are essential because the imaging findings help direct subsequent patient care.

Imaging Pelvic Floor Disorders: Trend Toward Comprehensive MRI

OBJECTIVEnThe purpose of this article is to review the relevant anatomy and sonographic, fluoroscopic, and MRI options for evaluating patients with pelvic floor disorders.nnnCONCLUSIONnDisorders of the pelvic floor are a heterogeneous and complex group of problems. Imaging can help elucidate the presence and extent of pelvic floor abnormalities. MRI is particularly well suited for global pelvic floor assessment including pelvic organ prolapse, defecatory function, and pelvic floor support structure integrity.

MR Imaging Evaluation of Abdominal Pain during Pregnancy: Appendicitis and Other Nonobstetric Causes

Clinical diagnosis of the cause of abdominal pain in a pregnant patient is particularly difficult because of multiple confounding factors related to normal pregnancy. Magnetic resonance (MR) imaging is useful in evaluation of abdominal pain during pregnancy, as it offers the benefit of cross-sectional imaging without ionizing radiation or evidence of harmful effects to the fetus. MR imaging is often performed specifically for diagnosis of possible appendicitis, which is the most common illness necessitating emergency surgery in pregnant patients. However, it is important to look for pathologic processes outside the appendix that may be an alternative source of abdominal pain. Numerous entities other than appendicitis can cause abdominal pain during pregnancy, including processes of gastrointestinal, hepatobiliary, genitourinary, vascular, and gynecologic origin. MR imaging is useful in diagnosing the cause of abdominal pain in a pregnant patient because of its ability to safely demonstrate a wide range of pathologic conditions in the abdomen and pelvis beyond appendicitis.

Abdominal Pain in Pregnancy: Diagnoses and Imaging Unique to Pregnancy—Review

Received November 14, 2008; accepted after revision November 4, 2009. 1Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Women and Infants Hospital, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903. Address correspondence to C. A. Woodfield (courtneywoodfield@yahoo.com). 2Present address: Department of Radiology, University of California at San Diego, San Diego, CA.

AJR teaching file: fat-containing retroperitoneal mass presenting with acute flank pain.

Radiologic Description Axial unenhanced CT images through the abdomen show a well-circumscribed, 13-cm, left retroperitoneal fat-containing mass (Fig. 1A). Along the inferior aspect of the mass is higher-attenuation (50–60 HU) material of recent blood products (Fig. 1B). A coronal reformatted image from a subsequent contrast-enhanced CT examination shows the retroperitoneal mass to be suprarenal in location, inferior displacement of the adjacent left kidney, and no “claw sign” (no rim of renal tissue extending partially around the mass) to suggest a renal origin for the mass. Nonenhancing higher-attenuation material is seen in the medial aspect of the mass and extending inferiorly to partially surround the left kidney, in keeping with both intratumoral and peritumoral hemorrhage (Fig. 1C). The left adrenal gland is indistinguishable from the mass.

Ureteral pseudodiverticulosis: a unique case diagnosed by multidetector computed tomography.

Presented is a case of ureteral pseudodiverticulosis diagnosed by multidetector computed tomography (CT). Axial and coronal reformatted CT images revealed multiple small (2-4 mm) outpouchings of both ureters, characteristic of ureteral pseudodiverticulosis. The unenhanced CT also revealed a 6-mm stone at the left ureterovesical junction and a high attenuation lesion at the right ureterovesical junction suspect for an associated uroepithelial neoplasm.

MDCT Angiography of Middle Mesenteric Artery with Associated Bowel Nonrotation Complicating Management of Abdominal Aortic Aneurysm

WEB This is a Web exclusive article. middle mesenteric artery is a very rare mesenteric arterial anomaly resulting from incomplete regression of the primitive paired segmental ventral arteries of the dorsal abdominal aorta which supply variable amounts of the small and large bowel [1–8]. We report the imaging findings of a middle mesenteric artery with associated bowel nonrotation in a patient undergoing preoperative MDCT angiography for a known abdominal aortic aneurysm (AAA). The patient was subsequently excluded from aortic stent-graft repair because the middle mesenteric artery was originating from the proximal aspect of the AAA, which, to our knowledge, has not previously been reported. In addition, findings of a middle mesenteric artery with associated bowel nonrotation on MDCT angiography examination have not been previously reported in the literature.

Abdominal Pain in Pregnancy: Diagnoses and Imaging Unique to Pregnancy—Self-Assessment Module

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging evaluation of abdominal pain during pregnancy.