Michèle A. Brown

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

To determine the benefit of screening ultrasonography for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma.

Screening Ultrasound in Blunt Abdominal Trauma

Ultrasound is used worldwide to evaluate patients with blunt abdominal trauma. Sometimes referred to as an extension of the physical exam, ultrasound can rapidly help distinguish patients with injury requiring computerized tomography (CT) or surgery (typically 5%-10%) from those with no abdominal injury (> 90%). Ultrasound has several advantages in the setting of trauma. It is portable, integrates easily into the resuscitation of trauma victims without causing delay in therapy, is noninvasive, and has no associated morbidity. Limitations of ultrasound include its dependence on operator skill and technique, poor image quality in patients with morbid obesity or extensive subcutaneous gas, limited visualization of the retroperitoneum, and less reliable localization of visceral injury compared to CT. Successful use of abdominal ultrasound in the setting of trauma can be maximized with adequate sonographer training, appreciation of technical limitations, and adherence to an appropriate trauma ultrasound protocol.

Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings

The purposes of this study were to determine the (1) frequency with which nonenhanced computed tomography (CT) (NECT) permits conclusive diagnosis of acute appendicitis, (2) accuracy of NECT when findings are conclusive, and (3) overall accuracy of a CT protocol consisting of NECT with selective use of contrast. Five hundred and thirty-six patients underwent a NECT protocol with selective use of contrast. Diagnostic accuracy was then determined separately for (1) patients with conclusive initial NECT, (2) patients with inconclusive initial NECT, and (3) all patients. NECT was conclusive on initial interpretation in 404/536 patients and inconclusive in 132/536. Of 132 inconclusive studies, 126 were repeated with contrast (intravenous, oral or rectal). Sensitivity, specificity, and positive and negative predictive value for diagnosis of acute appendicitis were (1) 90%, 96.0%, 84.8%, and 97.4% in patients with conclusive NECT (n = 404); (2) 95.6%, 92.3%, 73%, and 99% in patients with inconclusive NECT followed by repeat CT with contrast; and (3) 91.3%, 95%, 82%, and 98% in all patients. The initial diagnosis of appendicitis may be made by NECT in 75% of patients, with contrast administration reserved for inconclusive NECT studies.

MRI of the Female Pelvis Using Vaginal Gel

OBJECTIVE Vaginal distention with aqueous gel optimizes MRI evaluation of the vaginal walls and outer contours of the cervix. The objective of this pictorial essay is to illustrate the use of vaginal gel for MRI of the female pelvis. CONCLUSION Distention of the vagina with gel is an inexpensive, well-tolerated procedure that may improve MRI evaluation of a variety of gynecologic conditions.

Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary syndrome and age-matched controls

To compare ovarian morphology in adolescent girls with and without polycystic ovary syndrome (PCOS) using magnetic resonance imaging (MRI).

Quantification of Fluid on Screening Ultrasonography for Blunt Abdominal Trauma A Simple Scoring System to Predict Severity of Injury

A simple ultrasonographic method of fluid quantification, which counted the number of fluid recesses, was developed to predict the severity of injury after blunt abdominal trauma. From 1994 to 1998, 2,693 screening ultrasonographic examinations were performed for blunt abdominal trauma. Of this group, 2,499 patients had a fluid score of 0 (no fluid), and 1.4% had injuries (0.4% requiring surgery); 110 had a score of 1 (fluid in a single examined region), and 59% had injuries (13% requiring surgery); 33 had a score of 2, and 85% had injuries (36% requiring surgery); 30 had a score of 3, and 83% had injuries (63% requiring surgery); and 21 had a score of 4, and 95% had injuries (81 % requiring surgery). Patients with scores of 3 or greater had significantly higher rates of injury (P < .002) and injury requiring surgery (P < .0001) than patients with lower scores. The ability to predict injury severity on the basis of a simple ultrasonographic scoring system should expedite treatment of patients with severe trauma.

Patterns of fluid accumulation on screening ultrasonography for blunt abdominal trauma: comparison with site of injury.

The objectives of this study were to define where fluid accumulation is shown on screening ultrasonography after blunt abdominal trauma and to determine how fluid accumulation patterns are associated with the site of injury. From 1994 to 1998, 2,693 screening examinations for blunt abdominal trauma were performed, in which 7 regions were examined for fluid. On the basis of a preliminary analysis of patients with solitary injuries, all 194 patients with sonographically detected fluid were grouped by fluid accumulation pattern. Fluid patterns were compared with sites of injury. The patterns differed between hepatic and splenic injuries. Fluid in the left upper quadrant, in both upper quadrants, or diffusely distributed suggested splenic injury, whereas fluid in the right upper quadrant or the right upper quadrant and lower recesses suggested hepatic injury (P < .0001). Fluid accumulation was random after enteric injury. Patients with extraperitoneal injury had no fluid or had fluid focally at the injury site. The ability to predict the injury site on the basis of fluid patterns should expedite treatment of hemodynamically unstable patients with blunt abdominal trauma.

Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study

OBJECTIVE The purpose of this study was to determine the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis during pregnancy in a multiinstitutional study. STUDY DESIGN In this multicenter retrospective study, the cases of pregnant women who underwent MRI evaluation of abdominal or pelvic pain and who had clinical suspicion of acute appendicitis between June 1, 2009, and July 31, 2014, were reviewed. All MRI examinations with positive findings for acute appendicitis were confirmed with surgical pathologic information. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated. Receiver operating characteristic curves were generated, and area under the curve analysis was performed for each participating institution. RESULTS Of the cases that were evaluated, 9.3% (66/709) had MRI findings of acute appendicitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive values were 96.8%, 99.2%, 99.0%, 92.4%, and 99.7%, respectively. There was no statistically significant difference between centers that were included in the study (pair-wise probability values ranged from 0.12-0.99). CONCLUSION MRI is useful and reproducible in the diagnosis of suspected acute appendicitis during pregnancy.

Multifocal intravascular papillary endothelial hyperplasia in the retroperitoneum and spine: A case report and review of the literature

The authors present a unique case of intravascular papillary endothelial hyperplasia (IPEH) localized in the renal hilum, retroperitoneum, and spine in a patient with Wegener granulomatosis. IPEH rarely occurs in the abdomen or spine with few cases reported in the literature. No case has been reported of IPEH involving both the retroperitoneum and spine. In our case, MR imaging revealed enhancing masses in the right renal hilum and retroperitoneum as well as multiple focal enhancing lesions throughout the spine with lower thoracic ventral thecal sac compression. The diagnosis was established by resection of the renal hilum mass, and interval follow‐up is deemed necessary for the remaining lesions because the long‐term evolution of IPEH with conservative treatment alone is not well established. J. Magn. Reson. Imaging 2009;29:957–961.

Women's imaging : MRI with multimodality correlation

Contributors, vii Preface, ix 1 Pelvis MRI: introduction and technique, 1 Michele A. Brown & Richard C. Semelka 2 Imaging the vagina and urethra, 8 Shannon St. Clair, Randy Fanous, Mohamed El-Azzazi, Richard C. Semelka, & Michele A. Brown 3 Pelvic floor imaging, 27 Laura E. Rueff & Steven S. Raman 4 Imaging the uterus, 49 Randy Fanous, Katherine M. Richman, Chayanin Angthong, Mohamed El-Azzazi, & Michele A. Brown 5 Imaging the adnexa, 88 Michele A. Brown, Mary K. O Boyle, Chayanin Angthong, Mohamed El-Azzazi, & Richard C. Semelka 6 Imaging maternal conditions in pregnancy, 131 Lorene E. Romine, Randy Fanous, Michael J. Gabe, Richard C. Semelka, & Michele A. Brown 7 Fetal imaging, 180 Lorene E. Romine, Ryan C. Rockhill, Michael J. Gabe, Reena Malhotra, Richard C. Semelka, & Michele A. Brown 8 Breast MRI: introduction and technique, 239 Michael J. Gabe, Jasmina Boban, Dragana Djilas, Vladimir Ivanovic, & Haydee Ojeda-Fournier 9 ACR breast MRI lexicon and interpretation, 264 Julie Bykowski, Natasa Prvulovic Bunovic, Dragana Djilas, & Haydee Ojeda-Fournier 10 Preoperative breast cancer evaluation and advanced breast cancer imaging, 296 Jade de Guzman, Dragana Bogdanovic-Stojanovic, Dragana Djilas, & Haydee Ojeda-Fournier 11 Postsurgical breast and implant imaging, 322 Julie Bykowski, Dag Pavic, Dragana Djilas, & Haydee Ojeda-Fournier 12 MR-guided breast interventions, 346 Michael J. Gabe, Dragana Djilas, Dag Pavic, & Haydee Ojeda-Fournier Index, 363