Cardiac MR imaging and MR angiography for assessment of complex tetralogy of Fallot and pulmonary atresia.

Breath-hold electrocardiographically gated cardiac magnetic resonance (MR) imaging and contrast material-enhanced MR angiography are emerging as ideal techniques for the evaluation of complex congenital heart disease. Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease and, in its classic form, is associated with varying degrees of hypoplasia of the central and peripheral pulmonary arteries, with valvar pulmonary atresia and collateral aortopulmonary vessels occupying the extreme end of the spectrum. Accurate assessment of the size and anatomy of the pulmonary arteries is often difficult with echocardiography and conventional cineangiography. Compared with echocardiography in particular, cardiac MR imaging with three-dimensional reconstruction has distinct advantages for pre- or postoperative assessment of pulmonary anatomy in patients with tetralogy of Fallot and pulmonary atresia. MR imaging enables the clear and complete depiction of anatomy and thus can provide additional information about pulmonary artery abnormalities that are difficult to evaluate with conventional cardiac imaging techniques.

US of abnormal uterine bleeding.

Any significant deviation from a woman's established menstrual pattern may be considered abnormal uterine bleeding, and several factors direct evaluation of a patient with such bleeding. Premenopausal disorders that are well evaluated with ultrasound (US) include endometriosis, adenomyosis, and leiomyomas. A positive pregnancy test in a woman of childbearing age prompts a search for an intrauterine pregnancy. Possible complications that may contribute to bleeding include ectopic pregnancy; placental factors including position, trauma, and infection; gestational trophoblastic disease; preterm labor; and postpartum complications. Atrophic changes, hormonal status, and carcinoma are considerations in the postmenopausal patient with abnormal uterine bleeding. Foreign bodies, trauma, infection, polyps, and iatrogenic causes can be observed in all groups. Differential diagnoses for abnormal uterine bleeding in premenopausal, pregnant, and postmenopausal patients are well evaluated with US, and US techniques have greatly facilitated evaluation of pelvic disease. Urgent and emergent conditions such as ectopic pregnancy, placenta previa, and preterm labor are readily identifiable.