Biomedical subjects
Publications and source records attributed to J P Rouanet.
A case of acquired uterine arteriovenous fistula in a 28 Year old patient is reported that probably is secondary to a "difficult" delivery. Sono-graphic, MRI and angiographic findings are reported, before and after endovascular management.
The aim of this pictorial review was to illustrate the normal cervix appearance on T2-weighted images, and give a review of common or less common disorders of the uterine cervix that appear as high signal intensity lesions on T2-weighted sequences. Numerous aetiologies dominated by cervical cancer are reviewed and discussed. This gamut is obviously incomplete; however, radiologists who perform MR women's imaging should perform T2-weighted sequences in the sagittal plane regardless of the indication for pelvic MR. Those sequences will diagnose some previously unknown cervical cancers as well as many other unknown cervical or uterine lesions.
Membranous dysmenorrhea is an unusual clinical entity. It is characterized by the expulsion of huge fragments of endometrium during the menses, favored by hormonal abnormality or drug intake. This report describes a case with clinical, US, and MRI findings before the expulsion. Differential diagnoses are discussed.
The purpose of this paper is to describe the modifications in the radiologic approach to female infertility. The role of hysterosalpingography (HSG) has evolved from being the only source of information about the uterus to a more minor role, after ultrasound, that essentially deals with the morphology of the fallopian tubes. But if its diagnostic yield in the uterus is challenged by ultrasound and hysterosonography, it retains a major impact in the work-up of female infertility. Hysterosalpingography brings decisive diagnostic information concerning the state of the tubes and peritoneum. The interventional procedures of selective salpingography and tubal recanalization have a definite therapeutic effect and allow numerous pregnancies that would otherwise have required in vitro fertilization or tubal microsurgery.
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Endometriosis is defined by the presence of endometrial tissue outside the uterine cavity and having the functional property of menstrual bleeding. We report a case of endometriosis involving the abdominal wall muscles and canal of Nuck in a 28 year old woman. Abdominal wall sonography showed a hypoechoic lesion at the rectus abdominis insertion. T1W and T2W MRI images showed a hemorrhagic high signal intensity lesion in the muscle. MRI also showed a similar lesion in the canal of Nuck.
Female genital tract anomalies are common (1 to 2% of the female population), and may lead to multiple clinical manifestations: amenorrhea, infertility, spontaneous repeated miscarriage, pelvic pain, endometriosis. They are caused by intra-uterine insults between weeks 6 and 18 of gestation. They are classified according to their embryologic origin. Imaging relies essentially on ultrasound and MRI, and indications for hysterosalpingography are less common. Imaging must classify the malformation and detect complications in order to assess the fertility prognosis and treat complications.
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US and MRI currently are the best imaging modalities to evaluate pathology of the uterine cervix and vagina. Carcinoma of the cervix is the most frequent indication for imaging. MRI allows preoperative staging of cervical carcinoma based on FIGO classification, and post treatment follow-up. Other uterine cervix diseases are less frequently imaged and include a wide range of entities that most frequently cause increased T2W signal at MR imaging. Pathology of the pelvic floor, vagina, vulva, and perineum also includes a wide range of entities that have seldom been described in the imaging literature.
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Ninety years after it was first performed, hysterosalpingography remains one of the most important tests in helping an infertile couple decide between numerous treatment options. The application of angiographic techniques to hysterosalpingography has revolutionized diagnosis and treatment of proximal tubal obstruction. Results from worldwide centers have shown that nonsurgical catheter recanalization of proximally obstructed tubes can be accomplished in up to 90% of patients using standard techniques. Pregnancy incidence in a population who was recommended for tubal microsurgery or in vitro fertilization, but who underwent catheter tubal recanalization instead without any other therapy, was 58% at one year and all pregnancies were intrauterine. Fluoroscopic fallopian tube catheterization should be the first treatment for proximal tubal obstruction, with the more expensive and invasive procedures reserved for the small number of women who fail the radiologic procedure.
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The aim of this study was to describe by MRI, in dynamic conditions at rest and straining, the anatomical modifications induced by a commercially available intravaginal device (IVD) aimed at relieving female stress urinary incontinence. Ten female patients complaining of stress urinary incontinence (SUI) had pelvic MRI with static and dynamic sequences, without and with a self-inserted IVD. We studied positions and angulations of the IVD in the pelvis. Paired t-test allowed comparisons of: position of the bladder neck; urethral angulation with the pubis axis; position of the urethra; and posterior urethro-vesical angle (PUVA) without and with IVD. At rest, in ten of ten cases IVD laid cranial to the pubo-rectal muscle; with an average angulation of 95 +/- 10 degrees with the pubis axis, laterally tilted in three of ten cases. In maximum straining with IVD bladder neck descent was lower by an average of 5.2 +/- 3.1 mm (p = 0.001), pubo-urethral angle opening was smaller by an average of 22 +/- 20 degrees (p = 0.015), and bladder neck to pubis distance was shorter by an average of 5.7 +/- 4 mm. Posterior urethro-vesical angle was not significantly modified. Dynamic MRI allowed a non-invasive assessment of the mode of action of an IVD. The main modifications were a support of the bladder base and bladder neck, with a superior displacement of the urethra toward the pubis.
Static and dynamic MRI of the female pelvic floor is a new application of this technology. The capability of MRI to assess cavities and muscles on the same exploration is an important improvement. The authors describe successively: MRI is nowadays a decisive tool in the preoperative work-up of pelvic floor dysfunctions.
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A positive diagnosis of benign ovarian tumor indicates a laparoscopic approach or a conservative treatment. Benign ovarian tumors are often easy to recognize with non ionizing modalities such as US and MRI. The most common benign ovarian tumors are: mature teratomas including dermoid cysts, tumors in the fibro-thecal group including fibromas and thecomas, benign serous and mucinous tumors (cystadenomas). Apart from ovarian tumors, endometriomas are more commonly extra ovarian, but may involve the ovarian stroma.