Liina Poder

MRI of adnexal masses in pregnancy.

OBJECTIVE The objective of this article is to provide a practical review of the incremental benefit of MRI in the assessment of adnexal masses in pregnancy. CONCLUSION MRI can assist sonographic assessment of adnexal masses in pregnancy by depicting the characteristic findings of exophytic leiomyoma, red degeneration of leiomyoma, endometrioma, decidualized endometrioma, and massive ovarian edema. Accordingly, MRI should be considered as a useful adjunct when sonography is inconclusive or insufficient to guide management of adnexal masses discovered in pregnancy.

Fetal tracheolaryngeal airway obstruction: prenatal evaluation by sonography and MRI.

We reviewed the sonographic and MRI findings of tracheolaryngeal obstruction in the fetus. Conditions that can cause tracheolaryngeal obstruction include extrinsic causes such as lymphatic malformation, cervical teratoma and vascular rings and intrinsic causes such as congenital high airway obstruction syndrome (CHAOS). Accurate distinction of these conditions by sonography or MRI can help facilitate parental counseling and management, including the decision to utilize the ex utero intrapartum treatment (EXIT) procedure.

Radiologic mimics of cirrhosis.

OBJECTIVE The objective of this article is to provide a practical review of the conditions other than cirrhosis that can result in diffuse surface nodularity of the liver or portal hypertension. CONCLUSION Conditions that can mimic cirrhosis on imaging include pseudocirrhosis of treated breast cancer metastases to the liver, fulminant hepatic failure, miliary metastases, sarcoidosis, schistosomiasis, congenital hepatic fibrosis, idiopathic portal hypertension, early primary biliary cirrhosis, chronic Budd-Chiari syndrome, chronic portal vein thrombosis, and nodular regenerative hyperplasia.

Imaging of nontraumatic adrenal hemorrhage.

OBJECTIVE The purpose of this pictorial essay is to review the imaging findings of acute, chronic, and tumor-related nontraumatic adrenal hemorrhage. CONCLUSION Rapid development or evolution of a nonenhancing adrenal mass or masses with an adreniform shape or high T1 signal intensity on MR images of a patient under stress or with a bleeding diathesis, including anticoagulant use, suggests acute adrenal hemorrhage. Chronic hemorrhage appears as a thin-walled pseudocyst or atrophy. Imaging findings that may indicate underlying tumor include intralesional calcification, enhancement, and hypermetabolic activity on PET images.

Accuracy of Plain Abdominal Radiographs in the Detection of Retained Surgical Needles in the Peritoneal Cavity

Objective:To determine the accuracy of plain abdominal radiographs in the detection of retained surgical needles of varying size in the peritoneal cavity. Summary Background Data:Accidental retention of surgical foreign bodies in the peritoneal cavity is estimated to occur once in every 1000 to 1500 abdominal operations and early prevention and identification of retained foreign bodies is increasingly important because of mounting public awareness. Most of the existing literature on the imaging detection of surgical foreign bodies has focused on retained sponges, even though retained needles may account for up to 50% of such objects and the true accuracy of plain abdominal radiographs in the detection of retained needles is not well established. Methods:Eight plain radiographs were obtained of a 41 kg pig cadaver after placement of a total of 39 surgical needles of varying size (4–77 mm in length) in a randomized selection of the 9 segments of the peritoneal cavity. Five radiologists independently reviewed the radiographs and indicated the location of all suspected retained needles. Analyses were performed using the known site and size of placed needles as the standard of reference. Results:In total for all readers, 195 needles were detectable in 360 abdominal segments. The overall mean accuracy, sensitivity, and specificity for plain radiographs in the detection of retained surgical needles were 74% (267 of 360), 69% (135 of 195), and 80% (132 of 165), respectively. Sensitivity for needles 25 mm or more in length was significantly (P < 0.0001) higher than that for needles of 11 to 24 mm or 10 mm or less, with respective values of 99% (69 of 70), 84% (46 of 55), and 29% (20 of 70). Readers demonstrated moderate interobserver agreement, with a multireader κ value of 0.60. Conclusions:Abdominal radiographs have high sensitivity and interobserver agreement in the detection of retained surgical needles over 10 mm in length, but smaller needles are detected with significantly lower sensitivity and the utility of plain abdominal radiographs in this setting is more debatable.

Role of Sonography in the Recognition, Assessment, and Treatment of Cesarean Scar Ectopic Pregnancies

Objective. Cesarean scar ectopic pregnancies (CSEPs) are rare but may have serious adverse consequences and are therefore important to promptly recognize on sonography. We aim to describe the typical sonographic appearances. Potential treatments are discussed, including sonographic guidance for transcervical injection of methotrexate (MTX) into the gestational sac. Methods. Two patients with CSEPs were treated with systemic and intra‐amniotic administration of MTX under sonographic guidance. Results. Both patients were followed clinically after medical treatment, resulting in low maternal morbidity and mortality. Conclusions. Considering the increasing rate of cesarean delivery and the increased risk of CSEPs, sonologists should be familiar with the sonographic appearances of a pregnancy implanted into the cesarean scar. We show how to correctly diagnose scar implantation and describe how to perform sonographically guided transcervical injection of MTX.

Round ligament varices: sonographic appearance in pregnancy

Round ligament varices (RLV) are an important clinical entity as they may cause hernia‐like symptoms in the absence of a true hernia. When this condition is diagnosed correctly, unnecessary intervention may be prevented. We aimed to determine the significance and anatomy of RLV in pregnancy and to review and describe their clinical and sonographic appearance. We followed prospectively five patients who presented during pregnancy with clinical symptoms suspicious of an inguinal hernia. All patients were diagnosed with RLV on ultrasound examination. All patients were managed conservatively and in all five cases, RLV resolved spontaneously postpartum. The diagnosis of RLV should be considered in pregnant women presenting with a groin mass. Sonography is diagnostic and can save unnecessary surgical exploration and associated morbidity. Copyright

Decidualized Endometrioma During Pregnancy : Recognizing an Imaging Mimic of Ovarian Malignancy

Objective: To present the ultrasound and magnetic resonance imaging findings that may allow for a prospective diagnosis and expectant management of decidualized endometriomas because the rare occurrence of decidualization in the ectopic endometrial stroma of an endometrioma during pregnancy can mimic ovarian cancer at imaging. Case Report: Smooth lobulated mural nodules with prominent internal vascularity were noted in an apparent right ovarian endometrioma on serial ultrasound studies in a 34-year-old woman at 12, 21, 27, and 30 weeks of gestation. Magnetic resonance imaging demonstrated the nodules to be strikingly similar in intensity and texture to the decidualized endometrium in the uterus on T2-weighted sequences. A provisional diagnosis of decidualized endometrioma allowed for expectant management with immediate postpartum resection and confirmation of the diagnosis. Conclusions: Decidualized endometrioma can mimic ovarian malignancy during pregnancy, but a prospective diagnosis may be possible when solid smoothly lobulated nodules with prominent internal vascularity within an endometrioma are seen from early in pregnancy, and the nodules demonstrate marked similarity in signal intensity and texture with the decidualized endometrium in the uterus at magnetic resonance imaging.

Acute Appendicitis: Clinical Outcome in Patients with an Initial False-Positive CT Diagnosis

PURPOSE To investigate the clinical outcome in patients with a diagnosis of appendicitis at computed tomography (CT) in whom treatment is deemed unnecessary after clinical evaluation. MATERIALS AND METHODS After institutional review board approval, 2283 patients (856 men, 1427 women; mean age, 46 years; age range, 18-99 years) who underwent CT because they were suspected of having appendicitis between 2002 and 2007 were retrospectively identified. CT reports were reviewed, and the likelihood of appendicitis was assigned a score on a five-point scale: score 1, definitely absent; score 2, nonvisualized appendix with no secondary signs of inflammation; score 3, equivocal; score 4, probable; and score 5, definitely present. Diagnosis of appendicitis at CT was considered a false-positive result if the CT report was classified as probable or definite appendicitis but the patient was not treated within 4 days. Cases with false-positive results were reviewed by two readers blinded to patient outcome, supporting clinical data, and prospective scan interpretation, and a grade was assigned by using the same scale. Medical records were reviewed to determine outcomes. Descriptional statistics were used. RESULTS Overall, 516 (23%) of 2283 patients had CT findings of probable or definite appendicitis. Thirteen (3%) of 516 patients did not receive immediate treatment for appendicitis. Of these, five (38%; 95% confidence interval: 18%, 65%) underwent later appendectomy with proved appendicitis after a mean interval of 118 days (range, 5-443 days). Seven (54%) of 13 patients never developed appendicitis across a mean follow-up of 583 days (range, 14-1460 days). One (8%) of 13 had a normal appendix at eventual surgery. CONCLUSION Five of 13 patients with CT findings of appendicitis and reassuring clinical evaluation results in whom immediate treatment was deferred ultimately returned with appendicitis. In patients with CT results positive for appendicitis and benign or atypical clinical findings, a diagnosis of chronic or recurrent appendicitis may be considered.

CT and MRI of Early Intrauterine Pregnancy

OBJECTIVE The objective of this article is to describe the CT and MRI findings of early intrauterine pregnancy. CONCLUSION Early pregnancy should be considered when CT or MRI shows a fluid-filled cystlike structure in the uterus of a woman of reproductive age especially if there is a coexistent ovarian corpus luteum cyst.