Sima Naderi

Sonographic Evaluation of Clinically Significant Perigraft Hematomas in Kidney Transplant Recipients

OBJECTIVE The purpose of this study was to assess the sensitivity of ultrasound in evaluating peritransplant hematomas that require surgical evacuation in recipients of kidney transplants. MATERIALS AND METHODS Thirty-four patients who underwent 37 hematoma evacuations underwent ultrasound examinations in the 24 hours before surgical evacuation. The operative reports were evaluated for presence and size of collection, presence of active bleeding at operation, and composition of the hematoma. The clinical findings leading to the ultrasound examination were recorded. Ultrasound examinations were evaluated in consensus by two board-certified and fellowship-trained abdominal radiologists for the presence, size, and echogenicity of the collection; subjective perfusion visualized with color and power Doppler ultrasound; velocities of the renal arteries; and arcuate artery resistive indexes. RESULTS Ten of the 37 imaged hematomas (27%) had either no or small (< 50 mL) fluid collections on ultrasound examination. With sonographic volumetry, the reported intraoperative volumes were underestimated by 46%. The mean arcuate artery resistive index was 0.82 in the superior pole, 0.81 in the mid pole, and 0.78 in the inferior pole of the kidney. A decrease in hemoglobin level was the most sensitive clinical finding for determining the presence of perigraft hematomas. CONCLUSION Our results suggest that gray-scale sonography alone appears to have limited sensitivity in detecting clinically significant peritransplant hematomas and that its use may result in overall underestimates of hematomas.

Utility of MRI in the Characterization of Indeterminate Small Renal Lesions Previously Seen on Screening CT Scans of Potential Renal Donor Patients

OBJECTIVE The purpose of this study was to determine whether MRI could more confidently characterize indeterminate small renal lesions (< 15 mm) previously seen on CT scans of potential renal donor patients and whether such characterization could impact surgical management and donor candidate status. MATERIALS AND METHODS After dedicated contrast-enhanced renal CT examinations of a population of renal donor patients identified indeterminate small renal lesions (< 15 mm), dedicated renal MRI examinations were performed for 55 of those patients. Two radiologists used consensus reading of established MRI characteristics to characterize indeterminate small lesions as simple cysts, hemorrhagic cysts, angiomyolipomas, or solid renal masses. RESULTS A total of 94 indeterminate small renal lesions were detected on CT. MRI was able to confidently diagnose 93 of those lesions, including 83 cysts, eight hemorrhagic cysts, and two angiomyolipomas. MRI directly affected the surgical management of four of the patients (7%). CONCLUSION For potential renal donor patients, MRI can be an effective means of characterizing lesions that are deemed to be too small to characterize by CT. MRI can also potentially alter the surgical management and donor status of this group of patients.

A primer for fetal cardiac imaging: a stepwise approach for 2-dimensional imaging.

Detection of congenital heart disease (CHD) remains problematic, even with advances in imaging. Imaging modalities, such as magnetic resonance imaging, have been helpful in better understanding certain abnormalities, such as the fetal central nervous system. However, because of cardiac motion, screening and detection of CHD are best performed by sonography. Although newer technical advances in sonography, including 3-dimensional (3-D) dynamic multiplanar imaging and Doppler techniques, are extremely helpful in better delineating CHD, the mainstay of detection of CHD remains 2-D real-time imaging. Understanding 2-D imaging of the heart, using multiple views, is necessary to perform any type of multiplanar imaging as both require basic understanding of the same basic views. Although it is beyond the scope of this article to review all facets of fetal cardiac imaging, we will present a stepwise approach using 2-D imaging in the detection of CHD.

Müllerian adenosarcoma: A malignant progression of adenomyosis?: Pictorial review with multimodality imaging

Müllerian adenosarcoma represents a variant of mixed müllerian tumors, which are composed of a mixture of benign, mildly atypical glandular epithelial elements, admixed within a sarcomatous, malignant stromal component.1 This rare entity was originally described in 1974 as müllerian adenosarcoma.2 Adenosarcomas arise from ectopic, glandular endometrial tissue within the uterine body. Uterine sarcomas of any type are very rare. Müllerian adenosarcomas are even rarer and account for only 5.5% of all uterine sarcomas.3 There have only been a few reports of the imaging features of these adenosarcomas. Most of these publications reviewed the magnetic resonance imaging (MRI) features of these tumors.4 There have been no reports of multiple combined imaging features from sonography, computed tomography (CT), MRI, and positron emission tomography (PET) of this rare entity. We present an unusual case depicting a 20-year-old woman with a long-standing history of menorrhagia and abnormal vaginal bleeding, since the age of 12 years. At age 14 years, she presented to the emergency department with persistent vaginal bleeding and at that time was also found to have a mildly elevated serum quantitative β-human chorionic gonadotropin (β-hCG) level of 21 mIU/mL. She underwent suction dilation and curettage for what was thought to be an incomplete abortion. However, in the removed specimen, products of conception were not identified. Instead, the pathologic diagnosis was determined to be a benign endometrial polyp. For several years after, she continued to have persistent vaginal bleeding and mildly elevated serum quantitative β-hCG levels in the range of 50 to 80 mIU/mL. However, her human placental lactogen level remained low, negative, or undetectable. She underwent several trials of oral contraceptives and eventually had an intrauterine device placed, in an attempt to control the bleeding. She also completed 2 rounds (4 weeks) of methotrexate therapy for presumed trophoblastic disease; however, her β-hCG level still failed to normalize. At age 15 years, during a clinic visit to reevaluate her vaginal bleeding, she was discovered to have a bluish mass protruding from her cervix, roughly 4 to 5 cm in length. She underwent another suction dilation and curettage, and the tissue removed was again diagnosed as a benign endometrial polyp, with a proliferative and secretory endometrium. At age 16 years, the patient underwent color Doppler sonographic (Figure 1A) and MRI (Figure 1B) examinations of the pelvis. Sonography showed an enlarged and bulbous-