[Progress in imaging diagnostics of adrenal neoplasms]. / Postep w diagnostyce obrazowej guzów nadnerczy.

Computed tomography is the modality of choice in imaging of adrenal glands. Density measurements on images without contrast agent are essential for differentiation of adrenal masses. Application of spiral computed tomography for diagnostics of adrenal masses enables sensitive detection of small adrenal tumors and reliable density measurements by elimination of uneven breath-holds effect and minimization of partial volume effect. Tissue harmonic imaging in ultrasonography is a new technique, which enables visualization of abdominal parenchymal organs with higher tissue contrast with less artifacts and is especially useful in ultrasound imaging of difficult-to-image patients with high body weight. Further comparative research will enable to learn the advantages of using that technique in diagnostics of adrenal masses. Magnetic resonance imaging enables very accurate visualization diagnostics of adrenal masses. It is due to its inherent multiplanar imaging capabilities and high tissue contrast of soft tissues which enables very accurate visualization of anatomical structures in adrenal region. Introduction of new techniques of magnetic resonance imaging as chemical shift imaging and dynamic studies with paramagnetic contrast agent enables accurate differentiation of adrenal cortex adenomas from non-adenomas. In case of difficulties in adrenal diagnostics magnetic resonance imaging is often a problem solving examination in regard to other imaging techniques of adrenal region.

[Preoperative evaluation of the invasiveness of myometrial and pelvic lymph nodes in patients with endometrial cancer]. / Przedoperacyjna diagnostyka glebokosci naciekania miesnia macicy oraz przerzutów do wezlów chlonnych miednicy u chorych na raka endometrium.

Transvaginal sonography (TVS), computed tomography (CT) and magnetic resonance imaging (MRI) were used for preoperative diagnosis of myometrial and pelvic lymph nodes invasion in patients with endometrial cancer. Results of examinations were compared with histopathological findings. Sensitivity, specificity, efficacy, positive and negative prognostic values of these imaging techniques were compared. TVS and MRI had similar efficacy in the evaluation of depth of myometrial invasion (78.8% vs 67.6%). In the evaluation of deep invasion TVS in spite of lower sensitivity had higher specificity and positive prognostic value. Efficacy of all methods for evaluation of lymph nodes metastases was similar (80-82%), but TVS had higher positive prognostic value than MRI. CT in comparison with TVS and MRI was less useful in the diagnosis of myometrial invasion.

[Preoperative evaluation of cervical involvement in endometrial cancer]. / Mozliwosc przedoperacyjnej oceny zajecia szyjki macicy przez proces nowotworowy u chorych na raka endometrium.

Usefulness of fractionated curettage, histeroscopy, transvaginal sonography and MR-imaging in the preoperative diagnosis of cervical involvement of endometrial cancer was studied. Sensitivity, specificity, efficacy, positive and negative prognostic value of above-mentioned examinations were compared. None of examinations was adequate for diagnosis of presence of cervical invasion because of their low positive prognostic values. Negative prognostic value of all examinations was high. MR-imaging and transvaginal sonography had the highest efficacy and comparatively high sensitivity and specificity. Authors suggest, that transvaginal sonography--considering its simplicity and relative cheapness--should be obligatory in the diagnosis of endometrial cancer advancement.

Fractional curettage, hysteroscopy and imaging techniques: transvaginal sonography (TVS), magnetic resonance imaging (MRI) and computed tomography (CT) in the diagnosis of cervical canal involvement in cases of endometrial carcinoma.

The value of preoperative diagnostic procedures (FC, hysteroscopy, TVS, MRI, CT) used to evaluate cervical canal involvement in cases of endometrial carcinoma was assessed. The results of these diagnostic methods were compared to postoperative pathologic examination results. Evaluation of the cervix by CT was limited. High NPV of the rest of the methods together with their negative results allowed us to exclude cervical infiltration with a high probability. Alas, none of them was adequate to confirm the presence of cervical involvement because of their low PPV which ranged from 8.3% (hysteroscopy) to 50% (MRI). Among all these diagnostic procedures TVS was relatively efficient (77.8%), specific (78%), sensitive (75%) and inexpensive. This method is preferable in the evaluation of possible cervical infiltration.

Magnetic resonance imaging differentiation of adrenal masses at 1.5 T: T2-weighted images, chemical shift imaging, and Gd-DTPA dynamic studies.

The purpose of our study was to assess the potential role of spin-echo (SE), chemical shift, and gadolinium-enhanced magnetic resonance imaging (MRI) in the differentiation of adrenal masses. Seventy-two adrenal masses (26 nonhyperfunctioning adenomas, 16 aldosterone-secreting adenomas and 6 other different benign cortical masses, 18 pheochromocytomas, and 6 malignant masses) in 63 patients were evaluated with spin-echo sequences, chemical shift imaging (CSI) and gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) dynamic studies. Ratios and indices of signal intensity for all examined MRI methods were calculated and examined for significance of difference between different types of adrenal masses. Quantitative magnetic resonance evaluation of adrenal masses showed significant differences (at least alpha < 0.01) between nonhyperfunctioning adenomas vs. pheochromocytomas or vs. malignant lesions or vs. aldosterone-secreting adenomas and between pheochromocytomas vs. malignant lesions. The most specific indicators of adrenal mass character proved to be the CSI ratio based on opposed-phase and in-phase two-dimensional fast low-angle shot (FLASH) images, reflecting lipid content in the lesion, and Gd-DTPA dynamic studies ratios reflecting contrast agent inflow and washout in the lesion: WoMAX/LAST and Dyn1.2-3.2. There was no overlap of CSI ratio between adenomas and pheochromocytomas. The overlap of ranges of CSI ratio between nonhyperfunctioning adenomas and aldosterone-secreting adenomas was only 18.5%. There was no overlap of WoMAX/LAST ratio between adenomas and pheochromocytomas, or adenomas and malignant lesions. The overlap of ranges of Dyn1.2-3.2 ratio between pheochromocytomas and malignant lesions was only 17.6%. MRI enables good visualization and specific characterization of adrenal masses. The optimal MRI protocol for the adrenal region is presented.