European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis.

Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. KEY POINTS: • This report provides guidelines for MRI in endometriosis. • Minimal and optimal MRI acquisition protocols are provided. • Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria.

Utilidad de la tomografía computarizada de doble energía con un programa específico para la identificación de litiasis renales de ácido úrico / Usefulness of dual-energy computed tomography with and without dedicated software in identifying uric acid kidney stones

Objetivo. Valorar de manera prospectiva e in vivo la identificación de litiasis renales de ácido úrico con tomografía computarizada (TC) de doble energía (TCDE) con y sin software específico. Material y métodos. Se estudiaron 65 litiasis de 63 pacientes analizadas ex vivo con espectrofotometría y que habían sido estudiadas con una TCDE. Se valoró el rendimiento diagnóstico en identificar litiasis de ácido úrico con TCDE mediante el análisis de las densidades radiológicas de las litiasis utilizando el software específico, o sin utilizarlo (midiéndolo manualmente), y mediante el análisis de las ratios de densidad de las litiasis en ambas energías con o sin el software específico. Resultados. Las seis litiasis de ácido úrico incluidas fueron correctamente identificadas mediante la valoración de la ratio de densidades con un punto de corte de 1,21, tanto con el software específico como sin él, con un rendimiento diagnóstico perfecto, sin presencia de falsos positivos ni negativos. El estudio de densidades de las litiasis obtuvo valores de las curvas COR en clasificación de litiasis de ácido úrico de 0,92 para medición con la aplicación informática y de 0,89 para las mediciones manuales y una precisión diagnóstica del 84% (42/50) con el software y del 83,1% (54/65) para las mediciones manuales para un punto de corte de 538 UH. Conclusiones. El estudio de litiasis con TCDE permite identificar correctamente las litiasis de ácido úrico mediante el cálculo de la ratio de densidades en ambas energías. Los resultados obtenidos con y sin software específico son similares (AU)

Objective. To prospectively evaluate the usefulness of dual-energy computed tomography (DECT) with and without dedicated software in identifying uric acid kidney stones in vivo. Material and methods. We studied 65 kidney stones in 63 patients. All stones were analyzed in vivo by DECT and ex vivo by spectrophotometry. We evaluated the diagnostic performance in identifying uric acid stones with DECT by analyzing the radiologic densities with dedicated software and without using it (through manual measurements) as well as by analyzing the attenuation ratios of the stones in both energies with and without the dedicated software. Results. The six uric acid stones included were correctly identified by evaluating the attenuation ratios with a cutoff of 1.21, both with the dedicated software and without it, yielding perfect diagnostic performance without false positives or false negatives. The study of the attenuations of the stones obtained the following values on the receiver operating characteristic curves in the classification of the uric acid stones: 0.92 for the measurements done with the software and 0.89 for the manual measurements; a cutoff of 538 HU yielded 84% (42/50) diagnostic accuracy for the software and 83.1% (54/65) for the manual measurements. Conclusions. DECT enabled the uric acid stones to be identified correctly through the calculation of the ratio of the attenuations in the two energies. The results obtained with the dedicated software were similar to those obtained manually (AU)

Usefulness of dual-energy computed tomography with and without dedicated software in identifying uric acid kidney stones.

OBJECTIVE: To prospectively evaluate the usefulness of dual-energy computed tomography (DECT) with and without dedicated software in identifying uric acid kidney stones in vivo. MATERIAL AND METHODS: We studied 65 kidney stones in 63 patients. All stones were analyzed in vivo by DECT and ex vivo by spectrophotometry. We evaluated the diagnostic performance in identifying uric acid stones with DECT by analyzing the radiologic densities with dedicated software and without using it (through manual measurements) as well as by analyzing the attenuation ratios of the stones in both energies with and without the dedicated software. RESULTS: The six uric acid stones included were correctly identified by evaluating the attenuation ratios with a cutoff of 1.21, both with the dedicated software and without it, yielding perfect diagnostic performance without false positives or false negatives. The study of the attenuations of the stones obtained the following values on the receiver operating characteristic curves in the classification of the uric acid stones: 0.92 for the measurements done with the software and 0.89 for the manual measurements; a cutoff of 538 HU yielded 84% (42/50) diagnostic accuracy for the software and 83.1% (54/65) for the manual measurements. CONCLUSIONS: DECT enabled the uric acid stones to be identified correctly through the calculation of the ratio of the attenuations in the two energies. The results obtained with the dedicated software were similar to those obtained manually.

Cuantificación de la señal T2 pulmonar por resonancia magnética como factor pronóstico en las hernias diafragmáticas congénitas fetales / Prognostic usefulness of derived T2-weighted fetal magnetic resonance imaging measurements in congenital diaphragmatic hernia

Objetivo: Determinar el pronóstico neonatal de la hernia diafragmática congénita (HDC) partiendo de la señal relativa del pulmón contralateral en secuencias rápidas T2 de resonancia magnética (RM) fetal. Material y métodos: Estudiamos mediante ecografía y RM 28 fetos afectos de HDC y valoramos retrospectivamente en la ecografía fetal la relación entre el cociente observado y el esperado del diámetro axial máximo del pulmón dividido por el perímetro craneal (O/E LHR) y la posición hepática, y en la RM fetal el cociente de señal pulmón/hígado (LLSR) y el cociente de señal pulmón/líquido cefalorraquídeo (L/SF SR). Para determinar su valor pronóstico, los comparamos con los parámetros posnatales: supervivencia, hipertensión pulmonar, necesidad de oxígeno y la necesidad de oxigenación con membrana extracorpórea. Resultados: Encontramos diferencias significativas entre O/E LHR y la necesidad de oxigenación con membrana extracorpórea posnatal (p = 0,033) y la supervivencia posnatal (p = 0,01), y entre el LLSR de los fetos que sobrevivieron más de 45 días y los que no, con unas medianas de 1,91 y 2,56 respectivamente (p = 0,039). Conclusiones: El LLSR se correlaciona con la supervivencia posnatal en fetos con HDC y puede potencialmente utilizarse como parámetro pronóstico de la HDC fetal (AU)

Objective: To determine the usefulness of various parameters based on T2-weighted fetal magnetic resonance (MR) imaging measurements of the uninvolved lung for the neonatal prognosis of congenital diaphragmatic hernia (CDH). Material and methods: We used ultrasonography and MR imaging to study 28 fetuses with CDH. We retrospectively analyzed a) on fetal ultrasonography, the observed-to-expected lung to head ratio (O/E LHR) and the position of the liver, and b) on fetal MR imaging, the lung-liver signal ratio (LLSR) and the lungcerebrospinal fluid ratio (L/CSF SR). To determine the prognostic value of these parameters, we compared them with the following postnatal parameters: survival, pulmonary hypertension, need for oxygen supplementation, and need for extracorporeal membrane oxygenation. Results: We found significant differences between O/E LHR and the need for postnatal extracorporeal membrane oxygenation (P = .033) and postnatal survival (P = .01). We also found significant differences in LLSR between fetuses that survived more than 45 days and those that died within 45 days (1.91 vs. 2.56; P = .039). Conclusions: In fetuses with CDH, the LLSR correlates with postnatal survival and can potentially be used as a prognostic parameter in CDH (AU)

Prognostic usefulness of derived T2-weighted fetal magnetic resonance imaging measurements in congenital diaphragmatic hernia.

OBJECTIVE: To determine the usefulness of various parameters based on T2-weighted fetal magnetic resonance (MR) imaging measurements of the uninvolved lung for the neonatal prognosis of congenital diaphragmatic hernia (CDH). MATERIAL AND METHODS: We used ultrasonography and MR imaging to study 28 fetuses with CDH. We retrospectively analyzed a) on fetal ultrasonography, the observed-to-expected lung to head ratio (O/E LHR) and the position of the liver, and b) on fetal MR imaging, the lung-liver signal ratio (LLSR) and the lungcerebrospinal fluid ratio (L/CSF SR). To determine the prognostic value of these parameters, we compared them with the following postnatal parameters: survival, pulmonary hypertension, need for oxygen supplementation, and need for extracorporeal membrane oxygenation. RESULTS: We found significant differences between O/E LHR and the need for postnatal extracorporeal membrane oxygenation (P=.033) and postnatal survival (P=.01). We also found significant differences in LLSR between fetuses that survived more than 45 days and those that died within 45 days (1.91 vs. 2.56; P=.039). CONCLUSIONS: In fetuses with CDH, the LLSR correlates with postnatal survival and can potentially be used as a prognostic parameter in CDH.

Accuracy of contrast-enhanced ultrasound in the detection of bladder cancer.

OBJECTIVE: To assess the accuracy contrast-enhanced ultrasound (CEUS) in bladder cancer detection using transurethral biopsy in conventional cystoscopy as the reference standard and to determine whether CEUS improves the bladder cancer detection rate of baseline ultrasound. METHODS: 43 patients with suspected bladder cancer underwent conventional cystoscopy with transurethral biopsy of the suspicious lesions. 64 bladder cancers were confirmed in 33 out of 43 patients. Baseline ultrasound and CEUS were performed the day before surgery and the accuracy of both techniques for bladder cancer detection and number of detected tumours were analysed and compared with the final diagnosis. RESULTS: CEUS was significantly more accurate than ultrasound in determining presence or absence of bladder cancer: 88.37% vs 72.09%. Seven of eight uncertain baseline ultrasound results were correctly diagnosed using CEUS. CEUS sensitivity was also better than that of baseline ultrasound per number of tumours: 65.62% vs 60.93%. CEUS sensitivity for bladder cancer detection was very high for tumours larger than 5 mm (94.7%) but very low for tumours <5 mm (20%) and also had a very low negative predictive value (28.57%) in tumours <5 mm. CONCLUSION: CEUS provided higher accuracy than baseline ultrasound for bladder cancer detection, being especially useful in non-conclusive baseline ultrasound studies.

Cortical laminar necrosis caused by immunosuppressive therapy and chemotherapy.

We report three patients in whom neurologic symptoms and cortical laminar necrosis developed after immunosuppressive treatment (cyclosporin A and FK 506) and polychemotherapy (vincristine and methotrexate). Initial neuroradiologic studies showed cortical and white matter involvement. Follow-up studies showed cortical hyper-intense lesions on T1-weighted MR images, consistent with cortical laminar necrosis. The clinical and radiologic data indicate that a transient hypoxic-ischemic process could have been responsible for the encephalic lesions in these three patients.