Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma: comparison of multi-section dynamic MR imaging using a three dimensional FLASH technique and T2-weighted MR imaging.

INTRODUCTION: We aimed to show the diagnostic performance of magnetic resonance imaging by comparing T2-weighted images and dynamic 3D MR images in the assessment of myometrial and cervical invasion by endometrial carcinoma. METHODS: This prospective study included 53 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TSE T2-weighted images and 3D FLASH-VIBE dynamic MR images by two radiologists with a special training in gynecology. Sensitivity, specificity, negative and positive predictive values were calculated for each imaging modality with regard to assessment of myometrial and cervical invasion. RESULTS: The diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR imaging for the identification of any myometrial invasion were estimated as 64% and 84%, respectively. In the differentiation of deep myometrial invasion from the superficial invasion, the diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR images were 75.5%, and 88.7%, respectively. Additionally, in the determining of deep myometrial invasion the sensitivity, the specificity, PPV, and NPV were 76%, 75%, 50%, and 90.9% on T2-weighted images, respectively; 100%, 85%, 68.4%, and 100% on dynamic 3D MR images, respectively. The diagnostic accuracy of TSE T2-weighted and dynamic 3D FLASH-VIBE MR images for cervical invasion by endometrial carcinoma were 86%, and 92%, respectively. CONCLUSION: The multiplanar capabilities of MRI are invaluable to evaluate spreading and margins of an endometrial mass, and the 3D dynamic MR techniques offer the advantages of increased coverage and high spatial resolution. Three dimensional dynamic MR imaging may be recommended in the especially postmenopausal cases before performing potentially curative treatments.

Evaluation of cervical involvement in endometrial cancer by transvaginal sonography, magnetic resonance imaging and frozen section.

This study was undertaken to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and frozen section for detection of cervical involvement in endometrial cancer. The study included 64 consecutive patients with endometrial cancer. The subjects were evaluated with TVS and MRI by two radiologists and the frozen sections by a pathologist. The diagnostic accuracies of TVS, MRI and frozen section were compared using the McNemar test. The accuracy rates of TVS, MRI and frozen section were 90.6%, 92.2% and 95.5%, respectively. There were no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of cervical involvement, although frozen section seemed to be slightly superior to the imaging techniques. TVS and MRI have similar performance in determination of cervical involvement. However, although time consuming and expensive, MRI may be recommended in cases with poor quality TVS. Frozen section may be advocated where preop-tests are equivocal.

Comparison of CT virtual cystoscopy of the contrast material-filled bladder with conventional cystoscopy in the diagnosis of bladder tumours.

AIM: To investigate the value of virtual cystoscopy using contrast material to fill the bladder during routine abdominopelvic computed tomography (CT) examinations for the detection of bladder tumours. MATERIALS AND METHODS: Thirty-three consecutive patients (25 men and eight women; are range 51-82 years; mean age+/-SD, 65+/-7 years) who had painless macroscopic haematuria and were suspected to have bladder neoplasms were prospectively evaluated with virtual cystoscopy. After intravenous injection of contrast medium, the contrast material-filled bladders were examined with single-detector helical CT with 2-mm section thicknesses. Source CT data were transferred to a workstation for interactive navigation using surface rendering. All the patients also underwent conventional cystoscopy. RESULTS: The results of virtual cystoscopy were compared with the findings from the conventional cystoscopy. Seventy-one of 78 bladder tumours detected with conventional cystoscopy in 28 patients were also shown on virtual images. The bladders of five patients appeared normal on both conventional cystoscopy and virtual cystoscopy. On virtual cystoscopy, seven of the 12 lesions that were < or =5 mm in diameter could be identified. The following statistical values for the identification of bladder lesions using virtual cystoscopy were calculated: sensitivity 94%, specificity 90%, positive predictive value 87%, negative predictive value 93%, and accuracy 93%. CONCLUSION: CT virtual cystoscopy is a noninvasive technique that can be used successfully for detection of bladder tumours >5 mm in selected cases during daily routine abdominopelvic work.

Temporomandibular internal derangement: correlation of MRI findings with clinical symptoms of pain and joint sounds in patients with bruxing behaviour.

OBJECTIVES: The aim of this study was to correlate magnetic resonance imaging (MRI) findings of effusion, disc displacement, condylar bony changes and disc form with clinical findings of pain and sounds in patients with bruxing and non-bruxing behaviour. METHODS: Disc displacement was confirmed by MRI in 102 joints from 64 patients (total of 128 joints) with bruxing behaviour who were referred for clinically diagnosed internal derangements of the temporomandibular joint (TMJ). Sixty joints with internal derangement from 30 patients without bruxing behaviour served as a control group. The clinical inclusion criteria were pain in the pre-auricular area and muscles of mastication, limitation or deviation in mandibular range of motion, and TMJ sounds. Signs of bruxism were diagnosed clinically and were obtained from the patient's history given on their first visit. Pain was evaluated using a visual analogue scale. RESULTS: Of the 102 joints in the study group with disc displacement, 53 (52%) showed disc displacement with reduction and 49 (48%) showed disc displacement without reduction. In the control group, 16 joints were classified as normal. Of the remaining 44 joints, 27 (61%) had disc displacement with reduction and 17 (39%) had unilateral disc displacement without reduction. Condylar bony changes were seen in 55% of the reducing joints in the study group and in 38% of the reducing joints in the control group, compared with 86% of the non-reducing joints in the study group and 24% of the non-reducing joints in the control group. There was a strong correlation between age and degenerative change in the study group. In the reducing joints, there was a significant difference in the prevalence of condylar bony changes between the study and control groups (P<0.01). In non-reducing joints, 30% of painful joints in the study group and 59% of those in the control group showed a strong signal in the joint space on T(2) weighted imaging. Statistically significant differences between the study and control groups were also found for disc form and the prevalence of effusion and disc displacement. Joint sounds were important in unilaterally affected joints in the study group. A statistically significant correlation was found between joint sounds and reducing joints (P<0.05). CONCLUSION: It was demonstrated that a higher prevalence of condylar bony changes occurred in reducing joints in patients with bruxing behaviour.