Marshall C. Mintz

MR imaging of cerebral abnormalities in utero

In view of the lack of ionizing radiation, ability to image in a variety of planes, and high contrast resolution, magnetic resonance (MR) imaging may have a role in obstetrical management. Three fetuses with severe cerebral abnormalities were studied by MR in utero. The findings were correlated with ultrasound examinations and with autopsy results. Ventricular dilatation and progression of hydrocephalus were detected by MR. Although fetal motion may affect image quality, diagnostically useful images were obtained with imaging times of 2.5 min.

Mr Imaging of Fetal Brain

Magnetic resonance (MR) imaging was used to evaluate normal fetal intracranial anatomy in axial, coronal, and sagittal planes. The T1 and T2 weighted images (WI) of aborted fetuses of varying gestational ages were correlated with anatomic sections. In the premature fetus three distinct intensity zones were seen on MR that were not visualized on gross specimens. Unmyelinated white matter displays low intensity on T1 W1 and high intensity on T2 W1. Maturational changes of the brain were observed with advancing fetal age.

Hepatic and biliary tract abnormalities in patients with AIDS. Sonographic-pathologic correlation.

A retrospective evaluation of hepatobiliary sonograms in 22 patients with AIDS was performed and the sonographic abnormalities were correlated with pathologic findings in 10 patients. Hepatic parenchymal abnormalities noted on ultrasound include a hyperechoic parenchymal echo pattern in 45.5%, hepatomegaly in 41%, and focal masses in 9% of patients. Etiologies for the diffuse hyperechoic pattern based on pathologic correlation in eight cases were hepatic steatosis and granulomatous hepatitis. Biliary tract abnormalities identified included gallbladder wall thickening in 55% of patients, dilated gallbladder in 18%, biliary sludge in 23%, and gallstones in 5% of patients. Extrahepatic ductal dilation was seen in 23% of patients, but the intrahepatic ducts were dilated in only 5% of patients. Possible etiologies for biliary tract abnormalities suggested by pathologic correlation in five patients and literature review were cytomegalovirus and cryptosporidial infection, although constitutional factors may have played a role. Hepatobiliary ultrasound is, therefore, an effective screening tool for directing further diagnostic and therapeutic procedures in AIDS patients presenting with clinical evidence of hepatobiliary dysfunction.

Sonographic diagnosis of fetal growth disorders.

In summary, accurate identification of fetal growth disorders remains a difficult clinical challenge. Many diagnostic parameters have been devised to diagnose these conditions, however, no single test alone allows a confident antenatal diagnosis of IUGR or macrosomia to be established. Until new criteria or new methods such as Doppler analysis of umbilical artery flow permit a more accurate prediction of growth disturbances, multiple parameters should be monitored. Evaluation of the amniotic fluid volume, BPD, FL, AC, and EFW should be included in all studies. In high risk cases (unexplained oligohydramnios, previous history of growth retardation, poor nutritional status, abnormal sonographic parameters, maternal obesity, diabetes mellitus, etc.) additional measurements such as the HC/AC ratio and the FL/AC ratio should also be evaluated. Similarly, evaluation of suspected excessive fetal growth requires careful evaluation of AC measurements. Patients with suspected growth disorders should be reevaluated with serial scans at 2 to 3 weeks intervals. Careful monitoring of fetuses with suspected IUGR and macrosomia may decrease much of the morbidity and mortality associated with these conditions.

CT demonstration of pulmonary effects of tangential beam radiation

Breast cancer is sometimes treated with an excisional biopsy and a radiation portal limited to the breast and the adjacent chest wall, especially in patients with negative lymph node dissections. The beam passes through this portion of the chest wall tangentially. Such radiation can result in changes in the included lung parenchyma that are pleural-based and sharply demarcated from the normal lung on CT lung windows. In our experience CT lung windows were more sensitive than chest radiography in showing these changes. Such changes must be recognized and differentiated from pleural metastases. Computed tomography also resulted in a more specific diagnosis than chest radiography because it better localized the abnormality to the radiation portal.

Sonographic assessment of the endometrium in patients undergoing in vitro fertilization.

Sonography has an important role in the care of infertile patients undergoing in vitro fertilization. Unlike the ovarian follicle, sonographic changes in the endometrium during induction have not been extensively investigated. To determine whether changes in endometrial thickness or changes in endometrial texture would predict subsequent pregnancy, a randomized, double‐blind review of 320 studies was performed. None of the endometrial patterns nor any particular change from one pattern to another during induction was predictive of subsequent pregnancy. Although differences in endometrial thickness between non‐pregnant and subsequently pregnant patients were noted, on an individual basis, endometrial thickness was not a useful predictor.

Abruptio placentae: apparent thickening of the placenta caused by hyperechoic retroplacental clot.

Antepartum bleeding occurs in approximately 3.5 per cent of third trimester pregnancies, with placental abruption being the causative factor in up to 32 per cent of cases. 1 Although the diagnosis of abruptio placentae is often based solely on the clinical examination, sonographic studies may confirm the condition. Primary sonographic findings are visualization of a retroplacental mass of varying echogenicity and/or bulging of the chorionic plate. This mass effect has commonly been described as hypoechoic or anechoic and is related to bleeding or infarction. 2·3 In this report, two unusual cases are presented of abruptio placentae which initially presented as homogenously enlarged placentas. In the proper clinical setting, this finding should heighten suspicion of abruptio placentae.

Retroperitoneal manifestations of sarcoidosis on computed tomography

Surgicalhree patients with known or subsequently proven sarcoidosis had CT of the retroperitoneum because of clinical symptoms referable to this area. Gross splenomegaly was evident in all cases. The liver was massively enlarged in one patient and normal size in two patients. Lymphadenopathy was present in many nodal groups.

In utero sonographic diagnosis of intracerebral hemorrhage.

Figure 1. A (top left) , coronal sonogram showing dilated ventricles (arrowheads). c, choroid plexus. B (lower left), coronal sonogram showing a large echogenic area (arrows) in the region of the lateral ventricle. An additional smaller abnormal area (arrowhead) is seen nearby. t, ten~ torium. C (lower right) , axial sonogram re· vealing a possible fluid level (arrows) as£ sociated with an echogenic mass.

CT diagnosis of villous adenoma

Villous adenoma may have a specific appearance on barium enema examination but specific CT findings of villous adenoma have not been previously described. Two recently encountered cases of villous adenoma in the rectum had a distinctive pattern on CT. Suggested criteria for CT diagnosis of villous adenoma include a homogeneous water density component of less than 10 HU, occupying more than half the lesion and eccentric on the luminal side of the mass. This low density component interfaces with the majority of the luminal surface of the lesion. No air-fluid level is seen and the lesion should not have a round cystic configuration. A description of these findings is illustrated and discussed.