Malignant liver lesions: comparison of spiral CT arterial portography and MR imaging for diagnostic accuracy, cost, and effect on patient management.

We compared two imaging techniques, spiral CT arterial portography (CTAP) and MR imaging, for diagnostic accuracy, procedural cost, and effect on management of 26 patients referred for hepatic surgery for suspected limited malignant liver disease. CTAP and MR imaging were done within a 1-week period (19 within 24 hours); the results of the studies were interpreted prospectively by separate reviewers. Surgical data were evaluated in conjunction with imaging data in 10 patients. Lesion detection and segmental involvement were determined and sensitivity and specificity were calculated. Procedural cost was determined from hospital billing codes. Effect on patient management was determined by the referring oncologic surgeon. CTAP and MR imaging showed 185 and 176 true-positive malignant lesions, 15 and zero false-positive malignant lesions, zero and 18 true-negative malignant lesions, and 13 and 22 false-negative malignant lesions, respectively. CTAP and MR imaging showed 107 and 105 true-positive segments, 11 and zero false-positive segments, 80 and 91 true-negative segments, and four and six false-negative segments, respectively. There was a significant difference in specificity of segmental involvement between MR imaging (1.0 +/- 0) compared with CTAP (0.88 +/- 0.05), P = .03. Total procedural cost was $3,499 for CTAP and $1,224 for MR imaging. CTAP findings did not change patient management over MR imaging findings in any patient, whereas MR imaging findings resulted in a change in patient management over CTAP findings in seven patients (P = .015). The results of our study suggest that MR imaging has higher diagnostic accuracy and greater effect on patient management than CTAP does and is 64% less expensive.

Anatomic changes in the pelvis after uncomplicated vaginal delivery: evaluation with serial MR imaging.

PURPOSE: To demonstrate the normal involution process of the post-partum pelvis with serial magnetic resonance (MR) imaging. MATERIALS AND METHODS: MR imaging was performed in 14 women after uncomplicated vaginal delivery. Six women underwent serial MR examinations at less than 30 hours and at 1 week, 2 weeks, 6 weeks, and 6 months after delivery; eight women were examined only within 30 hours of delivery. The dimensions and signal intensity of the uterus and cervix and the appearance of other pelvic structures were evaluated. RESULTS: The mean length of the uterine corpus was 13.8 cm within 30 hours of delivery and 5.0 cm at 6 months. The mean length of the cervix was 5.6 cm within 30 hours of delivery and 2.9 cm at 6 months. The junctional zone was not visible before 2 weeks; however, it was visible in all cases at 6 months. The outer cervical stroma had high signal intensity less than 30 hours after delivery and intermediate signal intensity thereafter. The inner cervical stroma was visible as a low-signal-intensity stripe on all images. CONCLUSION: Knowledge of the normal MR appearance of the involuting postpartum pelvis provides a baseline for interpretation of MR images obtained during this period.

Endovaginal Doppler ultrasound in ovarian torsion: a case series.

Four women with acute pelvic pain clinically suspected to be secondary to ovarian torsion were examined with gray-scale and Doppler ultrasound. All affected ovaries were enlarged (volumes 3.2-34 times the volumes of the ovaries on the unaffected sides). Three ovaries showed no internal flow, and one showed internal arterial flow. Ovary-conserving treatment was attempted in all four cases but the three ovaries which showed no evidence of internal flow eventually required removal. The fourth case, in which arterial flow was present on Doppler examination, was treated only with laparoscopic untwisting of the pedicle and did not require oophorectomy. The results of our study suggest that Doppler findings may distinguish ovaries which are beyond salvage and require removal from those which may be saved by prompt laparoscopic untwisting of the adnexa, but further studies with larger numbers of patients will be necessary.

Comparison of breath-hold T1-weighted MR sequences for imaging of the liver.

Three rapid T1-weighted gradient-echo techniques for imaging of the liver were compared: fast low-angle shot (FLASH) and section-selective (SSTF) and non-section-selective (NSTF) inversion-recovery TurboFLASH. Ten healthy volunteers were imaged at 1.5 T, with breath-hold images acquired in the transaxial and coronal planes and non-breath-hold images in the transaxial plane. Breath-hold images were evaluated quantitatively and qualitatively, and non-breath-hold images were evaluated qualitatively. FLASH images had significantly higher (P < .001) spleen-liver signal difference-to-noise ratios (SD/Ns) than NSTF and SSTF images. Liver signal-to-noise ratios (S/Ns) were significantly higher (P < .001) on FLASH images than on NSTF and SSTF images. With breath hold, FLASH images were rated as having the highest quality in the axial plane, followed by NSTF and SSTF images. In the coronal plane, NSTF images were rated as having the highest quality. For images acquired during patient respiration, NSTF images had the highest quality and showed the least degradation. The results suggest that FLASH images have the highest SD/N and S/N for liver imaging and have the highest quality in the axial plane. In patients who cannot suspend respiration. NSTF images may be least affected by breathing artifact and provide reasonable image quality.