Search

The aim of this study was to evaluate feasibility and reproducibility of quantitative assessment of colonic morphology on CT colonography (CTC). CTC datasets from 60 patients with optimal colonic distension were assessed using prototype software. Metrics potentially associated with poor endoscopic performance were calculated for the total colon and each segment including: length, volume, tortuosity (number of high curvature points

Die ultraschallgesteuerte perkutane Biopsie einer Lasion am Hals ist eine kosteneffiziente, sichere und zielfuhrende diagnostische Masnahme ohne Strahlenbelastung. Sie ermoglicht eine Sichtkontrolle der Nadelposition in Echtzeit. Das hat den Vorteil, dass die Vorschubrichtung der Nadel sofort korrigiert und die Gewebeentnahme infolgedessen ohne grosere Risiken an der richtigen Stelle und in kurzer Zeit durchgefuhrt werden kann. Eine effektive ultraschallgesteuerte Biopsie erfordert Erfahrung mit der Technik, Grundlichkeit bei der klinischen Beurteilung und Geschicklichkeit bei der Durchfuhrung der Biopsie. Gute Kenntnisse der Anatomie und Pathologie von Kopf und Hals erlauben dem Neuroradiologen die Korrelierung der Ultraschallbildgebung mit transversalen Schnittbildern und erleichtern deren Interpretation. Vertrautheit mit den gangigen Halsoperationen und -rekonstruktionen und die Fahigkeit zur Beurteilung von Aufnahmen des behandelten Halses in verschiedenen Bildgebungsmodalitaten sind von unschatzbarem Wert bei der Bestimmung des Zieles einer ultraschallgesteuerten Biopsie bei Patienten mit behandlungsbedingten Veranderungen der anatomischen Gegebenheiten. Nach Knoten in der Schilddruse kommen die folgenden Raumforderungen am Hals von Erwachsenen haufig vor: Lymphadenopathien, Kopf-Hals-Malignome, Speicheldrusenneoplasien, Nervenscheidentumoren sowie entzundliche und infektiose Herde. Auch die diagnostische Expertise mit Blick auf die Bildgebungsmerkmale der genannten Erkrankungen und auf ihre Differenzialdiagnose spielt eine wichtige Rolle bei der Wahl der Biopsietechnik und der Gewinnung einer geeigneten Gewebeprobe fur die Diagnose einschlieslich Materials fur zusatzliche Laboruntersuchungen. Einer Einteilung in anatomische Zonen folgend skizziert dieser Artikel die praktischen Uberlegungen bei der Auswahl der Patienten, bei der methodischen Analyse der praprozeduralen Querschnittsbildgebung und deren Korrelierung mit der Beurteilung der Echtzeit-Ultraschallbildgebung sowie bei den allgemeinen Prinzipien zur Optimierung der Ultraschallinstrumentierung und der Biopsietechnik. In geubten Handen ist die Sonografie aufgrund ihrer Vielseitigkeit und ihrer Portabilitat eine wertvolle Modalitat fur die Gewinnung von Gewebeproben von oberflachlichen Kopf- und Halslasionen.

To explore quantitative differences between genders in morphologic colonic metrics and determine metric reproducibility.Quantitative colonic metrics from 20 male and 20 female CTC datasets were evaluated twice by two readers; all exams were performed after incomplete optical colonoscopy. Intra-/inter-reader reliability was measured with intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC).Women had overall decreased colonic volume, increased tortuosity and compactness and lower sigmoid apex height on CTC compared to men (p0.0001,all). Quantitative measurements in colonic metrics were highly reproducible (ICC=0.9989 and 0.9970; CCC=0.9945).Quantitative morphologic differences between genders can be reproducibility measured.

To assess the effectiveness of computer-aided detection (CAD) as a second reader or concurrent reader in helping radiologists who are moderately experienced in computed tomographic colonography (CTC) to detect colorectal polyps. Seventy CTC datasets (34 patients: 66 polyps ≥6 mm; 36 patients: no abnormalities) were retrospectively reviewed by seven radiologists with moderate CTC experience. After primary unassisted evaluation, a CAD second read and, after a time interval of ≥4 weeks, a CAD concurrent read were performed. Areas under the receiver operating characteristic (ROC) curve (AUC), along with per-segment, per-polyp and per-patient sensitivities, and also reading times, were calculated for each reader with and without CAD. Of seven readers, 86 % and 71 % achieved a higher accuracy (segment-level AUC) when using CAD as second and concurrent reader respectively. Average segment-level AUCs with second and concurrent CAD (0.853 and 0.864) were significantly greater (p

Although the Centers for Medicare and Medicaid Services (CMS) denied coverage for screening computed tomography colonography (CTC) in March 2009, little is understood about whether CTC was targeted to the appropriate patient population prior to this decision.Evaluate patient characteristics and known relative clinical indications for screening CTC among patients who received CTC compared to optical colonoscopy (OC).Cross-sectional study of all 10,538 asymptomatic Medicare beneficiaries who underwent CTC between January 2007 and December 2008, compared to a cohort of 160,113 asymptomatic beneficiaries who underwent OC, matched on county of residence and year of examination.Patient characteristics and known relative appropriate and inappropriate clinical indications for screening CTC.CTC utilization was higher among women, patients65 years of age, white patients, and those with household income75 % (p = 0.001). Patients with relatively appropriate clinical indications for screening CTC were more likely to undergo CTC than OC including presumed incomplete OC (OR 80.7, 95 % CI 76.01-85.63); sedation risk (OR 1.11, 95 % CI 1.05-1.17); and chronic anticoagulation risk (OR 1.46, 95 % CI 1.38-1.54), after adjusting for patient characteristics and known clinical indications. Conversely, patients undergoing high-risk screening, an inappropriate indication, were less likely to receive CTC (OR 0.4, 95 % CI 0.37-0.42). Overall, 83 % of asymptomatic patients referred to CTC had at least one clinical indication relatively appropriate for CTC (8,772/10,538).During the 2 years preceding CMS denial for screening, CTC was targeted to asymptomatic patients with relatively appropriate clinical indications for CTC/not receiving OC. However, CTC utilization was lower among certain demographic groups, including minority patients. These findings raise the possibility that future coverage of screening CTC might exacerbate disparities in colorectal cancer screening while increasing overall screening rates.

Purpose To assess the findings of recurrent Crohn's disease in the neoterminal ileum on small bowel follow through (SBFT) and computed tomography (CT) as well as the overall diagnostic performance of these imaging tests. Methods Our radiology database yielded 52 patients with an ileocolic anastomosis for Crohn's disease who underwent SBFT and CT. The images were reviewed to determine the sensitivity, specificity, PPV, and NPV for individual findings of recurrent Crohn's disease in the neoterminal ileum. The overall sensitivity, specificity, PPV, and NPV of these tests for recurrent Crohn's disease were determined by comparing imaging reports to endoscopic and surgical findings in 45 patients (87%) and clinical response to treatment in seven (13%). Results SBFT had a sensitivity of 90%, specificity of 85%, PPV of 95%, and NPV of 73% for detecting recurrent Crohn's disease, and CT had a sensitivity of 77%, specificity of 69%, PPV of 88%, and NPV of 50%. These tests combined had a sensitivity of 95%, specificity of 69%, PPV of 90%, and NPV of 82%. The most common findings were luminal narrowing, thickened folds, and ulcers (especially aphthoid lesions) on SBFT and bowel wall thickening on CT. CT also revealed extraenteric collections not visualized on SBFT in three patients (8%). Conclusions Our experience suggests that SBFT is more sensitive and specific than CT for detecting recurrent Crohn's disease in the neoterminal ileum, mainly because of the ability of barium studies to depict aphthoid lesions not visualized on CT. Conversely, CT is better for detecting extraenteric findings such as abscesses. When combined, these tests have a higher sensitivity for detecting recurrent Crohn's disease than either test alone.

Ultrasonographically (US) guided percutaneous biopsy of a neck lesion is a cost-effective, safe, and diagnostically effective procedure without radiation exposure. The benefit of real-time visualization of the needle location allows for instantaneous maneuvering of the needle trajectory for safe and accurate tissue sampling with short procedural time. Effective US-guided biopsy requires technical experience, strong clinical acumen, and skillful biopsy technique. A neuroradiologist's knowledge of head and neck anatomy and pathology allows correlation with cross-sectional imaging and enhances the understanding of US imaging evaluation. Familiarity with a spectrum of neck surgeries and reconstructions and expertise in imaging evaluation of the treated neck are invaluable in accurate identification of the target for biopsy in patients with treatment-related altered anatomy using US guidance. After thyroid nodules, the common adult neck masses are lymphadenopathy, head and neck cancer, salivary neoplasms, nerve sheath tumors, and inflammatory and infectious pseudomasses. Diagnostic expertise in the imaging characteristics of these individual pathologic conditions and their differential diagnoses also play an important role in choosing the biopsy technique and in procuring an adequate sample for diagnosis, including material for ancillary laboratory testing. Using an anatomic zone approach, this article illustrates the practical considerations in patient selection, the methodical analysis of preprocedure cross-sectional imaging and its correlation with real-time US evaluation, general principles for optimizing US instrumentation, and biopsy technique. In skillful hands, the versatility and portability of US make it the valuable modality for histologic sampling of superficial head and neck lesions. Online supplemental material is available for this article.

Saline-infused sonohysterography (SIS) may help improve visualization of the endometrium and endometrial cavity and assess tubal patency. Although most SIS procedures are straightforward, a variety of pitfalls may lead to an unsuccessful procedure or incomplete evaluation. SIS should be scheduled between days 4 and 10 of the patient's menstrual cycle, when the endometrium is at its thinnest, and physiologic changes during the secretory phase are not present. Performing preprocedure imaging serves many purposes, such as depicting hydrosalpinx, causes of uterine and adnexal tenderness, and pelvic inflammatory disease, as well as assessing the size and position of the uterus and the orientation of the cervix. It is important not to presume that fibroids are the cause of bleeding when the endometrium is obscured at preprocedure imaging. Obstacles to a successful procedure include issues related to patient anxiety and discomfort, which may be prevented or minimized at almost every step of the procedure. Inability to obtain access to the cervix is the most common cause of unsuccessful SIS; proper patient positioning in a semi-upright lithotomy position is important. Injection of air during any US-guided procedure may lead to shadowing that obscures the region of interest. Adequate distention of the endometrial cavity is crucial for successful SIS, and optimal positioning of the distended balloon may improve the degree of distention. However, poor distention may be indicative of an underlying pathologic condition. Knowledge of these pitfalls and the strategies to overcome them may prevent premature or unnecessary termination of an otherwise successful study.

Hematocolpos in a postmenopausal woman is uncommon because most cases are due to a congenital anomaly and present during the neonatal or perimenarchal period. In older women, hematocolpos results from near or complete vaginal occlusion secondary to radiation therapy for cervical carcinoma or from scarring after surgical procedures such as cone biopsy Rarely, vaginal obstruction may be due to postmenopausal atrophy, endometriosis, or vaginitis, leading to scarring or adhesions. 1―6 Hematocolpos after radiation therapy for colorectal carcinoma is a rare clinical entity. We report an unusual case of hematocolpos secondary to acquired vaginal scarring after radiation therapy for colorectal carcinoma in a postmenopausal woman who had dyspareunia and pelvic and lower back pain. Characteristics on 3-dimensional (3D) transvaginal sonography (TVS) and magnetic resonance imaging (MRI), as well as intraoperative sonographic guidance, are described, together with current management and a review of the literature. The diagnosis of vaginal scarring and associated hematocolpos was suggested by TVS and confirmed by intraoperative sonography.

Uterine artery embolization (UAE) is an effective treatment for symptomatic uterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis, and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post-UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE-associated common and uncommon MRI and CT appearances and discuss post-UAE complications that require urgent medical or surgical intervention.

This article examines the role of sonohysterography as an extension of the transvaginal ultrasound examination. This technique is used to improve visualization of the endometrial cavity and its relationship to the uterus. The authors find that it is well tolerated and causes few complications. The improved anatomic resolution increases diagnostic confidence and helps direct the patient to appropriate therapeutic options, potentially decreasing the need for more costly or invasive examinations. The addition of three-dimensional ultrasound makes the examination quicker and expands the utility of the procedure. The authors conclude that it will play a growing role in the evaluation of common gynecologic problems and in defining uterine pathology.

Our purpose was to assess the performance of CT colonography (CTC) in patients older than 60 years who were referred because colonoscopy was contraindicated or incomplete.Over a 2-year period, 61 patients underwent CTC at our institution, 42 of whom (26 women, 16 men) were 60 years old or older (range, 60-87 years; mean age, 71 years). After 24-48 hours of ingesting only clear liquids and after colonic cleansing, fecal tagging, and automated CO2 insufflation, patients were scanned using a 16-MDCT scanner. Images were obtained with the patient in the supine and prone positions and as needed in the right or left decubitus position. Axial 2D and 3D endoluminal views were evaluated on a dedicated workstation.Contraindications to colonoscopy in 12 (29%) of the 42 patients were as follows: anticoagulation (n = 8), increased anesthesia risk (n = 3), and poor tolerance for colonoscopy preparation (n = 1). Incomplete colonoscopy in the other 30 patients (71%) was due to diverticular disease (n = 10), colonic redundancy (n = 10), adhesions (n = 3), residual colonic content (n = 3), sigmoid stricture (n = 1), ventral hernia (n = 1), and unknown cause (n =2). No complications were observed. Optimal distention of the entire colon was achieved in 38 patients (90%). Thirty-nine (93%) of the 42 patients had abnormal findings: diverticular disease (n = 25), one or more polyps (n = 22), a mass lesion (n = 1), a lipoma (n = 1), and inflammatory stricture (n = 1). Extracolonic findings potentially requiring further evaluation or treatment were observed in 26 patients (62%).CTC using CO2 insufflation was well tolerated and successful in imaging the entire colon in most of the 42 patients, despite the presence of sigmoid diverticular disease or colonic redundancy.

Objective The purpose of this study was to review the clinical, imaging, and pathologic findings associated with adnexal torsion. Methods A review of surgically proven cases of torsion between 1990 and 2006 included clinical, surgical, and pathologic data and preoperative sonographic, computed tomographic (CT), and magnetic resonance imaging (MRI) studies. Imaging reports were assessed to determine whether a correct preoperative diagnosis was made. Factors related to failure to make a correct diagnosis were evaluated. Results Fifty-eight cases of torsion were evaluated (patient ages, 12-85 years; 14 postmenopausal). There was a slight right-sided predominance (55%); in most cases (72%), both the ovary and fallopian tube were involved. Common symptoms/signs were pain (91%), leukocytosis (64%), nausea/vomiting (62%), and a palpable mass (41%). Twenty-eight patients (48%) had previous abdominal surgery; in 12 (46%) of these 28, pelvic adhesions were noted. At pathologic examination, underlying adnexal masses were found in 30 cases (52%); they were benign in 26 (87%) of 30 cases. Common imaging findings were an adnexal mass (65% on sonography, 87% on CT, and 75% on MRI), a displaced adnexal mass/enlarged ovary (53% on sonography, 87% on CT, and 75% on MRI), and ascites (53% on sonography, 73% on CT, and 50% on MRI). A correct preoperative diagnosis was made by initial sonography in 15 (71%) of 21 cases versus initial CT in 5 (38%) of 13. A correct imaging diagnosis was made more frequently in premenopausal than in menopausal patients (P = .02) and in patients without an underlying adnexal mass compared with those with a mass (P = .05). Conclusions Although CT shows features suggestive of torsion, in our study, the diagnostic value of initial CT was less than that of initial sonography. A correct preoperative diagnosis was made less often with an underlying adnexal mass and in postmenopausal women. Previous surgery and adhesions may be predisposing factors for adnexal torsion.

While sudden onset of severe pelvic pain in an afebrile woman of reproductive age is considered the classic presentation of a patient with adnexal torsion, this constellation of findings occurs in the minority of patients with adnexal torsion. In fact, many patients with adnexal torsion present with mild or intermittent symptoms and adnexal torsion likely occurs more frequently than originally thought in post menopausal women. Thus, the clinical presentation is often non-specific and may mimic other gynecologic pathology and even renal or gastrointestinal causes of lower quadrant pain. Duplex Doppler ultrasound (US) is typically the initial imaging study performed in female patients with suspected gynecological pathology. Findings of an enlarged amorphous, heterogenous ovary with an underlying mass or peripheral small follicles in an abnormal midline location are suggestive of ovarian torsion on ultrasound examination. Color Doppler interrogation may demonstrate the twisted blood vessels in the adnexal pedicle. Absence of Doppler detected blood flow suggest torsion and/or infarction but the documentation of blood flow should not exclude the diagnosis of torsion in a painful ovary with suspicious morphologic features. Since computed tomography (CT) may be the first imaging study obtained in patients suspected of harboring gastrointestinal or renal pathology, the radiologist should be familiar with the CT findings or ovarian torsion such as the presence of an enlarged, non-enhancing midline ovary/mass with an adjacent thickened or beak shaped tube or hematoma. Magnetic resonance imaging (MRI) has a role in the work-up of pelvic pain when CT or US findings are non-specific. Findings of adnexal torsion on MR are similar to findings observed on CT. However, the presence of high signal intensity stromal edema and numerous peripheral foillicles as well as lack of stromal enhancement are more easily detected on MRI.

Objective. The purpose of this presentation is to show the imaging findings of the common and uncommon variants of adenomyosis as seen on sonography and magnetic resonance imaging (MRI). Methods. A 3-year database search was performed to identify women who had pelvic sonography and pelvic MRI within a 6-month interval. Images of these cases were retrospectively reviewed. Results. Eighty women were identified. Adenomyosis was diagnosed on MRI, which was used as the reference standard, in 45 of these women. The correct diagnosis was made on sonography in 73% of the cases. Conclusions. Awareness of the spectrum of imaging features of adenomyosis is important to use sonography effectively for diagnosing this entity and to help avoid misdiagnosis.

The American Institute of Ultrasound in Medicine convened a panel of physicians and scientists with interest and expertise in 3-dimensional (3D) ultrasound in obstetrics and gynecology to discuss the current diagnostic benefits and technical limitations in obstetrics and gynecology and consider the utility and role of this type of imaging in clinical practice now and in the future. This conference was held in Orlando, Florida, June 16 and 17, 2005. Discussions considered state-of-the-art applications of 3D ultrasound, specific clinical situations in which it has been found to be helpful, the role of 3D volume acquisition for improving diagnostic efficiency and patient throughput, and recommendations for future investigations related to the utility of volume sonography in obstetrics and gynecology.

Objective. The aim of this work was to review the technical aspects and clinical applications of three-dimensional ultrasonography in gynecologic imaging. Methods. With the use of a computerized database (MEDLINE), articles on three-dimensional ultrasonography were reviewed. Other pertinent references were obtained from the references cited in these articles. In addition, we reviewed our own clinical experience over the past 7 years. Results. Numerous applications of three-dimensional ultrasonography have been reported, including imaging of the uterus, the endometrial cavity, adnexa, and the pelvic floor and color and power Doppler applications. The accuracy of volume calculations and the networking opportunities with three-dimensional ultrasonography have also been reported. Technical problems and limitations of this technique are summarized. Conclusions. Three-dimensional ultrasonography has proved to be a useful imaging tool for clinical problem solving in gynecology, especially in imaging the uterus and uterine cavity.

Objective. To assess the use of intraoperative sonography for localization of breast masses at excisional biopsy, with specimen and surgical bed sonography to confirm excision. Methods. A computer search of the 5-year period from January 1993 through January 1998 revealed 138 consecutive women referred for sonographically guided excisional biopsy of 148 masses; 35 masses were excluded because they had no postoperative mammograms. One hundred thirteen masses constituted the study group. Specimen sonography (n = 60) or surgical bed sonography (n = 53) was performed as the initial evaluation to confirm excision, but ultimately, surgical bed sonography may have been necessary after specimen sonography, and specimen sonography may have been necessary after surgical bed sonography. The miss rates determined by postoperative imaging were calculated for each group and compared with those of mammographically guided needle localization series from the literature. Results. Follow-up physical examination and mammography showed no residual mass in the region of surgery in any patient. However, follow-up sonography had 1 miss in the initial specimen sonogram group (1 [1.7%] of 60) and 1 miss in the initial surgical bed group (1 [1.9%] of 53). As shown by the Fisher exact test, there was no significant difference between the miss rates of the 2 initial methods of confirming lesion excision or between the miss rates of these initial methods, both groups combined, and 6 mammographic localization series from the literature. Conclusion. Intraoperative breast sonography, using specimen sonography and scanning the surgical bed, has miss rates comparable with those of mammographic needle localization. Follow-up sonography must be performed if there is any doubt of complete excision.

Purpose To review the clinical indications, pathologic results, and success rate of all our sonographically guided solid renal mass biopsies over a 5-year period. Methods Between 1993 and 1998, 44 consecutive patients underwent sonographically guided percutaneous biopsy of a solid renal mass. Indications included prior history of nonrenal malignancy, metastatic disease of unknown primary origin, previous contralateral nephrectomy for a renal cell neoplasm, a renal transplant mass, suspected renal lymphoma, history of tuberous sclerosis, and poor surgical candidacy. Aspiration biopsies were initially performed with 22- to 18-gauge spinal needles. If the initial cytologic evaluation findings were nondiagnostic, core biopsies were then performed with 20- to 18-gauge core biopsy guns. Dictated sonographic reports of the biopsies were reviewed to determine the following: indication for biopsy, location and size of the renal mass, needle gauge and type, number of needle passes, and complications. Final cytologic and surgical pathologic records were reviewed. Results Thirty-six (82%) of the 44 biopsy specimens were diagnostic. Aspirated smears were diagnostic in 24 (67%) of these cases, with the diagnosis made on the basis of cell block alone in an additional 2 (6%). A definitive diagnosis came from core biopsy alone in 10 cases (28%). The 18-gauge core needle yielded diagnostic results more reliably than the 20-gauge core needle, and a significant correlation was seen between core biopsy needle size and the rate of diagnostic core samples (P = .017). Pathologic diagnoses included renal cell carcinoma (n = 18), lymphoma (n = 4), oncocytic neoplasm (n = 4), transitional cell carcinoma (n = 2), angiomyolipoma (n = 1), papillary cortical neoplasm (n = 1), and metastatic carcinoma (n = 6). Complications were seen in 4 (9%) of 44 cases; all were treated conservatively. Conclusions For specific clinical indications, sonographically guided fine-needle aspiration and core biopsy of a solid renal mass can be performed safely. In many cases, a definitive diagnosis can be made on the basis of fine-needle aspiration alone. However, diagnosis may ultimately require core biopsy, for which 18-gauge core needles would be more reliably diagnostic than 20-gauge needles.

The objective of this study was to assess the value of combining transvaginal sonohysterography with three-dimensional multiplanar ultrasonography to optimize assessment of the uterus. To make this assessment, we compared findings on three-dimensional sonohysterography with those on two-dimensional sonohysterography and X-ray hysterosalpingography. Of 20 women who underwent three-dimensional sonohysterography for various indications, 13 also underwent two-dimensional sonohysterography, and 12 had X-ray hysterosalpingography. We reviewed the 3 types of examinations separately and compared the standard techniques with three-dimensional sonohysterography to determine whether three-dimensional sonohysterography provided additional information. In 9 (69%) of 13 comparisons between three-dimensional sonohysterography and two-dimensional sonohysterography and in 11 (92%) of 12 comparisons between three-dimensional sonohysterography and X-ray hysterosalpingography, three-dimensional sonohysterography was advantageous. The coronal plane was most useful for displaying the relationship between lesions and the uterine cavity. Three-dimensional sonohysterography provided additional information compared with standard accepted techniques in the vast majority of women.

Objective To evaluate the feasibility and accuracy of fetal gender assignment from three-dimensional ultrasound (3D US) data at 10–24 weeks' gestation. Methods Three-dimensional ultrasound volume data on 47 fetuses were reviewed and divided into groups: 10–14, 15–18, and 19–24 weeks. Fetal genitalia were studied in axial and sagittal planes for gender assignment, using published criteria. The most valuable plane for assignment was noted. Gender assignment was compared with gender at birth. Results Gender assignment was possible in 44 of 47 fetuses; 25 assigned male and 19 female. Between 10 and 14 weeks the mid-sagittal plane alone was diagnostic for all fetuses. Accuracy of assignment between 11 and 14 weeks was 100%. Between 15 and 18 and 19 to 24 weeks, male assignment was 100% accurate. Female assignment was 100% accurate between 15 and 18 weeks. Accuracy decreased to 60% in the 19 to 24 week group, however, in two of the five cases in which gender was wrongly assigned to be male, the assignment was prospectively considered doubtful due to poor resolution of volume data. Excluding these two cases, accuracy for female assignment in the 19–24 week group was 100%. Conclusion Using 3D US, gender assignment was possible in 44 of 47 of fetuses, as early as 11 weeks' gestation. In early gestation, 11–14 weeks, accuracy of male and female gender assignment was 100%. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Objectives To develop a standard technique for using three-dimensional ultrasound (3D US) to study and evaluate the cervix in pregnant women at high risk for premature delivery, comparing the findings on 3D US with those on conventional two-dimensional ultrasound (2D US). Study Design Twenty-one pregnant women at high risk for premature delivery had a total of 37 transvaginal 2D and 3D US examinations of the cervix between 11 and 32 weeks' gestation. A 3D US vaginal probe (5.0–8.0 MHz, Voluson 530D, Medison, Pleasanton, CA, USA) was used. Measurements made from the 2D and 3D US were compared. Results Of the 37 cervical length measurements in 3D US sagittal plane, seven were shorter and three were longer than on 2D US (varying by 5–15 mm) indicating that the true mid-sagittal plane was not obtained in ten (27%) of the 37 2D US examinations. Of 21 examinations showing funneling, funneling was seen on both 2D and 3D US in 15, but was seen only on 3D US in six. There was a significant (P < 0.05) difference between funnel width as measured in the coronal 3D plane versus 2D US, as well as between funnel width in the coronal 3D US plane versus sagittal 3D US plane (P < 0.05). The cerclage was seen in its entirety in nine of 10 examinations; the 3D US axial plane was most valuable for imaging the cerclage. Conclusions 3D US appears to offer a more complete assessment of the cervix than 2D US. Multiplanar correlation shows that the standard 2D US sagittal view may under- or over-estimate cervical length. Our preliminary data suggest that 3D US has the potential to improve our understanding of cervical morphology. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Objectives To demonstrate that acoustic shadowing in 3D US may give rise to artifacts simulating limb defects and provide a solution to eliminate its occurrence. Methods Twenty second trimester fetuses (gestational age 15–24 weeks) were scanned with three-dimensional ultrasound (3D US) using a sagittal acquisition plane. Fetal tibia/fibula and radius/ulna pairs were assessed for completeness of imaging. A further 20 fetuses (gestational age 20–26 weeks) were scanned in both axial and sagittal planes and the results compared to verify clear visualization of both bones. Results Shadowing from adjacent structures produced an apparent limb defect in 55% of the first 20 fetuses imaged only sagittally (18% of limb pairs). Acquiring data from more than one orientation avoided this artifact. Conclusions The 3D US is subject to the same artifacts as two-dimensional (2D US) in terms of acoustic shadowing, although their presentation may be different. Awareness of this fact is essential for correct interpretation of 3D US studies. Three-dimensional scanning protocols should be modified to ensure that fetal structures are adequately visualized by acquiring volume data in more than one acquisition orientation. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Although fine-needle aspiration biopsy of salivary gland masses has been reported in the otolaryngology literature, the use of sonography to guide the biopsy of nonpalpable masses and masses seen on other cross-sectional imaging studies has not been described. Our goal was to evaluate sonographically guided biopsy of masses and lymph nodes related to the salivary glands. We analyzed the records of 18 patients who had undergone fine-needle aspiration biopsy of a salivary gland mass or lymph node with a 25-, 22-, or 20-gauge needle. A definitive cytologic diagnosis was made for 13 of the 18 patients (72%); cytology was suggestive but not definitive in three patients (17%) and insufficient in two (11%). Definitive diagnoses were made in three cases of reactive lymph node, in two cases each of lymph node metastasis and Warthin's tumor, and in one case each of pleomorphic adenoma, adenoid-cystic carcinoma, schwannoma-neurofibroma, parotid metastasis, parotid lymphoma, and Sjögren ‘s-related lymphoid-epithelial lesion. Sonographically guided biopsy allows for confident needle placement in masses seen on computed tomography and magnetic resonance imaging. Sonography can usually distinguish a perisalivary lymph node from true intrasalivary masses, and it can help the surgeon avoid the pitfall of a nondiagnostic aspiration of the cystic component of masses. We conclude that sonographically guided biopsy of salivary gland masses can provide a tissue diagnosis that can have a direct impact on clinical decision making.

The purposes of this study were to determine splenic volumes using three-dimensional ultrasonography and to compare these measurements with two-dimensional splenic indices. Fifty-two healthy volunteers were studied. Two-dimensional volume measurements were based on length, width, and thickness, and the splenic index was calculated using the standard prolated ellipsoid formula (length x width x thickness x 0.523). Three-dimensional volume planar measurements were obtained with a slice by slice technique by manually drawing a region of interest around the spleen from one end of the sweep to the opposite end. These measurements were recorded three times by two observers. In addition, in vitro determination of splenic volume was performed using three cadaveric human spleens in a water bath. No statistically significant interobserver or intraobserver variability was present for either two-dimensional or three dimensional ultrasonography. Three-dimensional sonographic estimations of planar splenic volumes and ellipsoid splenic volumes were consistently smaller than two-dimensional sonographic estimations of splenic volumes. Three-dimensional sonographic splenic volumes calculated in vitro using the planar method were accurate to within 2% of in vitro water displacement volumes. Three-dimensional ultrasonography is potentially superior to two-dimensional sonography for evaluation of irregularly shaped objects, such as the spleen, and can provide improved accuracy over that of traditional two-dimensional techniques.

Female reproductive tract anomalies are difficult to number in the general population but are often discovered in evaluations of menstrual complications or fertility disorders. Traditionally, assessment of the reproductive tract entailed hysterosalpingography to image the uterine cavity with the final diagnosis provided by combined hysteroscopy/laparoscopy. These approaches, while providing important information, were uncomfortable and invasive and for HSG, involved radiation exposure. Magnetic resonance imaging (MIR) allowed for the avoidance of these issues while offering accuracy, thus becoming the gold standard diagnostic imaging modality but entailing cost, patient discomfort, and inconvenience. Current advances in ultrasound technology, specifically 3-dimensional ultrasound, achieve the same benefits of MRI in being accurate and noninvasive but also offer the following advantages: they are available in the office, they are cost-effective, and they provide immediate results. As 3-dimensional technology continues to become more accessible and more providers become proficient in using it, ultrasound may replace MRI as the new gold imaging standard in diagnosing mullerian anomalies.

To assess the value of sonohysterography in the diagnosis and management of abnormal uterine bleeding.Sonohysterography was performed in 28 women (aged 29-55 years) in whom transvaginal sonography (TVS) suggested an abnormal endometrial echo (n = 14) or fibroids (n = 14). Its effect on diagnosis and treatment was studied.In the patients with an abnormal endometrial echo, sonohysterography depicted endometrial polyps (n = 9), intracavitary fibroids (n = 3), placental polyp (n = 1), and a normal cavity (n = 1). Hysteroscopic resection resolved the bleeding in 11 of 14 patients; surgery was obviated in one. In the group with fibroids, sonohysterography depicted small submucous fibroids amenable to hysteroscopic myomectomy (n = 5), a small mural fibroid with a normal cavity, which obviated surgical intervention (n = 4), and endometrial polyps, which altered the treatment plan (n = 1). Sonohysterography suggested the need for an abdominal myomectomy (n = 4) and alerted the surgeon to explore the uterine cavity in three patients.By helping elucidate the cause of bleeding, sonohysterography assisted in determining the therapeutic approach and often reduced the level of surgical intervention or obviated it altogether.

To determine the effects of level of training and other factors on the rate of discrepant interpretation of emergency body computed tomographic (CT) scans by trainees and staff radiologists.Five hundred ninety-eight consecutive emergency CT studies were prospectively interpreted by radiology residents or board-certified body imaging fellows over a 12-month period. Each interpretation was reviewed within 12 hours by an attending body CT radiologist. Major discrepancies between staff radiologists' and trainees' interpretations were defined and those with the potential to affect immediate patient therapy; minor discrepancies were defined ad those without such potential. The effects on discrepancy rates were examined for abnormal versus normal CT findings and trauma versus nontrauma cases.Major and minor discrepancy rates were 1.2% and 6.5%, respectively, between interpretations made by the trainee and the staff radiologist. Overall, fellows demonstrated statistically significantly lower discrepancy rates than did senior of junior residents (5.9%, 13.7%, and 13.3%, respectively). The discrepancy rate was higher when CT findings were abnormal than when they were normal (13.5% vs 2.6%). There were no differences between discrepancy rates for trauma and nontrauma cases.Experience appeared to decrease discrepancy rates. Trainees were more likely to miss findings than to read normal scans as abnormal.

An esophageal stricture is a narrowing of the lumen due to inflammation or tumor. Lack of distensibility is characteristic of stricture, which may be diffuse or localized and which may have abrupt or tapered margins. The purpose of this essay is to illustrate the imaging features of various types of strictures, focusing on their value in differential diagnosis.

The purpose of our study was to correlate the spectrum of radiologic and pathologic findings in a series of patients with biliary hamartomas and known extrahepatic malignancy.Biliary hamartomas were diagnosed in 18 patients with a primary malignant lesion who had liver biopsy for evaluation of possible metastatic disease. Prebiopsy imaging studies included CT in 16 patients and sonography in 11. Imaging studies were reviewed retrospectively and correlated with findings at surgery and on pathologic examination. The hamartomas were classified histologically by the degree of cystic dilatation of bile ducts within the lesion.Radiologically, biliary hamartomas presented a spectrum of findings including one or two circumscribed lesions (5-10 mm in diameter) in four patients; multiple (about five) lesions (approximately 5 mm each) in one patient; innumerable tiny, nearly uniform (2-5 mm) lesions in two patients; and innumerable lesions of varying size (2-15 mm) in three patients. Among the patients with innumerable lesions, the nodules were either uniformly or nonuniformly distributed throughout the liver. In all cases, the lesions were hypodense on contrast-enhanced CT scans and hypoechoic on sonograms. In eight patients, the lesions were not visible by imaging but biopsies were done at surgery when single or multiple tiny nodules were noted on the liver surface. The diagnosis was made by either wedge or core-needle biopsy; fine-needle aspirations were nondiagnostic. Pathologic examination revealed single or multiple hamartomas of varying sizes ranging from solid to largely cystic lesions; the degree of cystic dilatation did not correlate with imaging findings. Visibility on imaging correlated with larger lesion size; small surface lesions were usually occult.Biliary hamartomas cause single or multiple nonspecific hepatic lesions that may mimic metastases. This diagnosis should be considered in patients with a primary malignant tumor when single or multiple small hepatic lesions are seen, regardless of uniformity of size or distribution.

To determine the frequency of stability in malignant microcalcifications and its relationship to specific histologic diagnoses.During a 34-month period, microcalcifications were proved malignant in 182 patients referred for needle-guided biopsy. In 105 patients, the mammograms were compared with one or more than one previous mammogram. These patients were classified on the basis of interval change in two groups: those with stable and those with increasing or new microcalcifications. The histologic diagnoses were reviewed.Microcalcifications were stable for 8-63 months (mean, 25.4 months) in 26 patients (24.8%), only three (12%) of whom had invasive ductal carcinoma, which was found in 29 (37%) of the 79 patients with increasing or new microcalcifications.The odds for presence of invasive ductal carcinoma are statistically significantly lower (P.025) among patients with stable microcalcifications than among those with increasing or new microcalcifications. Stability of indeterminate or suspicious microcalcifications is unreliable for exclusion of a diagnosis of malignancy.

Background: To determine whether intravenous contrast improves the ability of radiologists to establish the cause of acute abdominal pain after nondiagnostic or normal unenhanced CT. Methods: Out of 164 consecutive emergency department patients presenting with less than 48 h of nontraumatic, acute abdominal pain, a confident diagnosis for cause of pain was made prospectively in 71/164 (43%) patients on these unenhanced scans by the monitoring radiologist. In the other 93 patients, our study sample, intravenous contrast-enhanced CT was obtained. At a later date, retrospectively, two experienced abdominal CT radiologists independently evaluated unenhanced CT scans alone for potential causes of pain and diagnostic confidence level on a 1–3 scale. At least 2 weeks later, intravenous enhanced and unenhanced scans were read side-by-side for the same assessment. Results: There was no significant difference in diagnostic confidence levels comparing unenhanced CT alone (2.59) vs. intravenous enhanced and unenhanced CT together (2.64). Chi-square analysis found no significant difference in finding a cause for pain when intravenous contrast was added compared to the initial unenhanced scan alone. Conclusions: Intravenous contrast did not significantly improve the ability of CT to establish a cause of abdominal pain after a negative or nondiagnostic unenhanced CT.

The majority of women with ovarian cancer have advanced stage disease at the time of diagnosis and a poor 5 year survival rate. Hence, screening has been investigated in the hopes of improving survival by diagnosing ovarian cancer at an earlier stage. Most screening methods thus far have included ultrasound and/or serum tumor markers. However, low prevalence of the disease, high false positive rate of current screening methods, and the probable rapid growth of most ovarian carcinomas from no defined precursor lesion, all contribute to difficulty in screening for ovarian cancer. While screening may be able to detect ovarian cancer at an earlier stage, adequate data is presently lacking on whether screening improves survival. The results of ongoing large clinical trials will be available in a few years and should provide critical information regarding the usefulness of screening. Pending results of those large clinical trials, screening is not currently recommended for women at average risk for ovarian cancer. Screening is most likely to be performed in women with an increased familial risk of ovarian cancer, but patients should be aware that even with this risk factor, there is currently insufficient evidence to know if screening is effective. New screening methods, including new or multiple serum markers and proteomics, are also being investigated.

Advances in the medical and surgical treatment of uterine leiomyomas have stimulated interest in the imaging of these common tumors. The purpose of this essay is to illustrate the appearance of leiomyomas on images obtained with various techniques. The advantages of each technique in particular clinical circumstances are discussed.

A case report is presented of the prenatal diagnosis of conjoined twins at 10 weeks and 2 days' gestation using three-dimensional ultrasound (3D US). The multiplanar display coupled with 3D US surface rendering clearly confirmed the presence of craniopagus. The twins were facing in opposite directions with the left occipital region of one embryo fused with the left parietal-temporal region of the other. Additional multiplanar analysis above the level of the biparietal diameter demonstrated brain sharing.

OBJECTIVE. The purpose of this study was to describe the sonohysterographic features of adenomyosis with MRI correlation.CONCLUSION. In this study, when the sonohysterographic findings suggested adenomyosis, MRI findings confirmed the diagnosis in 96% of cases. Myometrial cracks are, to our knowledge, a previously undescribed sonohysterographic sign of adenomyosis.

Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation.

The specific association of a uterus didelphys, an obstructed hemivagina, and an absent ipsilateral kidney was first described by Wilson 1 in 1925. Since that time, the constellation of a uterus didelphys, an obstructed hemivagina, and sometimes an absent ipsilateral kidney has been reported as presenting with a concurrent cyclical vaginal mass, 1-7 hematocolpos, 1-8 a foul vaginal discharge, 2,3,9,10 intermenstrual bleeding, 2,4,9 acute abdominal pain, 2,5,7,8 and urinary symptoms. 4 Methods for resection of the transverse vaginal septum have been proposed, and successful term pregnancy after resection has been reported.

The purpose of our study was to assess the relationship between the endometrium and submucosal fibroids before and after uterine artery embolization (UAE).Contrast-enhanced pelvic 1.5-T MRI was performed in 49 women before and after UAE over a 2-year period. Dominant (largest diameter) fibroids in intramural, submucosal, subserosal, pedunculated subserosal, and endocavitary locations were assessed on pre- (baseline) and postembolization MRI. Size, locations of dominant fibroids relative to endometrium and serosa before and after embolization were compared. The ratio between the largest endometrial interface and the maximum dimension of the dominant submucosal fibroid (interface-dimension ratio) was determined on baseline MRI. The infarction rate for dominant fibroids was estimated after UAE.One hundred forty dominant fibroids were identified on baseline MRI. Forty-nine (35%) were intramural, 39 (28%) were submucosal, 34 (24%) were subserosal, eight (6%) were pedunculated subserosal, and 10 (6%) were endocavitary in location on preembolization MRI. After UAE, of 39 dominant submucosal fibroids, 13 (33%) became endocavitary: complete (n = 4), partial (n = 9) on the basis of European Society of Gynaecological Endoscopy (ESGE) classification. The preembolization mean interface-dimension ratio and mean diameters for dominant fibroids that became endocavitary were significantly greater than for those that did not become endocavitary after embolization (0.65 vs 0.32, p0.005; 8 vs 5.4 cm, p0.05, respectively). All dominant submucosal fibroids showed 100% infarction after UAE.Submucosal fibroids with an interface-dimension ratio of greater than 0.55 are more likely to migrate into the endometrial cavity after UAE. The majority of these are expelled spontaneously without significant symptoms. Rarely, submucosal fibroids greater than 6 cm in size that become endocavitary may cause postprocedural complications requiring further intervention and medical treatment.

Intravenous urography and retrograde pyelography are the primary radiologic studies for detecting ureteral carcinoma but give limited information regarding stage of disease. Computed tomography (CT) and magnetic resonance imaging (MRI) delineate the extent of ureteral carcinomas with a high degree of accuracy by depicting the periureteral fat and presence or absence of lymphadenopathy. In selected cases, CT and MRI are valuable for assessing the presence or absence of tumor in a ureteral stump and for the differential diagnosis of ureteral obstruction. Five cases of ureteral carcinoma and 2 cases of stump carcinoma are presented with preoperative CT and/or MRI evaluation and staging.

We report MR and sonographic imaging features of an incidentally detected paraovarian adrenal rest in a 44-year-old woman who was being evaluated for menorrhagia. This is the first report of chemical shift imaging identifying the presence of lipid within an adrenal rest as well as rapid washout of contrast. Both of these MR characteristics are typically seen with an adrenal adenoma.

To report the radiological findings of a pseudolesion in the myometrium mimicking adenomyosis presumably due to air intravasation during sonohysterography (SHG).We searched magnetic resonance imaging (MRI) and transvaginal ultrasound (TVUS) examination results before and after SHGs, in which echogenic foci were found suggesting adenomyosis in the myometrium, and found 7 female cases. MRI and TVUS findings were compared to the SHG findings to assess the persistence of echogenic foci seen with SHG and other imaging modalities, and to exclude the possibility of pseudolesions secondary to saline-air intravasation into the myometrium during SHG.Ages of the 7 patients ranged from 27 to 60 years; 2 of them were postmenopausal. SHG examinations showed solitary or multiple echogenic foci measuring 4-15 mm, with acoustic shadowing, which were adjacent to the endometrium and consistent with adenomyosis. Only 1 of the patients underwent both MRI and TVUS, 2 of them had TVUS after SHG, and 1 had TVUS before SHG; the 3 remaining patients had TVUS as a baseline examination prior to SHG. None of these TVUS or MRI examinations confirmed the echogenic foci found with SHG.In order to differentiate echogenic myometrial pseudolesions from true adenomyosis lesions, a detailed preliminary TVUS is essential before any SHG procedure. If such lesions are encountered despite meticulous care to avoid the inadvertent introduction of air into the endometrial cavity, TVUS findings should be reviewed and a pelvic MRI is recommended in cases with heterogeneous myometrium.

Background Certain characteristics in patients have been associated with decreased endoscopic performance and outcomes. However, little objective quantitative data have been reported on differences in colonic morphology, which could explain why certain patient populations are at higher risk than others for incomplete or difficult colonoscopy. Poor performance and bad experiences in patients may negatively affect their choice for future screening for colon cancer. Knowledge before colonoscopy of patients with complex morphology could help endoscopists appropriately prepare for these particular patients. Methods Prototype quantification software was used to assess CT colonography datasets. To limit selection bias, all patients had a history of failed colonoscopy. Colonic morphology metrics were investigated, including: length, volume, tortuosity (number of acute angles), compactness (volume of box containing centreline divided by centreline length), and height of the sigmoid apex (HSA). Patient factors assessed included: sex ( n = 40), age ( n = 32), height ( n = 32), BMI ( n = 32), and hysterectomy ( n = 73). Patient groups were compared with the t -test. Distance navigated at colonoscopy was compared and relative risk was assessed. Findings Despite similar lengths, women’s colons were more tortuous and compact, less voluminous, and had lower HSA ( p 65 years), shorter ( p ⩽ 0.05) colons and demonstrated decreased distance travelled at endoscopy, although the differences were not statistically significant. Women with hysterectomy had more tortuous and less voluminous sigmoid segments with lower HSA ( p ⩽ 0.02). At endoscopy, the hysterectomy group had 46% chance of failure to pass the sigmoid segment, versus 22% in the non-hysterectomy group (relative risk 2.068, p = 0.043). Interpretation Differences in colonic morphology exist between patient populations. Factors including female sex, older age, shorter stature, thinner body habitus, and hysterectomy status show quantitative evidence of more complex colonic morphology which can make endoscopy more challenging in these patients. Consideration of these factors could help endoscopists prepare for challenging cases and provide a better screening experience.

3Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107. s the use of colonoscopy has increased greatly in recent years, awareness of its complications has become more important. Hemorrhage is the most common complication, with an incidence of 1–2% [1]. Perforation is the next most common complication, with an incidence of 0.1–0.2% [1]. Unusual complications of colonoscopy include pneumothorax, septicemia, mesenteric tears, and colonic volvulus. Splenic trauma is a rare complication of colonoscopy and was first reported by Wherry and Zehner in 1974 [2]. Two early studies that included nearly 13,000 patients reported no cases of splenic rupture [3, 4]. Since then, at least 26 cases of splenic rupture after colonoscopy have been reported in the English-language surgical and medical literature [5, 6]. To our knowledge, there is only one such report in the English-language radiology literature [7]. Given the increasing use of colonoscopy, it is important that radiologists are aware of this rare but potentially fatal complication of colonoscopy. We present two cases of splenic injury secondary to colonoscopy that were diagnosed by sonography and CT and managed conservatively by clinical observation and follow-up CT scans.

Since synovial fluid is an important marker of disease, we performed three-dimensional ultrasound volumetric measurements of synovial fluid to provide baseline normative data.Volume data were acquired using a 7-10 MHz three dimensional ultrasound probe on 40 ankles in 20 volunteers (25-61 years). Amounts of fluid were assessed in the ankle joint recesses, bursae and tendon sheaths. Images were acquired in the sagittal plane and were reconstructed in three orthogonal planes; transverse, sagittal and coronal. Fluid volumes were calculated from the volume data set using the manual planimetric method.Fluid in tendon sheaths was most common about the peroneals, and unlike prior MRI results, was less common around the flexors. In the flexors, fluid was most common around the flexor hallucis longus tendon, less common around posterior tibial tendon, and rare around fleksor digitorum longus tendon. In the extensors, fluid was less common but, when present, of greater volume, especially around the extensor hallucis longus tendon. Fluid was most common around the anterior tibial tendon and rare around the extensor digitorum longus tendon. Sparse fluid was seen in the majority of retrocalcaneal bursae. Fluid in the anterior ankle recess was quite common. Visualization of fluid in the posterior ankle recess was infrequent.Three-dimensional ultrasound permits measurement of fluid volume in the normal ankle/hindfoot; normative data are provided.