Cynthia L. Janus

Comparison of magnetic resonance imaging and ultrasound in evaluating follicular and endometrial development throughout the normal cycle

A prospective study was undertaken to evaluate and compare magnetic resonance imaging (MRI) and ultrasound (U/S) in monitoring follicular and endometrial development during the normal menstrual cycle. Results of MRI, U/S, estradiol (E2), and progesterone were obtained from five ovulatory volunteers on days 4, 8, 12, 16, 20, and 24 of the cycle. On U/S, all the women had only one dominant follicle, whereas MRI was able to detect a secondary cohort of follicles in three of five volunteers. Endometrial development on U/S and MRI showed similar patterns of growth with an increase on MRI from 5.8 +/- 1.1 mm on day 4 to a mean peak of 10.3 +/- 1.7 mm on day 24. A distinct feature of MRI was the demonstration of a junctional zone (JZ), which has a pattern of growth that resembles that of the endometrium, with accelerated growth from day 8 to day 16 (5.1 +/- .7 mm to 6.7 +/- .7 mm). The JZ corresponds anatomically to the distribution of the arcuate vessels and may therefore represent changes in blood supply to the endometrium. MRI, similar to U/S, is noninvasive and does not involve any radiation exposure but provides new information on uterine changes in the normal cycle. At present, its clinical applications are limited.

Staging of cervical carcinoma: accuracy of magnetic resonance imaging and computed tomography.

A prospective study was undertaken to assess the ability of magnetic resonance imaging (MRI) to stage cervical carcinoma. Compared to computed tomography (CT), MRI showed a high degree of accuracy in correctly demonstrating involvement of the vagina, parametria and sidewalls, bladder, and lymph nodes but tended to overestimate disease in all of the categories studied. Large-scale studies comparing the two modalities are necessary because the most accurate staging of cervical carcinoma is crucial for selecting the best treatment protocols.

Magnetization Prepared RApid Gradient-Echo (MP-RAGE) MR imaging of the liver: Comparison with spin-echo imaging

We have implemented an MR technique that employs a rapid gradient echo sequence, preceded by magnetization preparation pulses to provide T1- and T2-weighted tissue contrast. With this technique, which can be identified as a member of a new family of pulse sequences, generically named Magnetization Prepared RApid Gradient Echo (MP-RAGE), very short repetition times are used, allowing acquisition times of less than one second and images virtually free of motion-induced artifacts during quiet respiration. Fifteen patients with known liver lesions (metastases, hemangiomas, and cysts) were examined using T1- and T2-weighted 2-dimensional MP-RAGE sequences, and the images were compared with conventional T1- and multi-echo T2-weighted spin-echo (SE) sequences. Signal difference-to-noise ratios (SD/Ns) of the lesions were calculated for all pulse sequences using corresponding axial images and were normalized for voxel volume. The mean normalized SD/Ns of the MP-RAGE sequences were generally comparable to those for the SE sequences. In addition, there were no noticeable respiratory artifacts on the MP-RAGE images whereas these were clearly present on the T2-weighted SE images and to a lesser degree on the T1-weighted SE images. It is concluded that the MP-RAGE technique could become an important method for evaluating the liver for focal disease.

Magnetic resonance imaging of the menstrual cycle

This study examines the ability of magnetic resonance imaging (MRI) to monitor follicular and endometrial development during the menstrual cycle. MR scans, sonograms and hormonal levels of estradiol (E2) and progesterone (P) obtained from five ovulatory volunteers were evaluated on approximately days 4, 8, 12, 16, 20 and 24 of the cycle. MRI reliably demonstrated folliculogenesis in all of the volunteers. Changes depicted in the endometrial and junctional zones of the uterus reflected physiologic events occurring during the normal cycle. Important implications exist for infertile women undergoing stimulated cycles and/or in-vitro fertilization.

Benign prostatic hyperplasia : appearance on magnetic resonance imaging

Benign prostatic hyperplasia (BPH) has a variable appearance on magnetic resonance imaging (MRI). This study reviews and categorizes the MRI findings of this entity in a sample of 26 men. Cases where atypical or suspicious changes are incidental findings should be reported to the urologist for further investigation. In addition, familiarity with both the appearance of the normal prostate and the changes caused by BPH is necessary when staging patients with known prostate cancer.

Gynecologic magnetic resonance imaging.

Magnetic resonance imaging (MRI) is an excellent modality with which to delineate normal anatomic structures and a variety of pathologic conditions in the female pelvis. It excels at demonstrating the extent of local tumor involvement in cases of endometrial and cervical cancer. It can help to elucidate the origin and nature of a variety of benign pelvic masses in cases where ultrasound findings are equivocal, and it is an accurate tool in demonstrating congenital abnormalities of the female reproductive tract. As technology continues to evolve, MRI will likely assume an even greater role in evaluating the female pelvis.

Aspiration of metallic mercury: clinical significance

The aspiration of metallic mercury has a characteristic appearance on chest X ray and can be distinguished from other conditions causing abnormal radiopacities in the lung fields. Although this phenomenon occurs rarely, its appearance should be recognized as serious sequelae for the patient may ensue. A 97-year-old man with a history of psoriasis, organic mental syndrome, arteriosclerotic heart disease and congestive failure was admitted to Mount Sinai Medical Center on September 1, 1981 with a two-day history of nausea, vomiting and abdominal distension. His past medical history included a right inguinal herniorrhaphy many years previously. On admission, vital signs and laboratory data were normal. Physical examination revealed diffuse psoriatic lesions. Rales were heard at both lung bases. The abdomen was diffusely tender, distended and tympanitic with no audible bowel sounds and a left inguinal hernia was present. Rectal examination revealed guiaiac negative stools. Chest radiograph showed cardiomegaly...

Computed tomography of the thorax in workers exposed to hard metals.

Hard metal disease is an occupational lung disorder occurring primarily among workers employed in the cemented tungsten carbide industry.1-6 Interstitial pulmonary fibrosis, acute obstructive pulmonary disease (asthma), and dermatitis are the main clinical manifestations of such exposure. The workers in this industry are at risk from exposure to powders of a variety of hard metals during the manufacture of tools. These metals include tungsten, titanium, tantalum, vanadium, niobium, and cobalt.1-3 They provide the hardness, strength, and heat resistance required in tools. Many are inert and harmless but cobalt is believed to be a causative agent of pulmonary disease. We performed thoracic computed tomography (CT) scans on 11 hard metal workers and describe the findings here.

Evaluation of the stimulated menstrual cycle by magnetic resonance imaging

Changes in uterine zonal anatomy in six women during a cycle of treatment with clomiphene citrate is studied by magnetic resonance imaging. There was a rapid rate of increase in endometrial thickness during the periovulatory period that was similar to the pattern seen in a prior study of women with normal (nonstimulated) cycles. Junctional zone thickness did not parallel the endometrial pattern and differed from the response seen in nonstimulated cycles. Results of large scale studies may help to further understand the effects of these medications.

Squamous cell carcinoma of the esophagus in Fanconi's anemia

The fifth reported case of esophageal carcinoma complicating Fanconis pancytopenia is described and discussed. This is a rare complication of Fanconis anemia, which is uncommonly associated with squamous cell malignancies and more commonly with leukemia.