High signals in the uterine cervix on T2-weighted MRI sequences.

The aim of this pictorial review was to illustrate the normal cervix appearance on T2-weighted images, and give a review of common or less common disorders of the uterine cervix that appear as high signal intensity lesions on T2-weighted sequences. Numerous aetiologies dominated by cervical cancer are reviewed and discussed. This gamut is obviously incomplete; however, radiologists who perform MR women's imaging should perform T2-weighted sequences in the sagittal plane regardless of the indication for pelvic MR. Those sequences will diagnose some previously unknown cervical cancers as well as many other unknown cervical or uterine lesions.

Imaging of membranous dysmenorrhea.

Membranous dysmenorrhea is an unusual clinical entity. It is characterized by the expulsion of huge fragments of endometrium during the menses, favored by hormonal abnormality or drug intake. This report describes a case with clinical, US, and MRI findings before the expulsion. Differential diagnoses are discussed.

Interventional radiology in female infertility: technique and role.

The purpose of this paper is to describe the modifications in the radiologic approach to female infertility. The role of hysterosalpingography (HSG) has evolved from being the only source of information about the uterus to a more minor role, after ultrasound, that essentially deals with the morphology of the fallopian tubes. But if its diagnostic yield in the uterus is challenged by ultrasound and hysterosonography, it retains a major impact in the work-up of female infertility. Hysterosalpingography brings decisive diagnostic information concerning the state of the tubes and peritoneum. The interventional procedures of selective salpingography and tubal recanalization have a definite therapeutic effect and allow numerous pregnancies that would otherwise have required in vitro fertilization or tubal microsurgery.

A review of selective salpingography and fallopian tube catheterization.

Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.

Static and dynamic MRI of a urinary control intra-vaginal device.

The aim of this study was to describe by MRI, in dynamic conditions at rest and straining, the anatomical modifications induced by a commercially available intravaginal device (IVD) aimed at relieving female stress urinary incontinence. Ten female patients complaining of stress urinary incontinence (SUI) had pelvic MRI with static and dynamic sequences, without and with a self-inserted IVD. We studied positions and angulations of the IVD in the pelvis. Paired t-test allowed comparisons of: position of the bladder neck; urethral angulation with the pubis axis; position of the urethra; and posterior urethro-vesical angle (PUVA) without and with IVD. At rest, in ten of ten cases IVD laid cranial to the pubo-rectal muscle; with an average angulation of 95 +/- 10 degrees with the pubis axis, laterally tilted in three of ten cases. In maximum straining with IVD bladder neck descent was lower by an average of 5.2 +/- 3.1 mm (p = 0.001), pubo-urethral angle opening was smaller by an average of 22 +/- 20 degrees (p = 0.015), and bladder neck to pubis distance was shorter by an average of 5.7 +/- 4 mm. Posterior urethro-vesical angle was not significantly modified. Dynamic MRI allowed a non-invasive assessment of the mode of action of an IVD. The main modifications were a support of the bladder base and bladder neck, with a superior displacement of the urethra toward the pubis.

Effect of field strength on MR images: comparison of the same subject at 0.5, 1.0, and 1.5 T.

To assess the effect of field strength on magnetic resonance (MR) images, the same healthy subject was imaged at three field strengths: 0.5, 1.0, and 1.5 T. Imaging was performed with three similarly equipped MR imagers of the same generation and from the same manufacturer. The same imaging sequences were used with identical parameters and without repetition time correction for field strength. Imaging was performed in four anatomic locations: the brain, lumbar spine, knee, and abdomen. Quantitative image analysis involved calculation of signal-to-noise ratio, contrast-to-noise ratio, and relative contrast; qualitative image analysis was performed by four readers blinded to field strength. The results of all of the examinations were considered to be of diagnostic value. In general, signal-to-noise ratio and contrast-to-noise ratio were lowest at 0.5 T and highest at 1.5 T; relative contrast was not related to field strength. At qualitative analysis, images obtained at 1.0 and 1.5 T were superior to images obtained at 0.5 T; qualitative differences were less important in locations where there is motion or high magnetic susceptibility differences between tissues (e.g., the spine and abdomen). However, excellent image quality was obtained with all three field strengths.

Unselected brain 0.5-T MR imaging: comparison of lesion detection and characterization with three T2-weighted sequences.

PURPOSE: To compare the diagnostic values of three T2-weighted sequences in unselected brain 0.5-T magnetic resonance (MR) imaging examinations. MATERIALS AND METHODS: MR imaging was performed in 102 patients because of neurologic symptoms or the follow up "previously known disease." The protocol comprised three T2-weighted sequences: turbo spin-echo (SE), turbo fluid-attenuated inversion-recovery (FLAIR), and gradient and SE (GRASE) sequences. In a prospective, blinded analysis, sequences were compared quantitatively and qualitative by three independent readers for lesion detection and characterization. RESULTS: Twenty-four patients had normal findings, and 78 had abnormal findings, with 121 final diagnoses. Quantitatively, the "white" cerebrospinal fluid (CSF) sequences, turbo SE and GRASE, had higher contrast-to-noise ratios (CNRs) than the "black" CSF sequence, FLAIR, with respect to the signal intensity of white manner, but lower CNRs than FLAIR with respect to the signal intensity of CSF. Qualitatively, for lesion detection, sensitivity and accuracy were significantly higher for FLAIR than for turbo SE or GRASE (P < .05); there was no statistically significant difference between turbo SE or GRASE. FOR lesion characterization, FLAIR was significantly superior to GRASE and turbo SE for white matter disease (P < .05), superior to only turbo SE (P < .05) for vascular disease, and not superior to GRASE or turbo SE for tumors. CONCLUSIONS: The black CSF T2-weighted turbo FLAIR sequence is a useful adjunct to the usual white CSF T2-weighted sequences in unselected brain 0.5-T MR imaging.

Penile fracture: MRI demonstration of a urethral tear associated with a rupture of the corpus cavernosum.

We report a case of traumatic urethral tear associated with a rupture of the corpus cavernosum, demonstrated on MRI. We discuss the potential role of a non-invasive preoperative assessment by MRI.

Endoscopic transvaginal approach to the rabbit uterine cervix: improvement in the technique of selective tubal catheterization.

RATIONALE AND OBJECTIVES: The authors compared two methods of selective fallopian tube catheterization in female rabbits. METHODS: Technical success rates and procedure times in two groups of animals were compared. Group 1 consisted of 20 female rabbits catheterized with a fluoroscopic technique. Group 2 consisted of 55 rabbits catheterized with a combination of endoscopic and fluoroscopic guidance. RESULTS: The technique used in group 2 allowed a statistically significant reduction in the time required for cervical catheterization and the total procedural time (P < .01). There was a parallel statistically significant reduction in fluoroscopy time (P < .01). Technical success rates and adverse effects were similar for the two techniques. CONCLUSION: The combined endoscopic-fluoroscopic technique requires a shorter time than the established fluoroscopic technique and should be considered for future selective tubal catheterization experiments in rabbits.

Tubal sterilization by means of selective catheterization: comparison of a hydrogel and a collagen glue.

PURPOSE: To test, in an animal model, two potentially suitable materials for nonsurgical selective tubal sterilization. MATERIALS AND METHODS: A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed in four rabbit fallopian tubes, and a proprietary collagen glue was placed into three rabbit fallopian tubes by means of transvaginal fluoroscopic fallopian tube catheterization. As controls, 11 tubes were catheterized without sterilization material injection. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy. Histologic analysis was performed. RESULTS: The short-term contraception rate was 100% in the hydrogel group, 33% in the collagen glue group, and 0% in the control group (P < .001 hydrogel group, P not significant in collagen group). Inflammation was minimal in the three groups (P not significant). CONCLUSION: The collagen glue had an insufficient contraceptive effect and should be abandoned. The hydrogel used proved effective and biocompatible, and long-term studies of this compound are warranted.

PIP: The purpose of this study was to test, in an animal model, two potentially suitable materials for nonsurgical selective tubal sterilization. A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed in four rabbit fallopian tubes, and a proprietary collagen glue was placed into three rabbit fallopian tubes by means of transvaginal fluoroscopic fallopian tube catheterization. As controls, 11 tubes were catheterized without sterilization material injection. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy. Histologic analysis was performed. The short-term contraception rate was 100% in the hydrogel group, 33% in the collagen glue group, and 0% in the control group (P .001 hydrogel group, P not significant in collagen group). Inflammation was minimal in the three groups (P not significant). The collagen glue had an insufficient contraceptive effect and should be abandoned. The hydrogel used proved effective and biocompatible, and long-term studies of this compound are warranted.

Selective tubal sterilization in rabbits: experience with a hydrogel combined with a sclerosing agent.

PURPOSE: To test a method of nonsurgical sterilization. MATERIALS AND METHODS: A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed into fallopian tubes of eight rabbits by means of transvaginal rabbits by means of transvaginal fluoroscopic fallopian tube catheterization. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy. RESULTS: Seven of the eight rabbits became pregnant. Six of these rabbits contained embryos in the control uterus but not in the uterus on the side of the hydrogel injection. The seventh rabbit had embryos in both uteri, but the hydrogel had been expelled. All seven tubes that contained hydrogel showed evidence of acute and chronic salpingitis and a foreign-body reaction. The tube from which hydrogel had been expelled and the eight control tubes were not inflamed. CONCLUSION: Transcervical catheter methods of tubal occlusion and sterilization are promising, but a non-reactive material is needed.