Rochelle F. Andreotti

Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement.

The Society of Radiologists in Ultrasound convened a panel of specialists from gynecology, radiology, and pathology to arrive at a consensus regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women. The panel met in Chicago, Ill, on October 27-28, 2009, and drafted this consensus statement. The recommendations in this statement are based on analysis of current literature and common practice strategies, and are thought to represent a reasonable approach to asymptomatic ovarian and other adnexal cysts imaged at ultrasonography.

Preoperative Sonographic and Clinical Characteristics as Predictors of Ovarian Torsion

The purpose of this study was to determine the most closely associated sonographic and clinical characteristics of ovarian torsion.

Contrast-Enhanced Transvaginal Sonography of Benign Versus Malignant Ovarian Masses : Preliminary Findings

Objective. The aim of this prospective study was to evaluate differences in contrast enhancement and contrast enhancement kinetics in benign versus malignant ovarian masses with pulse inversion harmonic transvaginal sonography. Methods. Seventeen consecutive patients with 23 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic transvaginal sonography. The following parameters were assessed in all tumors: detectable contrast enhancement, time to peak enhancement (wash‐in), peak contrast enhancement, half wash‐out time, and area under the enhancement curve. Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Fourteen benign masses and 9 malignancies were studied. There was a statistically significant difference in the peak enhancement (mean ± SD, 23.3 ± 2.8 versus 12.3 ± 3.9 dB; P < .01), half wash‐out time (139.9 ± 43.6 versus 46.3 ± 19.7 seconds; P < .01), and area under the enhancement curve (2012.9 ± 532.9 versus 523.9 ± 318 seconds−1; P < .01) in malignant masses compared with benign disease. There was no statistically significant difference in the time to peak enhancement (26.1 ± 6.3 versus 24.9 ± 7.6 seconds; P = .07). Conclusions. Overall, our data showed a significant difference in the contrast enhancement kinetic parameters between benign and malignant ovarian masses.

Management of asymptomatic ovarian and other adnexal cysts imaged at US Society of Radiologists in Ultrasound consensus conference statement.

The Society of Radiologists in Ultrasound (SRU) convened a panel of specialists from gynecology, radiology, and pathology to arrive at a consensus regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women. The panel met in Chicago, IL, on October 27-28, 2009, and drafted this consensus statement. The recommendations in this statement are based on analysis of current literature and common practice strategies, and are thought to represent a reasonable approach to asymptomatic ovarian and other adnexal cysts imaged at ultrasonography.

Advances in Sonographic Detection of Ovarian Cancer: Depiction of Tumor Neovascularity With Microbubbles

OBJECTIVE The purpose of this article is to discuss and illustrate the use of contrast-enhanced transvaginal sonography for the early detection of ovarian cancer and suggest how this technique may best be used to distinguish benign from malignant ovarian masses. CONCLUSION Microbubble-enhanced transvaginal sonography can enhance the evaluation of ovarian masses by early detection of tumor microvascularity.

Diagnostic Parameters to Differentiate Benign From Malignant Ovarian Masses With Contrast-Enhanced Transvaginal Sonography

Objective. The aim of this study was to evaluate diagnostic parameters to differentiate between benign versus malignant ovarian masses using contrast‐enhanced transvaginal sonography (TVS). Methods. Thirty‐three consecutive patients with 36 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic TVS. The following parameters were assessed: presence of contrast enhancement, time to peak enhancement, peak contrast enhancement, half wash‐out time, and area under the enhancement curve (AUC). Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Twenty‐six benign masses and 10 malignancies were studied. Of all examined criteria, an AUC of greater than 787 seconds−1 was the most accurate diagnostic criterion for ovarian cancer, with 100.0% sensitivity and 96.2% specificity. Additionally, peak contrast enhancement of greater than 17.2 dB (90.0% sensitivity and 98.3% specificity) and half wash‐out time of greater than 41.0 seconds (100.0% sensitivity and 92.3% specificity) proved to be useful. Conclusions. Our data suggest that the AUC, peak enhancement, and half wash‐out time had the greatest diagnostic accuracy for contrast‐enhanced TVS in differentiation between benign and malignant ovarian masses.

ACR Appropriateness Criteria on acute pelvic pain in the reproductive age group.

Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation.

The changing sonographic appearance of fetal kidneys during pregnancy.

One hundred consecutive women between 11 and 40 weeks of gestation were studied to evaluate the changing appearances of the fetal kidneys. In the first trimester, the kidney was never positively identified. Between 15 and 26 weeks it was seen but was difficult to distinguish from surrounding tissue. In the early third trimester, either an echogenic border or increased echogenicity of the renal sinus was observed; in the late third trimester this increased echogenicity was observed in both areas. It is thought that the echogenicity is the result of fat deposition in the pararenal space and in the renal sinus.

Color Doppler sonography in obstetrics and gynecology

This review aims to provide the reader with an overview of the present and future clinical applications in color Doppler sonography for the evaluation of vascularity and blood flow within the uterus (both gravid and nongravid), ovaries, fetus and placenta. The clinical use of color Doppler sonography has been demonstrated within many organ systems. Color Doppler sonography has become an integral part of cardiovascular imaging. Significant improvements have recently occurred, improving the visualization and evaluation of intraorgan vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/or amplitude-based color Doppler sonography. Spatial representation of vascularity can be improved by utilizing 3D and 4D (live 3D) processing. Greater sensitivity of color Doppler sonography to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy and for pelvic organs. The potential use of contrast enhancement is also mentioned as a means to further differentiate benign from malignant ovarian lesions. The rapid development of these new sonographic techniques will continue to enlarge the scope of clinical applications in a variety of obstetric and gynecologic disorders.

ACR Appropriateness Criteria® Pretreatment Planning of Invasive Cancer of the Cervix

The prognosis of cervical cancer is linked to lymph node involvement, and this is predicted clinically and pathologically by the stage of the disease, as well as the volume and grade of the tumor. Staging of cervical cancer based on International Federation of Gynecology and Obstetrics (FIGO) staging uses physical examination, cystoscopy, proctoscopy, intravenous urography, and barium enema. It does not include CT or MRI. Evaluation of the parametrium is limited in FIGO staging, and lymph node metastasis, an important prognostic factor, is not included in FIGO staging. The most important role for imaging is to distinguish stages Ia, Ib, and IIa disease treated with surgery from advanced disease treated with radiation therapy with or without chemotherapy. This article reviews the current role of imaging in pretreatment planning of invasive cervical cancer. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.