Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration.

OBJECTIVES: Endometriosis is the ectopic localization of endometrial glands. Symptoms include a wide variety of chronic pelvic pain. Ovarian endometriosis represents the most frequent site of implantation followed by the Douglas pouch which is undepicted unless peritoneal fluid is present. Pelvic exams may be reported as normal in 40% of evaluations, although multiple nodularities are located in this region. Nowadays, laparoscopy represents the standard technique for endometriosis evaluation. However, magnetic resonance imaging (MRI) remains the best noninvasive technique for the evaluation of pelvic lesions. According to the importance of a precise preoperative diagnosis of deep infiltrative endometriosis involving the Douglas pouch, we evaluated feasibility of a 3-T system in the evaluation of this particular region. METHODS: We enrolled 19 women coming with either ultrasound or anamnestic suspicion of endometriosis. Pelvic MRI examination was performed on the 3-T system. We applied a standard exam protocol including pulse sequences [single-shot fast spin echo (FSE)] and high-resolution T2W and T1W FSE sequences with and without FS. RESULTS: MRI diagnosed posterior cul-de-sac obliteration in 15/19 patients. MRI findings were compared with laparoscopy, thus obtaining the following statistical values: mean sensitivity, specificity, positive predictive value and negative predictive value, respectively, of 93%, 75%, 93% and 75%. Moreover, we calculated an interobserver agreement k value of 0.72 with a substantial degree of agreement between two radiologists of a sensitivity value of 93% and specificity value of 75%. CONCLUSIONS: Precise preoperative mapping of posterior cul-de-sac region is essential for a preoperative planning. In our work, the 3-T MRI was shown to be excellent in the evaluation of posterior cul-de-sac obliteration associated to an optimal evaluation of the uterosacral ligaments due to the higher contrast spatial resolution.

Role of foetal MRI in the evaluation of ischaemic-haemorrhagic lesions of the foetal brain.

OBJECTIVE: The purpose of this study is to define the role of foetal magnetic resonance imaging (MRI) in evaluating cerebral ischaemic-haemorrhagic lesions and the extension of parenchymal injuries. STUDY DESIGN: From September 2006 to September 2010, 271 foetal MRI have been performed on cases referred to us for ultrasound suspect of brain abnormalities or cytomegalovirus infection and Toxoplasma serum conversion. Foetal MRI was performed with a 1.5-T magnet system without mother sedation. RESULTS: Foetal MRI detected ischaemic-haemorrhagic lesions in 14 of 271 foetuses, consisting of 5% incidence. MRI confirmed the diagnosis in three of 14 cases with ultrasonography (US) suspect of ischaemic-haemorrhagic lesions associated with ventriculomegaly. In one of 14 cases with US findings of cerebellar haemorrhage, MRI confirmed the diagnosis and provided additional information regarding the parenchymal ischaemic injury. In eight of 14 cases with US suspect of ventriculomegaly (3), corpus callosum agenesis (2), hypoplasia of cerebellar vermis (1), holoprosencephaly (1) and spina bifida (1), MRI detected ischaemic and haemorrhagic lesions unidentified at US examination. In two of 14 foetuses with US suspect of intracerebral space-occupying lesion, MRI modified the diagnosis to extra-axial haematoma associated with dural sinus malformation. Results were compared with post-mortem findings or afterbirth imaging follow-up. CONCLUSIONS: Foetal MRI is an additional imaging modality in the diagnosis of cerebral ischemic-haemorrhagic lesions, and it is useful in providing further information on the extension of the parenchymal injury and associated abnormalities, thus improving delivery management.

MRI and DWI: feasibility of DWI and ADC maps in the evaluation of placental changes during gestation.

OBJECTIVE: To establish if a correlation exists between apparent diffusion coefficient (ADC) values, obtained by diffusion-weighted imaging (DWI), and placental aging. METHOD: The study is divided into a retrospective phase and a prospective one.In the first phase, 145 pregnant women underwent fetal magnetic resonance imaging (MRI) for suspected disorders in several organs. We performed DWI (b value 0, 200 and 700 s/mm(2)) in all the fetuses, evaluating the patients in whom the whole placenta was visible.In the prospective phase, 50 women (52 fetuses) underwent MRI. We performed, in the same patient, two echo-planar sequences with b values of 0, 200 and 700, and 50, 200 and 700 s/mm(2), including the whole placenta.The ADC maps were calculated for all fetuses, divided into three groups based on gestational age (GA): group I: 20-26 weeks' gestation, II: 27-33, III: 34-40. RESULTS: In the retrospective phase, ADC values had a range from 1 to 2.4 mm(2)/s, showing a significant correlation between ADC values and GA.ADC values obtained by DWI with b value 0, 200 and 700 s/mm(2) had a range from 0.8 to 2.5 mm(2)/s, with an inverse correlation between ADC values and GA, whereas the ADC values with b value 50, 200 and 700 s/mm(2) did not show any statistical correlation (range: 1.5-1.7 mm(2)/s). CONCLUSION: DWI with ADC maps can not be considered markers for placental aging because they are affected by perfusional and circulatory motion.

Diffusion-weighted MR imaging and apparent diffusion coefficient of the normal fetal lung: preliminary experience.

OBJECTIVE: To assess if a correlation is present between apparent diffusion coefficient (ADC) values and normal lung maturation during gestation to define potential reference values as indicators of the lung development. METHODS: Our study included 50 pregnant women (gestational age, GA: 18-36 weeks), with normal fetal development of lungs assessed by a previous obstetric ultrasound (US), and then confirmed by our magnetic resonance (MR) examination. We used T2-weighted sequences, diffusion-weighted imaging sequences (DWI) and ADC maps for studying pulmonary tissue. In all cases the resulting ADC values were related to GA using Pearson correlation. RESULTS: ADC values ranged from 1,2 microm(2)/ms at 18 weeks' gestation to 3,9 microm(2)/ms at 36 weeks' gestation with a mean value, regardless for the gestational age, of 2, 352 +/- 0,623106 microm(2)/ms. We found a significant correlation between ADC and gestational age (Pearson correlation = 0,816). CONCLUSION: The ADC values correlate with gestational age since alveolar fluid secretion and angiogenesis increase gradually. Therefore, ADC can be considered as a new parameter for studying lung maturity.

New mu-oxo octanuclear complexes of 3d elements stabilized by dialkylcarbamato ligands. Synthesis and X-ray crystal and molecular structures.

The octanuclear aggregates M(8)(mu(4)-O)(2)(O(2)CN(i)()Pr(2))(12) [M = Mn(II) 1, Co(II) 2, Ni(II) 3] have been prepared in good yields by controlled hydrolysis of the corresponding metal carbamate precursors [M(O(2)CN(i)()Pr(2))(2)](n)(). X-ray analysis has shown compounds 1-3 to be isostructural. The core of 2 contains two distorted [M(4)O] tetrahedra related by an inversion center. The hexanuclear carbamates M(6)(O(2)CNEt(2))(12) in toluene undergo a metal redistribution process with formation of the hexanuclear carbamates M'(x)M' '(6-x)(O(2)CNEt(2))(12), M' = Co, M' ' = Mn, as evidenced by mass-spectrometric data. In the presence of moisture, the mixed octanuclear carbamates Co(x)Mn(6-x)(MnO)(CoO)(O(2)CNEt(2))(12) were promptly formed and detected by DCI/MS measurements. Mass spectral data of Co(8)(mu(4)-O)(2)(O(2)CN(i)Pr(2))(12) are also reported.