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Purpose: This study was undertaken to prospectively determine the diagnostic capabilities of magnetic resonance (MR) imaging in detecting myometrial and cervical invasion and lymph node involvement in endometrial carcinoma and to identify the causes of errors in staging endometrial carcinoma., Materials and Methods: Twenty consecutive patients with a histological diagnosis of endometrial carcinoma underwent preoperative MR imaging. MR findings were compared with surgical staging, considered as the standard of reference., Results: In assessing myometrial invasion, MR imaging showed 70% accuracy, 80% sensitivity, 40% specificity, 80% positive predictive value (PPV), and 40% negative predictive value (NPV). In detecting cervical invasion, MR imaging had 95% accuracy, 100% sensitivity, 94.4% specificity, 66.7% PPV, and 100% NPV. In evaluating lymph node involvement, MR imaging showed 100% accuracy, sensitivity, specificity, PPV and NPV. Errors in evaluating myometrial invasion were caused by polypoid tumour, adenomyosis and leiomyomas, whereas those in evaluating cervical invasion were caused by dilatation and curettage., Conclusions: MR imaging is a reliable technique for preoperative evaluation of endometrial carcinoma. Its main limitation is differentiating between stage IA and IB carcinomas, which is not highly important for surgical planning. Cooperation between the gynaecologist and radiologist is mandatory to avoid staging errors.

Purpose: This study prospectively compared the diagnostic capabilities of magnetic resonance (MR) imaging with conventional defecography (CD) in outlet obstruction syndrome., Materials and Methods: Nineteen consecutive patients with clinical symptoms of outlet obstruction underwent pelvic MR examination. The MR imaging protocol included static T2-weighted fast spin-echo (FSE) images in the sagittal, axial and coronal planes; dynamic midsagittal T2-weighted single-shot (SS)-FSE and fast imaging employing steady-state acquisition (FIESTA) cine images during contraction, rest, straining and defecation. MR images (including and then excluding the evacuation phase) were compared with CD, which is considered the reference standard., Results: Comparison between CD and MR with evacuation phase (MRWEP) showed no significant differences in sphincter hypotonia, dyssynergia, rectocele or rectal prolapse and significant differences in descending perineum. Comparison between CD and MR without evacuation phase (MRWOEP) showed no significant differences in sphincter hypotonia, dyssynergia or enterocele but significant differences in rectocele, rectal prolapse and descending perineum. Comparison between MRWEP and MRWOEP showed no significant differences in sphincter hypotonia, dyssynergia, enterocele or descending perineum but significant differences in rectocele, rectal prolapse, peritoneocele, cervical cystoptosis and hysteroptosis., Conclusions: MR imaging provides morphological and functional study of pelvic floor structures and may offer an imaging tool complementary to CD in multicompartment evaluation of the pelvis. An evacuation phase is mandatory.

Purpose: We investigated the accuracy of a new US investigation technique, called retrograde cystography US, in the early diagnosis and staging of vesicoureteral reflux., Material and Methods: We examined 5 patients, aged 3 months to 10 years, suffering from hydronephrosis and/or pyelonephritis. Retrograde cystography US was followed by conventional retrograde cystography. Retrograde cystography US consists in the transcatheter introduction of a contrast agent (Levovist, Schering AG, Berlin, Germany) into the bladder and a subsequent color Doppler examination to show or exclude the presence of reflux. Superpubic scanning of bladder, ureters and pyelocaliceal cavity was performed after echocontrast agent introduction to assess the reflux grade. US was performed with an Esaote AU 590 asynchronous scanner (Esaote Biomedica, Genova, Italy) with a 3.5 MHz convex probe., Results: After the transcatheter introduction of Levovist, vesicoureteral reflux was seen in 5/5 patients. Reflux grade was also measured with US and then confirmed at retrograde cystography. In a patient with pyelonephritis and no reflux at follow-up cystography, retrograde cystography US identified a unilateral reflux (grade 1)., Discussion and Conclusions: Retrograde cystography US showed the echocontrast agent in the urinary tract and assessed the reflux grade in all 5 patients, which was then confirmed at cystography. In a patient with grade 1 unilateral reflux at cystography US, follow-up conventional cystography showed no reflux, which seems to confirm a higher sensitivity of the US technique. The total agreement of conventional and US findings seems to confirm the importance of the US method for the diagnosis and staging of vesicoureteral reflux.

Introduction: The differential diagnosis of focal hepatic lesions is still studied by diagnostic imaging operators. A big step forward in the field of ultrasound (US) has come from the color Doppler mode permitting accurate studies of the vascularization of focal hepatic lesions. Echocontrast agents have further improved color Doppler sensitivity to slow flows and have permitted to visualize intralesional vascular signals which were missed at B-mode US. New data have thus been acquired which can be integrated with flowmetric findings to help make the correct differential diagnosis with a fair safety margin. We studied the pathognomonic US pattern for each type of lesion., Material and Methods: We examined 55 patients with single hepatic lesions which had already been typified: they were 10 hepatic angiomas, 3 focal nodular hyperplasias (FNH), 2 hepatic adenomas, 20 hepatocarcinomas and 20 hepatic metastases. Color Doppler investigations were performed on each patient before and after the intravenous (i.v.) administration of an echocontrast agent (Levovist, Schering AG, Berlin, Germany). For each lesion we studied the morphological characteristics, the resistance index (RI) of intralesional arterial vessels, the hepatic perfusion index and the maximum speed in intralesional vessels., Results: Contrast-enhanced US showed no intralesional signals or afferent branches in 8 hepatic angiomas, which however exhibited some peripheral vascularization; weak intralesional vascular signals were demonstrated in 2 cavernous angiomas. Intralesional signals, as well as peripheral vascularization, were detected in the 3 FNH cases, which also exhibited a centripetal afferent branch; the hepatic perfusion index in these lesions never exceeded .25. The two hepatic adenomas had similar color flowmetry to FNH also after i.v. contrast agent administration, except for the contripetal afferent vessel which was not seen. In the 20 hepatocarcinomas, contrast-enhanced images showed numerous intralesional signals and afferent branches which, with the peripheral vascularization, resulted in a basket-like pattern. Flowmetry of intralesional arterial vessels showed an irregular systodiastolic range, with RI = .32 +/- .5 in 12 lesions and high in the remaining 8 lesions (RI = .82 +/- 10). The hepatic perfusion index was .65 +/- 10 in all patients. In 14 of the 20 hepatic metastases, B-mode US showed no intralesional signals except for 6 metastases from colorectal carcinoma, and contrast-enhanced findings were about the same. The hepatic perfusion index at flowmetry ranged .30 to .45 in all patients.

Müllerian duct alterations in development or fusion in the embryo cause congenital uterine anomalies which may be responsible for decreased fertility or problems in carrying out a normal pregnancy. In this study, the MR findings in uterine agenesis (1 case), unicornuate (2 cases), didelphys (3 cases), bicornuate (3 cases), arcuate (6 cases) and septate uterus (8 cases) are described, together with the optimal section planes for their demonstration. The examinations were performed with an 0.5-T superconductive magnet, the spin-echo technique and mostly T2-weighted sequences. The anomalies were grouped according to Buttram and Gibbons classification, which is the most used in clinics. In particular, the bicornuate uterus was distinguished from the septate uterus, the latter associated with the highest spontaneous abortion rates, on the basis of external fundal outline appearance. In such anomalies, the muscular or fibrotic nature of any intracavitary septum was assessed based on septal thickness more than on signal intensity at this level. MR diagnostic accuracy in 23 patients with Müllerian anomalies, compared with surgical, hysteroscopic, laparotomic and laparoscopic findings, was 100%. Nevertheless, if Müllerian duct anomalies responsible for gynecologic-obstetric problems are known or suspected, MRI should always be used, on the basis of a close gynecologist-radiologist collaboration, for classification agreement and the evaluation of any intracavitary septum morpho-biometric appearance and possibly nature, to discuss treatment options.

In uterine cervical canal carcinoma, the current clinical FIGO criteria often fail not only to differentiate stage IA2 from stage IB but also to demonstrate possible parametrial involvement. Moreover, the analysis of tumor volume and of the depth of neoplastic stromal invasion is not very reliable. The authors investigated MR accuracy in the definition of such variables: to this purpose, 24 patients with histologically confirmed endocervical adenocarcinoma were submitted to MRI, which was performed with an 0.5-T superconductive magnet. Sagittal and oblique transverse or sometimes coronal SE images, oriented so as to be perpendicular to longitudinal cervical major axis were obtained with T2 weighting (TR 1800 ms, TE 25-90 ms). MR data were correlated with pathologic findings. MR accuracy in demonstrating parametrial involvement was 92%, its sensitivity was 86% and specificity 97%. Volumetric MR data showed a high correlation (r = 0.970) with those derived from pathologic findings. In 92% of cases stromal invasion exceeded 5 mm. MRI, thanks to its high accuracy, should be included in diagnostic pretreatment protocols, even though FIGO criteria do not require it yet, especially in the presence of an endocervical adenocarcinoma. Moreover, the accurate definition of tumor volume can allow less extensive surgery with the same survival rates and fewer complications, which are frequently observed after radical hysterectomy.