Adnexal incidentalomas on multidetector CT: how to manage and characterise.

Although CT is not considered the examination of choice for the detection and characterisation of adnexal diseases, adnexal masses may be incidentally detected during CT examination performed for other clinical indications. Most adnexal incidentalomas are benign, and therefore may not require further investigation, follow-up or intervention; however, few of them may prove malignant. Multidetector CT has improved the diagnostic performance of the technique in the detection and differentiation of adnexal mass lesions. Radiologists should be able to recognise the normal CT appearance of the ovaries and the CT characteristics of various adnexal incidentalomas. This may obviate unnecessary imaging evaluation and allow optimal treatment planning. Regarding the management of adnexal lesions incidentally found on CT, recommendations based on the collective experience of the members of the American College of Radiology Incidental Findings Committee II have recently been presented.

Early-stage cervical carcinoma: the role of multidetector CT in correlation with histopathological findings.

The objective of this retrospective study was to assess the diagnostic performance of multidetector CT (MDCT) in staging patients with surgical-pathological proven early-stage cervical carcinoma. A total of 22 women were referred for preoperative staging by MDCT, on a 16-row CT scanner. The protocol included scanning of the abdomen during the portal phase using a detector collimation of 16 × 0.75 mm and a pitch of 1.2. The evaluated parameters were: tumour detection, tumour maximal diameter, tumour extension to the uterine body and/or the vagina, parametrial invasion and presence of pelvic lymph node metastases. CT stage was assigned for each cervical carcinoma. The surgical-pathological stage was assigned on the basis of the operative findings and the histology report. The overall accuracy of MDCT in detecting and staging primary cervical carcinoma was 86% and 86%, respectively. Our results showed good diagnostic performance of MDCT in the detection and local staging of early-stage cervical carcinoma.

Apparent diffusion coefficient values of the normal uterus: Interindividual variations during menstrual cycle.

OBJECTIVES: To assess the apparent diffusion coefficient (ADC) changes of the normal uterine zones among reproductive women during the menstrual cycle. METHODS: The study included 101 women of reproductive age, each with regular cycle and normal endometrium/myometrium, as proved on histopathology or MR imaging examination. Diffusion-weighted (DW) imaging was performed along the axial plane, using a single shot, multi-slice spin-echo planar diffusion pulse sequence and b-values of 0 and 800s/mm(2). The mean and standard deviation of the ADC values of normal endometrium/myometrium were calculated for menstrual, proliferative and secretory phase. Analysis of variance followed by the least significant difference test was used for statistical analysis. RESULTS: The ADC values of the endometrium were different in the three phases of the menstrual cycle (menstrual phase: 1.25±0.27; proliferative phase: 1.39±0.20; secretory phase: 1.50±0.18) (F: 9.64, p: 0.00). Statistical significant difference was observed among all groups (p<0.05). The ADC values of the normal myometrium were different in the three phases of the menstrual cycle (menstrual phase: 1.91±0.35; proliferative phase: 1.72±0.27; secretory phase: 1.87±0.28) (F: 3.60, p: 0.03). Statistical significant difference was observed between menstrual and proliferative phase and between proliferative and secretory phase (p<0.05). No significant difference was noted between menstrual and secretory phase (p>0.05). CONCLUSIONS: A wide variation of ADC values of normal endometrium and myometrium is observed during different phases of the menstrual cycle.

Primary diffuse large B-cell testicular lymphoma: magnetic resonance imaging findings.

Testicular lymphoma represents the commonest testicular malignancy in men older than 50 years. MR imaging of the scrotum is an efficient supplemental diagnostic tool in the evaluation of scrotal diseases. We report two cases of primary diffuse large B-cell testicular lymphoma, presented in men over the age of 50 years. MR imaging revealed the presence of a hypointense intratesticular mass lesion on T2-weighted images, strongly and heterogeneously enhancing after gadolinium administration.

Proportion of excision and cervical healing after large loop excision of the transformation zone for cervical intraepithelial neoplasia.

OBJECTIVE: To determine how the proportion of the cervical volume excised affects cervical regeneration. DESIGN: Prospective observational study. SETTING: University Hospital. POPULATION: Women planning to undergo excisional treatment for cervical intraepithelial neoplasia who wish to have future pregnancies. METHODS: The cervical volume (and dimensions) is calculated with magnetic resonance imaging (MRI) before treatment. The volume (and dimensions) of the cone is assessed before fixation by a volumetric tube and a ruler; the percentage (%) of excision is computed. Cervical regeneration is estimated by repeat MRI at 6 months. MAIN OUTCOME MEASURES: Cervical regeneration in relation to proportion of excision. Statistical analysis was performed by box plots and analysis of variance. RESULTS: A total of 48 women have been recruited; 29 have completed 6 months follow up. Both the total cervical volume (from MRI) before treatment and the volume of the excised/ablated cone varied substantially. The estimated proportion of excision varied significantly between 4% and 39% (median 11%). Multivariate linear regression revealed that the proportional deficit at 6 months post-treatment was determined mainly by the proportion of the excised volume. CONCLUSIONS: Careful assessment of risks and benefits of treatment is essential when deciding to treat women who wish to have future pregnancies. Assessment of the proportion of the cervical volume and length excised might identify those that need further surveillance during future pregnancy.

Early-stage sarcomatoid renal cell carcinoma: multidetector CT findings.

A 64-year-old woman was referred for multidetector CT examination of the abdomen due to an incidental right renal mass, found on routine sonographic examination. A lower pole renal mass was detected on CT, with no signs of invasiveness or metastatic disease. The mass was sharply demarcated and heterogeneously enhanced, the last finding suggestive of malignancy. Pathologically, the tumor was an early-stage sarcomatoid renal cell carcinoma. The patient remains well, with no signs of recurrence or metastases 18 months after surgery.

Small cell carcinoma of the urinary bladder: virtual CT cystoscopic findings.

A 74-year-old man underwent multidetector CT virtual cystoscopy due to macroscopic hematuria. A large, irregularly-surfaced, solid bladder mass was detected, infiltrating the perivesical fat, the seminal vesicles and the prostate. CT examination of the chest and abdomen showed no distant metastases. Radical cystectomy was performed and pathology reported pure small cell carcinoma of the urinary bladder.

Case report. Tuberculous epididymo-orchitis: MRI findings.

A 70-year-old man presented with fever, left flank pain and scrotal enlargement. CT scan of the thorax and abdomen revealed findings compatible with pulmonary and kidney tuberculous involvement. Sonographic and MRI examination of the scrotum showed bilateral testicular enlargement and the presence of multiple nodules involving both the testis and the epididymis. Urine cultures obtained from a percutaneous left nephrostomy were positive for tuberculous bacilli, and the patient was placed on anti-tuberculous treatment.

Adnexal masses: accuracy of detection and differentiation with multidetector computed tomography.

OBJECTIVE: The aim of our study was to evaluate the accuracy of multidetector computed tomography (MDCT) on a 16-row CT scanner in the detection and differentiation of adnexal masses. METHODS: We prospectively examined 102 consecutive women with clinically or sonographically detected adnexal masses. Preoperative CT examination was performed, including scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. Multiplanar reformatted images were evaluated for the presence of an adnexal mass and differentiation between benign and malignant ones, using the surgical and pathologic results as standard of reference. CT findings used to diagnose malignancy were: diameter greater than 4 cm, presence of masses bilaterally, cystic-solid mass, necrosis in a solid lesion, cystic lesion with thick, irregular walls or septa and/or with papillary projections. Presence of ascites, peritoneal metastases and lymphadenopathy was used to confirm malignancy. Multiple logistic regression analysis of the MDCT findings was performed to determine those more predictive of malignancy. RESULTS: Histopathologic examination demonstrated 143 adnexal mass lesions, 96 (67%) of which were benign and 47 (33%) malignant. Multidetector CT detected 129 (90%) of the 143 adnexal masses, with an overall accuracy for the diagnosis of malignancy of 89.15%. The MDCT findings that found more predictive of malignancy were the presence of papillary projections in a cystic lesion, necrosis in solid mass and peritoneal metastases. CONCLUSION: Multidetector computed tomography on a 16-row CT scanner proved accurate in the detection and characterization of adnexal masses.

Local staging of endometrial carcinoma: role of multidetector CT.

The purpose was to evaluate the accuracy of multidetector CT (MDCT) on a 16-row CT scanner in local staging of endometrial carcinoma and more specifically in the assessment of the depth of myometrial invasion and presence of cervical infiltration. This prospective study includes 21 women with newly diagnosed endometrial carcinoma. All CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen after intravenous administration of iodinated contrast material, during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. Sagittal, parasagittal and oblique reformatted images were evaluated for the depth of myometrial invasion, whether superficial or deep, and the presence of cervical infiltration. Imaging findings were correlated with the histopathologic results. The sensitivity, specificity and accuracy of MDCT in evaluating myometrial invasion were 100%, 80% and 95%, respectively, and for assessing cervical infiltration were 78%, 83% and 81%, respectively. In conclusion, MDCT on a 16-row CT scanner proved accurate in local staging of endometrial carcinoma.

Comparative evaluation of multidetector CT and MR imaging in the differentiation of adnexal masses.

The purpose was to compare the accuracy of multidetector CT (MDCT) on a 16-row CT scanner and magnetic resonance (MR) imaging in the characterization of ovarian masses. Preoperative CT examination of the abdomen and MR imaging of the pelvis was performed in 67 women, with clinically or sonographically detected adnexal masses. The CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. We used a 1.5-T magnet unit to perform T1, T2 and fat-suppressed T1-weighted sequences, before and after intravenous administration of gadolinium chelate compounds. The accuracy of multidetector CT and MR imaging in the differentiation between benign and malignant ovarian masses was evaluated, using histopathologic results as the standard of reference. The sensitivity, specificity and accuracy of MDCT in the characterization of ovarian masses were 90.5%, 93.7% and 92.9%, respectively, and that of MR imaging 95.2%, 98.4% and 97.6%, respectively. Although MRI performed slightly better, this did not reach statistical significance. In conclusion, both MDCT on a 16-row CT scanner and MR imaging demonstrated satisfactory results in the characterization of ovarian masses.

Multi-detector row CT urography on a 16-row CT scanner in the evaluation of urothelial tumors.

The purpose of this study was to assess the role of multi-detector row CT urography (MDCTU), on a 16-row CT scanner in the evaluation of patients with painless hematuria, with emphasis placed in the detection of urothelial tumors. We retrospectively reviewed the MDCT urographies of 75 patients, referred for painless hematuria. The CT protocol included unenhanced images, obtained with a detector configuration of 16x1.5 mm and pitch of 1.2, nephrographic and excretory-phase images, obtained with a detector collimation of 16x0.75 mm and pitch of 1.2. Axial and coronal reformatted images were evaluated. Three-dimensional reformation of the excretory-phase images was performed using the volume-rendering technique. The standard of reference included clinical and imaging follow-up, cystoscopic, surgical and histologic findings. In 55 (73%) of 75 patients, the cause of hematuria was identified on MDCTU; the most common cause was urothelial cancer, including seven tumors with a diameter equal or smaller than 0.5 cm in diameter. Sixteen-row MDCTU provided satisfactory results in the investigation of patients with painless hematuria. The main advantage of the technique is its ability to detect uroepithelial malignancies.

Solitary fibrous tumour of the epididymis: MRI features.

We present a case of a solitary fibrous tumour, located at the epididymis, in a 65-year-old man, presented with a scrotal mass. Ultrasound and MRI of the scrotum revealed a paratesticular mass, with rich vascularity, arising in the left epididymis. Radiological findings were non-specific and the patient underwent surgery.

Computed tomographic virtual cystoscopy for the detection of urinary bladder neoplasms.

OBJECTIVE: To evaluate the role of computed tomographic virtual cystoscopy (CTVC) in the detection of bladder neoplasms and to compare CTVC at conventional and reduced milliAmperes-second (mAs) settings. METHODS: Twenty-four patients with known bladder neoplasms from previous conventional cystoscopy were examined with CTVC. The urinary bladder was insufflated with room air and helical CT data were obtained. Virtual images were created using volume rendering algorithms. In eight patients we used both regular (240) and reduced (70) mAs values. The lesions were recorded on transverse tomographic slices and virtual images and compared with conventional cystoscopy, operative and pathology results. RESULTS: All bladder lesions (30) seen on conventional cystoscopy were demonstrated with CTVC. Two lesions detected on imaging studies and subsequently found at operation were not seen on conventional cystoscopy. In a third case of a neobladder, conventional cystoscopy was impossible due to neoplastic involvement of the penis. In all cases the lesions were equally conspicuous with conventional and low mAs values. CONCLUSIONS: Computed tomographic virtual cystoscopy is a minimally invasive technique that can provide comprehensive information about urinary bladder tumors. Furthermore, low mAs studies are equally effective for the examination of such patients.

CT colonoscopy for obstructive sigmoid endometriosis: a new technique for an old problem.

Endometriosis of the sigmoid colon is a pathologic entity which is infrequently reported. A 29-year-old woman was admitted to the hospital because of abdominal pain, constipation, and menstrual rectal bleeding. Endometriosis was suspected, and CT (virtual) colonoscopy showed severe stenosis of the orthosigmoid canal due to a submucosal mass. Sigmoidoscopy using a pediatric endoscope was successful, and biopsies confirmed the original diagnosis. Non-invasive techniques such as endoscopic ultrasound and CT (virtual) colonoscopy now make it possible to diagnose sigmoid endometriosis. The latter technique, in particular, is feasible and well tolerated.