Solitary fibrous tumor of the pleura: Can computed tomography features help predict malignancy? A series of 56 patients with histopathological correlates.

OBJECTIVE: To identify computed tomography (CT) predictors of malignancy, from a retrospective study of preoperative CT scans of patients with solitary fibrous tumors (SFT) of the pleura. PATIENTS AND METHODS: The CT scans of 56 patients with histopathologically confirmed SFT (33 women and 23 men; mean age, 60years) who underwent surgery between December 2004 and November 2012 were retrospectively analyzed by three radiologists working in consensus, blinded to the final histological diagnosis. RESULTS: SFT was asymptomatic and incidentally discovered in 22 patients (45.8%). Resection specimen analysis (R0 resection in all cases) revealed that 23 tumors (41%) were malignant. The CT features, which significantly differed between malignant and benign SFTs were tumor size (P=0.002) with a discriminative threshold value of 10cm, tumor heterogeneity before (P=0.02) and after (P=0.03) intravenous administration of iodinated contrast material, presence of intratumoral hydric attenuation areas (P=0.01), pleural effusion (P=0.01), measurable intratumoral vessels (P=0.02), hypervascularization with visible intratumoral vessels and/or marked enhancement (P=0.001). Presence of intratumoral calcifications (P=0.2) and maximum post-contrast enhancement value (P=0.6) were not significantly different between the two groups. CONCLUSION: A size greater than or equal to 10cm, hypervascularization, attenuation heterogeneity and association with pleural effusion are individual variables that suggest malignant SFT on CT.

Thoracic endometriosis syndrome: CT and MRI features.

Thoracic endometriosis is considered to be rare, but is the most frequent form of extra-abdominopelvic endometriosis. Thoracic endometriosis syndrome affects women of reproductive age. Diagnosis is mainly based on clinical findings, which can include catamenial pneumothorax and haemothorax, non-catamenial endometriosis-related pneumothorax, catamenial haemoptysis, lung nodules, and isolated catamenial chest pain. Symptoms are typically cyclical and recurrent, with a right-sided predominance. Computed tomography (CT) is the first-line imaging method, but is poorly specific; therefore, its main role is to rule out other pulmonary diseases. However, in women with a typical clinical history, some key CT findings may help to confirm this often under-diagnosed syndrome. MRI can also assist with the diagnosis, by showing signal changes typical of haemorrhage within diaphragmatic or pleural lesions.

Ultrasonography and MRI features of the Mayer-Rokitansky-Küster-Hauser syndrome.

Although Mayer-Rokitansky-Küster-Hauser syndrome is a rare condition with a reported incidence of 1/4500 female live births, it represents the second most common cause of primary amenorrhea and has psychologically devastating consequences. The radiologist plays a pivotal role in both making the accurate initial diagnosis of this condition and assessing findings that may contribute to treatment planning. The purpose of this article is to provide an overview of the capabilities of ultrasound and magnetic resonance imaging (MRI) for the diagnosis and management of this syndrome with emphasis on the relevant clinical and surgical findings and to describe potential associated abnormalities and differential diagnosis.

Ovarian hyperthecosis on grayscale and color Doppler ultrasound.

OBJECTIVES: To describe the grayscale and color Doppler ultrasound findings in women with ovarian hyperthecosis. METHODS: In a retrospective study, we reviewed the findings on ultrasound examination of the ovaries in 10 patients with proven hyperthecosis. Clinical features had been recorded and testosterone levels measured in all cases. The ovaries had been examined using grayscale ultrasound in all patients and color Doppler in six patients. Bilateral stromal hyperthecosis had been pathologically confirmed in all patients. RESULTS: The clinical features were polymorphic, with symptoms of virilization in four patients. Type 2 diabetes was present in four patients. Testosterone levels were greater than 2 ng/mL in four patients. On grayscale ultrasound examination, the ovaries were normal in two patients but showed bilateral abnormalities in eight; both ovaries were increased in size in seven patients and had a round shape in two patients, the ovary being both increased in size and round in shape in one of these patients. A very peculiar nodular stromal pattern was observed in two out of 10 patients, while a homogeneous stromal pattern was observed in eight patients. On color Doppler, performed in six patients, no areas of hypervascularization were observed. CONCLUSION: Findings on grayscale ultrasonography and on color Doppler examination, in association with clinical and biological findings, are useful in the diagnosis of ovarian hyperthecosis and in ruling out the presence of an androgen-secreting tumor.

[Value of sonography and MR imaging for the evaluation of deep pelvic endometriosis]. / Valeurs diagnostiques de l'echographie et de l'IRM pour l'evaluation de l'endométriose pelvienne profonde.

Deep pelvic endometriosis may involve the uterosacral ligaments, cul-de-sac of Douglas, vagina, rectum, and occasionally the bladder. Evaluation by physical examination is difficult, and imaging techniques are needed to evaluate the location and extent of endometriosis. In this review, we review the transvaginal and transrectal sonographic and MR imaging features suggestive of deep pelvic endometriosis and their diagnostic value.

Sclerosing stromal tumor of the ovary: color Doppler findings.

The sclerosing stromal tumor (SST) of the ovary is a distinct benign neoplasm that differs from fibromas, thecomas, luteinized tumors and lipoid cell tumors. It accounts for 6% of ovarian stromal tumors and tends to occur at an earlier age. On gray-scale ultrasound examination, SSTs of the ovary are solid or cystic and multilocular. We describe here, we believe for the first time, the findings on color Doppler imaging of an SST of the ovary. A 29-year-old woman presented with an organic ovarian mass. She underwent a transvaginal ultrasound examination that revealed an echogenic cyst with acoustic shadowing. Color Doppler demonstrated marked peripheral vascularization. Findings on computed tomography and magnetic resonance imaging strongly suggested the preoperative diagnosis of SST of the ovary, which was confirmed at pathology. Association of an echogenic ovarian mass with acoustic shadowing and a high degree of peripheral vascularization may strongly suggest the diagnosis of SST of the ovary.

[Pelvic endometriosis]. / Endométriose pelvienne.

Endometriosis is a common disease that affects about 20% of women of childbearing age. At transabdominal and endovaginal ultrasound, in 90% of cases, ovarian endometriosis appears as a homogeneous lesion with low level echoes most often associated with clots. However this modality is insufficient to detect associated lesions. MRI is as accurate as ultrasound to detect ovarian endometriosis which most often appears with a signal higher than that of adipose tissue on T1W images and a bright signal area on fat suppressed images. The main advantage of this examination is not only to detect small ovarian implants but to also detect associated subperitoneal implants. These lesions involving the bladder as well as posterior structures such as the uterosacral ligaments, rectovaginal septum, and rectum appear as fibromuscular masses containing hyperintense signal areas on T1W images, or as purely fibrotic lesions that can be quite difficult to diagnose. Laparoscopy remains the procedure of choice to detect peritoneal implants.

[Bladder endometriosis. Apropos of 4 cases and review of the literature]. / Endométriose vésicale. A propos de quatre cas et revue de la littérature.

The aim of our study is to evaluate the diagnostic and therapeutic attitude toward endometriosis of the bladder. We have analysed four observations treated in the gynecologic service of Hotel-Dieu in Paris between January 1989 and January 1998, which represents 1.3% of all endometriosis operated during this period. Every patient underwent echography, RMN, UIV and cystoscopy. In all for cases a surgical treatment by laparotomy was realised. The choice of this way is explained by the multiple localisations of endometriosis in three cases and the impossibility of a coelioscopic treatment in the forth. The anatomopathologic exam found endometriosis in all of the cases.

[Malignant tumors of the ovaries: role of imaging]. / Tumeurs malignes de l'ovaire. Rôle de la radiologie.

Malignant ovarian tumors are developed in more than 95% in the epithelium surface of the ovary. In the mainly cystic forms, vegetations greater than 2cm, with an irregular surface, with a broad base on implantation, containing vessels on color Doppler are very suggestive of malignancy. Ultrasound is highly accurate in these forms. In most of the mixed forms on mainly solid forms, the irregular solid portions with degenerative changes containing tumoral vessels are very suggestive of malignancy. CT scan or MR imaging are usually more indicative of showing malignancy than ultrasound. In the multilocular forms, diagnosis of malignancy or benignity is often difficult. Extension to the pelvis, peritoneum and lymph nodes is easier to define on CT scan.

Correlation between computed tomography and gross anatomy of the suspensory ligament of the ovary.

To assess the morphology of the suspensory ligament of the ovary on CT scan examination, an anatomic study of the suspensory ligament of the ovary was performed to demonstrate its morphology on CT and to facilitate the visualization of the ovaries. Twelve female cadavers were studied after intravascular injection of latex (venous: 2, arterial: 6, arterio-venous: 4). We first observed all the pelvises after their transection. Six dissections were then made to obtain optimal anatomic correlations on the content and relations of the infundibulo-pelvic ligament. The arterial opacifications were poor compared with to the good quality of the venous or arteriovenous opacifications. An upright correlation between CT slices and the anatomic study was made. This radio-anatomic study emphazises the importance of the veins, which really support the suspensory ligament of the ovary, as opposed to the involution of the arteries. This study points out the link between the infundibulo-pelvic ligament above and the utero-ovarian below, then with the superficial uterine vv. All these structures were well analyzed on CT and during the anatomic studies. A very well developed periovarian venous plexus which frequently concealed the ovaries was demonstrated. Some anatomic variations which were invisible on the CT scan examinations were displayed. The visualization of the suspensory ligament of the ovary should facilitate the visualization of the ovaries and could optimize the search for lymphadenopathies originating from ovarian cancers.

Hyperreactio luteinalis in a normal pregnancy: sonographic and MRI findings.

A case of hyperreactio luteinalis in an otherwise normal pregnancy is reported. Ascites was present, but no peritoneal implants or adenopathy were seen. Findings that would have suggested the correct diagnosis are the symmetrical and bilateral pattern of the mass, as well as the rather uniform size of the loculi, which were 1 to 3 cm in diameter.

[Pulmonary embolism. The role of computed tomography angiography]. / Embolie pulmonaire. La place de l'angioscanner.

NONINVASIVE PROCEDURE: Helical CT angiography is a noninvasive procedure whose only relative contraindications are renal insufficiency and iodine allergy. MASSIVE PULMONARY EMBOLISM: If a massive pulmonary embolism is suspected, helical CT angiography is the examination of choice because of its high accuracy in detecting proximal thrombi and its safety profile. NON-MASSIVE PULMONARY EMBOLISM: If a non massive pulmonary embolism is suspected, helical CT angiography, because of its high specificity, can be the first examination instead of scintigraphy. If a thrombus is depicted by CT, the diagnosis of pulmonary embolism is confirmed and treatment is started. If no thrombus is visualized by CT, pulmonary embolism can be ruled out in most cases. In case of doubt, another noninvasive procedure should be performed. Angiography should be the exception and seldom is needed.

Anatomic approach to the parametrium: value of computed tomographic in vitro study compared to dissection.

The aim of this study is to describe the morphology of the normal parametrium by correlating the slices obtained with computed tomography of 12 female cadavers studies after intravascular injection of latex with the dissection findings in 6 of the these patients. the upper limit, represented by the isthmus was defined by the uterine a. and/or a superficial uterine v. and/or the coronary v. (Charpy). The lower limit corresponded to the insertion of the levator ani mm. at the junction of the middle and inferior thirds of the vagina. The paracervical and paravaginal tissues above the levator ani m. and medial to the pelvic fascia covering these muscles were perfectly visualized. The posterior limit, formed by the lateral ligament of the rectum and/or the sacrouterine ligaments, and the anterior limit determined by the umbilico-vesical fascia were more difficult to demonstrate. In this study the parametrium appeared as a highly vascular and essentially venous connective structure with a variable morphology dependent on the uterine position.

MR and CT findings in a case of hibernoma of the thigh extending into the pelvis.

Review of the literature shows no report of hibernoma of the thigh extending into the pelvis. Herein we report a case of hibernoma which appeared on CT and MR as a well-defined pelvic mass with contrast enhancement extending through the obturator foramen into the thigh. Fat was demonstrated by CT, whereas MR, using multiplanar sections, better analyzes the extension of the mass. This case demonstrates that hibernoma as liposarcoma can extend through the obturator foramen. However, no definite diagnosis could be made by CT or MR and the tumor must be considered as a "potential" malignant liposarcoma.

Idiopathic thrombocytopenic purpura as the presenting feature of a primary bilateral adrenal non Hodgkin's lymphoma.

Primary lymphomas arising in the adrenal gland are extremely rare. The presenting symptoms are nonspecific and may be related to lymphoma or to associated adrenal insufficiency. In this report we describe the case of a 61 year old woman with idiopathic thrombocytopenic purpura and primary bilateral non Hodgkin's lymphoma of the adrenals.

Swyer-James syndrome documented by spiral CT angiography and high resolution inspiratory and expiratory CT: an accurate single modality exploration.

Spiral CT angiography was performed in a patient suspected of having pulmonary embolism. The right pulmonary system was normal. The left arterial system was small but patent. The left upper lobe was small and hyperlucent. The left lower lobe was collapsed and contained bronchiectasis. The bronchi were patent. High resolution CT in inspiration and expiration confirmed air trapping in the left upper lobe. A diagnosis of Swyer-James syndrome of the left upper lobe was made.

Characterization of adnexal masses: combination of color Doppler and conventional sonography compared with spectral Doppler analysis alone and conventional sonography alone.

OBJECTIVE: To evaluate the importance of color Doppler combined with conventional sonography in characterizing adnexal masses and to compare the results with those of spectral Doppler analysis alone and conventional sonography alone. MATERIALS AND METHODS: One hundred and fifteen women with 132 adnexal masses (98 benign, three borderline, and 31 malignant) were prospectively studied with conventional and Doppler sonography (transabdominal in all patients and transvaginal in 111). Three methods differentiated benign from borderline and malignant masses. In the first, conventional sonography was used. In the second, conventional sonography was combined with color Doppler. In this method, the presence of color flow in an echogenic portion classified as indeterminate or malignant by conventional sonography indicated malignancy; the absence of color flow in an echogenic portion classified as indeterminant or malignant at conventional sonography indicated benignancy; the presence or absence of color flow in a regular wall or septum indicated benignancy. The third method used spectral Doppler analysis. Malignancy was indicated by a resistive index (RI) less than or equal to 0.4, a pulsatility index (PI) less than or equal to 1, or a peak systolic velocity (PSV) greater than or equal to 15 cm/sec. RESULTS: Using conventional sonography alone, accuracy was 83%, sensitivity was 88%, and specificity was 82%. Using conventional sonography and color Doppler, accuracy was 95%, sensitivity was 88%, and specificity was 97%. Using spectral Doppler analysis and an RI less than or equal to 0.4, accuracy was 77%, sensitivity was 18%, and specificity was 98%. For a PI less than or equal to 1, accuracy was 68%, sensitivity was 71%, and specificity was 67%. For a PSV greater than or equal to 15 cm/sec, accuracy was 72%, sensitivity was 47%, and and specificity was 81%. CONCLUSION: Adding color Doppler to conventional sonography produced a specificity and positive predictive value higher than those of conventional sonography alone. Specificity increased from 82% to 97% (p < .001), and positive predictive value increased from 63% to 91%. RI, PI, and PSV were of limited value.

Mature cystic teratomas of the ovary: CT and MR findings.

OBJECTIVE: To correlate CT and MR patterns of ovarian mature cystic teratomas (MCT). SUBJECTS AND METHODS: CT and MR findings in 25 histologically proven ovarian MCT were retrospectively reviewed. MCT characterization at CT and MR was based on detection of fat and/or a Rokitansky protuberance. MR signal intensity and CT density numbers of fat were correlated. RESULTS: At pathology, 24/25 tumors contained fat, 1/25 a water content, and 23/25 a Rokitansky protuberance. Twenty one MCT contained fat with a density number less than-20 HU (mean density: -95 HU) and a signal intensity superior or equal to sub-cutaneous fat on T1 images, however, only six of these had a signal intensity equal to sub-cutaneous fat on T1 and T2 images and 12 had a reversed chemical shift artifact. Three contained fat with a density number ranging from -13 to +8 HU and a signal intensity inferior to subcutaneous fat on T1 images. CT showed a Rokitansky protuberance in 21/23, containing adipose tissue in 16 and calcified structures in 21. Standard MR showed a Rokitansky protuberance in 14/23 and characterized adipose tissue in eight cases, and calcified material in six cases. Finally, CT characterized 24/25 (96%) MCT. Standard MR characterized 22/25 (88%) MCT, and standard MR with fat-suppression sequences characterized 23/25 (92%) MCT. CONCLUSION: Standard MR is less effective than CT in characterizing fat and has the same difficulty as CT in characterizing fat mixed with hair when its density is high. When fat cannot be identified by either technique, diagnosis of a Rokitansky protuberance is more easily made at CT than at MR.