Ultrasonographic and clinical appearance of hemorrhagic ovarian cyst diagnosed by transvaginal scan.

We examined clinical and sonographic findings in 112 patients diagnosed as having hemorrhagic ovarian cyst (HOC) who had clinical and transvaginal sonographic follow up. The patients were classified into group A (n=40) with signs and symptoms of acute abdomen and group B (n=72) with no symptoms or mild abdominal pain, and their ultrasonographic and clinical findings were compared. Significant differences were found in mean age, white blood cell (WBC) count, greatest diameter of the mass, shortest diameter of the mass, and size of cross section of the mass. The internal echograms of HOCs were grouped into 4 types: (1) hyperechoic and hypoechoic solid type; (2) reticular or sponge-like type; (3) mixture type of solid and cystic components; and (4) cystic types. In all image types, septum-like or thread-like echoes were seen. Transvaginal sonography (TVS) of type 1, type 2, and type 3 images showed a clear division into hyperechoic and other areas with the passing of time which was finally changed into a cystic pattern and disappeared. HOCs were found more frequently in nulliparous patients (n=79, 70.5%) than in multiparous (n=33, 29.5%). There were many luteal phase (n=86, 76.8%) in comparison with follicular phase (n=13, 11.6%). Thirteen cases were detected during early gestation (n=13, 11.6%). In group A, severe pain reduced or disappeared within 3 h in 37/40 (92.5%) of the patients. Blood flow inside the masses was analyzed in 14 patients by the color Doppler method and showed no significant change. Taken together, this study elucidated the ultrasonographic and clinical characteristics of HOCs, which provide useful information to differentiate HOCs from organic masses and help to avoid unnecessary laparotomy.

The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography.

PURPOSE: To evaluate the demonstration of the pearl necklace sign at magnetic resonance (MR) cholangiopancreatography (MRCP) in patients with proven adenomyomatosis and carcinoma of the gallbladder. MATERIALS AND METHODS: MRCP findings and those of a combination of unenhanced and arterial phase computed tomography (CT) and arterial phase MR imaging were retrospectively compared in 29 patients who were pathologically proven to have adenomyomatosis of the gallbladder and in 18 patients with pathologically proven gallbladder carcinoma. Receiver operating characteristic (ROC) analysis was used with a five-point confidence scale. The relative sensitivity, specificity, and accuracy of each imaging modality were also calculated. The pearl necklace sign was defined on MRCP images as small round foci, with the same markedly high signal intensity as bile, within the thickened wall of the gallbladder. RESULTS: The mean area under the ROC curve of MRCP alone and that of the combination of MRCP and arterial phase MR imaging was significantly higher than that of combined CT (unenhanced and arterial phase) and arterial phase MR imaging alone (P <.01). The relative sensitivities in the diagnosis of adenomyomatosis of the gallbladder were 24% for the combined CT, 29% for arterial phase MR imaging, 62% for MRCP, and 57% for the combination of MRCP and arterial phase MR imaging. The mean relative sensitivity, specificity, and accuracy of the pearl necklace sign on MRCP images were 62%, 92%, and 74%, respectively. In eight (28%) of 29 patients with adenomyomatosis of the gallbladder, the pearl necklace sign was not identified by all three readers on the MRCP images. CONCLUSION: The pearl necklace sign, which indicates the presence of Rokitansky-Aschoff sinuses within the thickened gallbladder wall, was specifically detected at MRCP for adenomyomatosis of the gallbladder.