Diane Bergin

Adnexal Torsion New Clinical and Imaging Observations by Sonography, Computed Tomography, and Magnetic Resonance Imaging

The purpose of this study was to review the clinical, imaging, and pathologic findings associated with adnexal torsion.

Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast-enhanced magnetic resonance cholangiography

To determine the diagnostic performance of functional magnetic resonance cholangiography (fMRC) for the evaluation of anatomic and functional biliary disorders.

Indirect magnetic resonance arthrography

Indirect MR arthrography is useful for evaluation of joints such as the elbow, wrist, ankle and shoulder where there is a large synovial surface area relative to joint volume. It allows simultaneous assessment of both intra-articular and extra-articular soft tissues with the added advantage of minimal invasiveness. The established and potential uses of this imaging technique are reviewed below and the pathology that is demonstrated by this technique is discussed.

Adenomyosis:Common and Uncommon Manifestations on Sonography and Magnetic Resonance Imaging

Objective. The purpose of this presentation is to show the imaging findings of the common and uncommon variants of adenomyosis as seen on sonography and magnetic resonance imaging (MRI). Methods. A 3‐year database search was performed to identify women who had pelvic sonography and pelvic MRI within a 6‐month interval. Images of these cases were retrospectively reviewed. Results. Eighty women were identified. Adenomyosis was diagnosed on MRI, which was used as the reference standard, in 45 of these women. The correct diagnosis was made on sonography in 73% of the cases. Conclusions. Awareness of the spectrum of imaging features of adenomyosis is important to use sonography effectively for diagnosing this entity and to help avoid misdiagnosis.

Imaging Shoulder Instability in the Athlete

Athletes who partake in overhead or throwing activities frequently suffer from shoulder pain. Glenohumeral instability plays an important role in sports-related shoulder pain. Shoulder instability can be traumatic, atraumatic, or microtraumatic in origin. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement and chronic damage to intra-articular structures. MR arthrography is the modality of choice for assessing glenohumeral instability and diagnosing labroligamentous injuries. This article reviews imaging of instability-related injuries in athletes, with special emphasis on MR imaging.

Adenomyosis: Sonohysterography with MRI Correlation

OBJECTIVE The purpose of this study was to describe the sonohysterographic features of adenomyosis with MRI correlation. CONCLUSION In this study, when the sonohysterographic findings suggested adenomyosis, MRI findings confirmed the diagnosis in 96% of cases. Myometrial cracks are, to our knowledge, a previously undescribed sonohysterographic sign of adenomyosis.

Indirect Soft-Tissue and Osseous Signs on Knee MRI of Surgically Proven Meniscal Tears

OBJECTIVE The purpose of this study was to determine the frequency of abnormal MR signal intensity in soft tissues and osseous structures in association with surgically proven meniscal tears. MATERIALS AND METHODS Seventy patients underwent 1.5-T MRI of the knee and arthroscopy within 3 months. MR images were reviewed by two radiologists for parameniscal cysts, bowing and edema around the collateral ligament, meniscal extrusion, cartilage loss, and nonlinear and linear subchondral marrow edema. The findings were correlated with the arthroscopic findings. The positive predictive value (PPV), sensitivity, and specificity of indirect signs were calculated. RESULTS Fifty-three medial and 28 lateral meniscal tears were found at arthroscopy. The PPV of indirect signs of meniscal tear was 0.17-1.00 for reader 1 and 0.37-1.00 for reader 2. The PPV of parameniscal cysts was 1.00 for medial and lateral meniscal tears for both readers. The specificity and PPV of periligamentous edema and cruciate ligament bowing for medial meniscal tear were 0.94 and 0.98 for both readers, 0.88 and 0.94 for reader 1, and 0.94 and 0.97 for reader 2. The specificity and PPV of subchondral marrow edema for medial meniscal tear were 0.88 and 0.96 for reader 1 and 0.94 and 0.97 for reader 2 and for lateral meniscal tear were 0.98 and 0.92 for reader 1 and 1.00 and 1.00 for reader 2. The specificity and PPV of linear subchondral marrow edema for medial meniscal tear were 0.94 and 0.97 for reader 1 and 1.00 and 1.00 for reader 2. For lateral meniscal tear, the values were 0.98 and 0.89 for reader 1 and 1.00 and 1.00 for reader 2. The specificity and PPV of nonlinear subchondral marrow edema for medial meniscal tear were 0.94 and 0.89 for reader 1 and 1.00 and 1.00 for reader 2. For lateral meniscal tear, the values were 0.89 and 0.97 for reader 1 and 1.00 and 1.00 for reader 2. The specificity and PPV of cartilage loss for medial meniscal tear were 0.88 and 0.94 for reader 1 and 0.88 and 0.93 for reader 2. For lateral meniscal tear, the values were 0.85 and 0.56 for reader 1 and 0.97 and 0.80 for reader 2. CONCLUSION Indirect MRI signs occur in association with meniscal tears and can aid diagnostic confidence when the MRI meniscal appearance is equivocal.

Submucosal Fibroids Becoming Endocavitary Following Uterine Artery Embolization: Risk Assessment by MRI

OBJECTIVE The purpose of our study was to assess the relationship between the endometrium and submucosal fibroids before and after uterine artery embolization (UAE). MATERIALS AND METHODS Contrast-enhanced pelvic 1.5-T MRI was performed in 49 women before and after UAE over a 2-year period. Dominant (largest diameter) fibroids in intramural, submucosal, subserosal, pedunculated subserosal, and endocavitary locations were assessed on pre- (baseline) and postembolization MRI. Size, locations of dominant fibroids relative to endometrium and serosa before and after embolization were compared. The ratio between the largest endometrial interface and the maximum dimension of the dominant submucosal fibroid (interface-dimension ratio) was determined on baseline MRI. The infarction rate for dominant fibroids was estimated after UAE. RESULTS One hundred forty dominant fibroids were identified on baseline MRI. Forty-nine (35%) were intramural, 39 (28%) were submucosal, 34 (24%) were subserosal, eight (6%) were pedunculated subserosal, and 10 (6%) were endocavitary in location on preembolization MRI. After UAE, of 39 dominant submucosal fibroids, 13 (33%) became endocavitary: complete (n = 4), partial (n = 9) on the basis of European Society of Gynaecological Endoscopy (ESGE) classification. The preembolization mean interface-dimension ratio and mean diameters for dominant fibroids that became endocavitary were significantly greater than for those that did not become endocavitary after embolization (0.65 vs 0.32, p < 0.005; 8 vs 5.4 cm, p < 0.05, respectively). All dominant submucosal fibroids showed 100% infarction after UAE. CONCLUSION Submucosal fibroids with an interface-dimension ratio of greater than 0.55 are more likely to migrate into the endometrial cavity after UAE. The majority of these are expelled spontaneously without significant symptoms. Rarely, submucosal fibroids greater than 6 cm in size that become endocavitary may cause postprocedural complications requiring further intervention and medical treatment.

Abnormalities on MRI of the Subscapularis Tendon in the Presence of a Full-Thickness Supraspinatus Tendon Tear

OBJECTIVE Our objective was to determine the association between size and chronicity of full-thickness supraspinatus tendon tears with subscapularis tendon abnormalities on MRI. MATERIALS AND METHODS One hundred forty-two MRI examinations with full-thickness supraspinatus tendon tears were categorized on the basis of the supraspinatus muscle (SS): normal muscle (SS(normal)), suggesting a recent or small tear; reduced muscle bulk without fatty atrophy (SS(volume loss)); and those with fatty atrophy, suggesting a large or chronic tear (SS(fatty atrophy)). Subscapularis tendon abnormalities, the subcoracoid interval, and subcortical bone marrow edema in the lesser tuberosity and coracoid process were recorded. RESULTS The mean size of supraspinatus tendon tears in the SS(normal) (n = 45) group was 8.5 mm, 16.6 mm in SS(volume loss) (n = 53), and 29 mm in the SS(fatty atrophy) group (n = 44). Subscapularis tendon abnormality was identified in 22% of SS(normal) patients, 61% of SS(volume loss), and 86% of the SS(fatty atrophy) group (p < 0.001). There was moderate correlation between chronicity of supraspinatus tendon tears and subscapularis tendon abnormality (r = 0.47; p < 0.0001), with no correlation between the subcoracoid interval and abnormalities of the subscapularis tendon. There was moderate correlation between chronicity of supraspinatus tendon tears and bone marrow changes in the lesser tuberosity (r = 0.44; p < 0.0001). CONCLUSION Subscapularis tendon abnormality is related to chronicity of supraspinatus tendon tears. Bone marrow edema in the lesser tuberosity with a subscapularis tendon abnormality suggests increased stress at the subscapularis tendon insertion with chronicity of full-thickness supraspinatus tendon tears. Lack of correlation with the subcoracoid interval indicates that anterior instability may be a more important contributing factor to subscapularis tendon abnormalities than static subcoracoid impingement in the setting of a full-thickness supraspinatus tendon tear.

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.