Accuracy of combined physical examination, transvaginal ultrasonography, and magnetic resonance imaging to diagnose deep endometriosis.

OBJECTIVES: To assess the ability of physical examination (PE), transvaginal ultrasonography (TVUS), and magnetic resonance imaging (MRI) alone and combined to diagnose deep infiltrating endometriosis (DIE). DESIGN: We retrospectively queried our pelvic MRI database to identify women who underwent PE, TVUS, and pelvic MRI for DIE up to 12 months before surgery between January 1, 2016 and August 31, 2020. The presence of uterosacral ligaments (USL), vaginal, rectosigmoid (RS), parametrial, or sacrorectogenital septum (lateral) DIE shown by PE, TVUS, and MRI were correlated with surgical and histological findings. SETTING: Academic hospital. PATIENT(S): We included 178 patients. INTERVENTION(S): Clinical and imaging evaluation of women who were diagnosed at surgery with deep pelvic endometriosis. MAIN OUTCOME MEASURE(S): The sensitivity, specificity, positive and negative predictive values, and accuracy of each technique separately and combined were assessed for each location. When the 3 techniques were combined, 2 models were tested as follows: all 3 techniques positive and concordant; and ≥2 techniques positive and concordant. RESULT(S): The prevalence of USL, vaginal, RS, and lateral DIE were 94.4%, 20.2%, 34.3%, and 32.6%, respectively. In addition, MRI was more sensitive than PE, TVUS or any combination to detect DIE. Moreover, MRI and model B were the most accurate for detecting USL and RS locations with an accuracy of 90.4% and 82.6%, a sensitivity of 91.1% and 50%, and a specificity of 77.8% and 90.9%, respectively. Model B was the most accurate for the vaginal location with an accuracy, sensitivity, and specificity of 82.6%, 50%, and 90.9%, respectively. Finally, MRI was more accurate than any combination for identifying a lateral location with an accuracy, sensitivity, and specificity of 75.1%, 36%, and 93.8%, respectively. CONCLUSION(S): A combination of PE, TVUS, and MRI was more accurate than each technique separately to diagnose DIE because of the equally high sensitivity of each, as well as the high specificity of PE and TVUS.

MR Imaging Features of Obturator Internus Bursa of the Hip

The authors report two cases with distension of the obturator internus bursa identified on MR images, and describe the location and characteristic features of obturator internus bursitis; the "boomerang"-shaped fluid distension between the obturator internus tendon and the posterior grooved surface of the ischium.

CT and MR Findings of Presacral Epidermoid Cyst: A Case Report

Epidermoid cyst of the presacral space is a rare benign congenital lesion which is lined with keratinized squamous epithelium. We describe the computed tomography(CT) and magnetic resonance (MR) imaging findings in a case of presacral epidermoid cyst in a 35-year-old woman. The lesion appeared on CT as a well defined cystic mass with a thin wall. MR imaging showed heterogeneously low signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images.

Usefulness of Enteral Contrast Media in MR Evaluation of Pelvic Mass

PURPOSE: To assess the value of enteral contrast media for the evaluation of pelvic masses by MR imaging. MATERIALS AND METHODS: Between April and July 1998, 16 women with pelvic masses were examined by MRI. The origin of the lesion was the ovary in twelve cases, the uterus in three, and the sigmoid in one. Using a 1.5T scanner(Magnetom Vision, Siemens), T1-weighted axial spin echo(SE), T2-weighted turbo spin echo(TSE), two-dimensional fast low-angle shot(FLASH 2D), and half-Fourier TSE(HASTE) images were obtained in all patients after the administration of Magnevist Enteral (Shering, Berlin, Germany). In each MR imaging sequence, distinction between the lesion and adjacent bowel (1, not distinguished; 2, partly distinguished; 3, clearly distinguished), artifact (0, absent; 1, mild; 2, severe), image quality (1, poor; 2, fair; 3, good), were compared before and after the use of enteral contrast media. Changes in MRI impression after the use of enteral contrast media were also evaluated. Two radiologists reached a consensus after reviewing the images. Statistical significance was determined by Wilcoxon's signed ranked test. RESULTS: For distinguishing lesions, SE T1WI and FLASH 2D with enteral contrast media were significantly superior to SE T1WI without enteral contrast media (p<0.05). With regard to image quality, FLASH 2D and HASTE, both with enteral contrast media, were significantly superior to SE T1WI and TSE T2WI, respectively, both without enteral contrast media (p<0.05). Artefacts were more frequently found after the application of enteral contrast media in conventional sequences but were not present in breathhold sequences. In two patients, MRI impression changed after the appilication of enteral contrast media. CONCLUSION: In a limited number of cases, enteral contrast media improved lesion detection, image quality and diagnostic accuracy when breathhold fast MR imaging was applied.

Aggressive Angiomyxoma in Female Pelvic Cavity: A Case Report

Aggressive angiomyxoma is a rare neoplasm occurring in the female pelvic cavity or perineum, and tends torecur. The radiographic findings of angiomyxoma have not been previously reported in Korea ; we describe a case ofaggressive angiomyxoma in the female pelvic cavity, with emphasis on the pathologic and radiologic findings, andreview the literature.

Multishot Echoplanar MR Imaging of the Female Pelvis: Comparison with T2 weighted Fast Spin Echo Imaging

PURPOSE: To compare the usefulness of multishot echoplanar imaging (EPI) with T2-weighted fast spin-echoimaging (FSE) for the evaluation of female pelvic organs and pathologic conditions. MATERIALS AND METHODS:Twenty-nine patients with pelvic lesion underwent MR imaging (GE Medical Systems) using a pelvic array coil (GEMedical Systems). Axial EPI (TR/TE=2,000/80, 6mm slice thickness, 2.5mm gap, multishot 16) and T2-weighted FSE(TR/TE=3,400/117, 5mm slice thickness, 1.5mm gap, ETL=12) were obtained. Overall image quality, the parametrialvenous plexus, anatomy of the uterine zone and outer margin, identification of the ovaries, pelvic pathologiccondition, and frequency of artifact, as seen on EPI and FSE imaging were reviewed separately by two radiologists. RESULTS: For overall imaging quality, EPI was superior to FSE in 14% of patients(4/29), equal in 24%(7/29), andinferior in 62%(18/29). For delineation of the parametrial venous plexus, EPI was superior to FSE in 79%(23/29).For uterine zonal anatomy and the outer margin, EPI was inferior to FSE in 55%(16/29) and in 45%(13/29),respectively. On EPI, visualization of the ovary was rated superior to FSE in 0%(0/9), equal in 52%(15/29), andinferior in 48%(14/29). Conspicuity of pelvic pathologic lesions was superior in 14%(4/29), equal in 52%(15/29),and inferior in 48%(14/29). Image distortion and susceptibility artifacts were seen on EPI in six cases, while onFSE motion artifacts were seen in two cases. CONCLUSIONS: As EPI is inferior to FSE in overall image quality,delineation of the normal anatomy of pelvic organs and conspicuity of pelvic lesions, it cannot replace FSE forimaging the female pelvis. However, because EPI reduces imaging time, further technical progress in this area maystimulate the use of ultrafast imaging of the femal pelvis.