Assessment of multidetector CT virtual hysterosalpingography as a reliable modality for the evaluation of female genital system abnormalities

Background: virtual hysterosalpingography is a novel, noninvasive modality that combines the capabilities of multidetector CT with the established technique of hysterosalpingography to allow a simultaneous non-invasive evaluation of the entire uterine wall, uterine cavity, cervix and Fallopian tubes. The evaluation of the para-uterine pelvic structures is considered as a great advantage of the procedure that can be an alternative diagnostic technique in the infertility workup algorithm. Virtual hysterosalpingography with the reconstruction of two-dimensional, three-dimensional, and virtual endoscopic views allows a comprehensive evaluation of the female reproductive system with a single imaging test, it gives well-appointed anatomic information and a detailed characterization of the different pathologic processes. In comparison with HSG, US and MR imaging techniques that have been used for the diagnostic work-up of female infertility; virtual hysterosalpingography provides more detailed information about abnormalities of the cervix, uterus, Fallopian tubes and other pelvic structures and it may allow a more accurate evaluation of tubal patency. However, the resultant exposure of the patient to ionizing radiation is a relative disadvantage that must be weighed against the clinical purpose

Aim of the work: this study aimed to evaluate the role of virtual CT hysterosalpingography as a new noninvasive modality for the assessment of the uterus and the Fallopian tubes abnormalities

Conclusion: VHSG has the ability to integrate most of the advantages of the diagnostic studies methods in the diagnosis and evaluation of the infertile female. Whether it should completely replace the use of standard conventional HSG among the infertile females, or be used as a back up to HSG and indicated when questionable or abnormal findings are encountered

Role of diffusion weighted MRI in diagnosis of cervical cancer

Background: Diffusion weighted magnetic resonance imaging [DW-MRI] is a functional, non-invasive imaging technique which generates tissue contrast from differences in mobility of water molecules that occurs during an MR pulse sequence. Information regarding the integrity of cellular membranes and tissue cellularity can be obtained, so that DW-MRI can now be included in routine patient assessment

Aim of the work: The aim of this study is to evaluate the role of DW-MRI in the diagnosis of cervical carcinoma, with pathological diagnosis was taken as the reference

Patients and Methods: This is a retrospective study that included 20 patients in whom cervical cancer had been suspected clinically or by transvaginal ultrasound [U/S] and the control group consisted of 20 patients in whom cervical cancer had not been suspected and MRI was performed because of other Pelvic diseases. The study was conducted in El-Demerdash Hospital. The patients were referred from the Gynecology Department to the Radiology Department [Women's imaging unit] for further MRI assessment with diffusion weighted images [DWIs]

Results: Lesions in all cases show restricted diffusion, however on apparent diffusion coefficient [ADC] map, only one case showed high signal proved to be chronic cervicitis on histopathology. Also, the mean ADC values for malignant lesions were [0.82 x10-[3] mm[2]/sec], while the mean ADC value in the control group was [1.58x10-[3] mm[2]/sec]. Therefore ADC value of [1.04 x10-[3] mm[2]/sec] is a cut off between normal cervical tissue and malignant cervical lesion by sensitivity 95% and specificity 95%. DWIs had elicited the same accuracy to Dynamic contrast-enhanced [DCE] sequences [95%] when added to the non-contrast MRI in the estimation of cancer cervix

Conclusion: Our results proved that [DW-MRI] was significantly beneficial in terms of diagnostic performance that increases the radiologist's confidence in image interpretation. So it implies a non-invasive technique which can be used especially if contrast intake is avoided as in pregnancy. Thus, we suggest that DWI should be included in the routine pelvic MRI protocol. The ADC value in case of cervical carcinoma was significantly lower than in the normal cervical tissue. The ADC threshold of [1.04 x10-[3] mm[2]/sec] was a cut off value, which was detected when differentiating between cancer-affected and non-affected cervical tissues