Biomedical subjects

S M Ascher

Publications and source records attributed to S M Ascher.

At least 19 recordsLinked to original sources

PubMed2000

MR hysterosalpingography: protocol development and refinement for simulating normal and abnormal fallopian tube patency--feasibility study with a phantom.

PURPOSE: To develop and refine a pulse sequence and protocol for testing the feasibility of magnetic resonance (MR) hysterosalpingography in a phantom model. MATERIALS AND METHODS: A phantom simulating the uterus, fallopian tubes, and surrounding pelvic cavity was constructed. T2-weighted acquisition strategies-breath-hold fast spin-echo, rapid acquisition with relaxation enhancement (RARE), and haff-Fourier RARE-were refined to acquire sequential 70-mm coronal imaging volumes. Contrast agent was injected into the introducing catheter entering the os of the simulated uterus. Interacquisition interval, type of contrast agent (eg, sterile saline solution or water), and quantity of contrast agent (eg, 1-5 mL per acquisition) were varied. Digital image subtraction was used to enhance image quality. Images were qualitatively analyzed and rated good, fair, or poor for temporal resolution, spatial resolution, fallopian tube conspicuity, and free spill conspicuity. Once the technique was refine, the phantom was reconfigured to simulate unilateral and bilateral hydrosalpinx. RESULTS: The RARE sequence with an 8-second interacquisition interval and a 5-mL interacquisition of sterile water produced good images of the simulated fallopian tubes and free spill. Depiction of unilateral and bilateral hydrosalpinx was also reliably demonstrated. CONCLUSION: This study with a phantom model demonstrates the feasibility of MR hysterosalpingography to depict normal and diseased fallopian tubes.

Constriction, Pathologic↗

PubMed2000

Tamoxifen-induced uterine abnormalities: the role of imaging.

Tamoxifen citrate is an orally administered, nonsteroidal antiestrogen agent that is widely used for the treatment of breast cancer and that has recently been found to prevent breast cancer in some high-risk populations. Tamoxifen may, however, cause adverse effects at the uterine level. In this article, the authors review (a) the histopathologic uterine changes associated with tamoxifen therapy, (b) the spectrum of uterine imaging findings in women treated with tamoxifen, and (c) the recommendations of the American College of Obstetrics and Gynecology for women treated with tamoxifen. An algorithm for imaging evaluation of the uterus in women treated with tamoxifen is presented.

Antineoplastic Agents, Hormonal↗

PubMed1999

T2-weighted MRI of the uterus: fast spin echo vs. breath-hold fast spin echo.

This study compared one routine T2-weighted fast spin echo (T2FSE) sequence with a breath-hold T2FSE (BH T2FSE) sequence of the female pelvis for image quality, uterine anatomy, lesion detection, and signal intensity measurements. Thirty-two consecutive women (mean age 41.7 years) were imaged at 1.5 T with one high-resolution routine T2FSE sequence and one BH T2FSE sequence in the sagittal plane as part of comprehensive pelvic magnetic resonance imaging. The different image sets were rated separately for imaging characteristics (overall image quality, uterine anatomy definition, lesion detection, and free fluid conspicuity) and then compared side by side. The image sets were also compared for artifacts (ghosting, blurring, pulsatility, and chemical shift misregistration). Signal-to-noise (S/N) and signal difference-to-noise (SD/N) ratios were calculated for the different uterine zones, uterine abnormalities, free fluid, rectus abdominis muscle, and bladder. Contrast-to-noise ratios (CNRs) were calculated for uterine abnormalities. Twenty-eight uterine abnormalities were detected in 20 patients and included leiomyomata (13 patients), adenomyosis (7 patients), benign endometrial polyps (6 patients), endometrial carcinoma (1 patient), and pregnancy (1 patient). BH T2FSE was superior or equivalent to T2FSE for overall image quality in 23/32 patients (71.8%), uterine anatomy definition in 19/32 patients (59.3%), and lesion detection in 13/20 patients (65%). BH T2FSE performed less well than T2FSE for free fluid conspicuity in 5/5 (100%) patients. BH T2FSE was equivalent to or less affected than T2FSE for ghosting artifact in 24/32 patients (75%) and blurring artifact in 29/32 patients (90.6%). Pulsatility and chemical shift artifacts were not problematic for either image set. S/N and SD/N were higher for all BH T2FSE determinations compared with T2FSE. For the endometrium, junctional zone, myometrium, and bladder, these differences were statistically significant. There were no statistically significant differences for CNR between the two image sets, although BH T2FSE values for leiomyomata, adenomyosis, and abnormal endometria were higher than those calculated for T2FSE. All pathology detected with T2FSE was detected on BH T2FSE despite the breath-hold sequence's inherently poorer spatial resolution compared with the non-breath-hold sequence. BH T2FSE may be able to replace T2FSE for some uterine applications with a substantial time savings.

Adult↗

PubMed1999

Acute and subacute liver-related hemorrhage: MRI findings.

We retrospectively reviewed the MR studies on all patients with liver-related fluid collections compatible with acute or early subacute hemorrhage, who underwent MR imaging at our center between June 1994 and January 1998. All patients had a clinical history of an underlying liver lesion or injury with a duration of symptomatology of less than 5 days. In three patients with only 2-3 days of symptoms, the liver-related hemorrhagic fluid was hypointense on T1-weighted images and markedly hypointense on T2-weighted images relative to liver, consistent with intracellular deoxyhemoglobin. The fluid was relatively homogeneous in signal intensity. In three patients with 3-5 days of symptoms, the majority of liver-related fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images relative to liver, consistent with intracellular methemoglobin. Three of these latter four patients also had fluid collections of varying T1-and T2-weighted signal intensity consistent with blood breakdown products of varying ages. Clinical findings matched the MR findings of acute/early subacute blood in all cases. Our results describe the findings of acute and early subacute liver hemorrhage. The most helpful MR feature of bleeding of recent origin is very low signal intensity of the fluid on T2-weighted imaging.

Acute Disease↗

PubMed1999

Initial results from uterine fibroid embolization for symptomatic leiomyomata.

PURPOSE: To evaluate the safety and short-term efficacy of uterine fibroid embolization (UFE) in patients with symptomatic uterine fibroids. MATERIALS AND METHODS: Bilateral UFE was performed in 61 patients with symptomatic uterine leiomyomata during a 16-month period. Imaging was performed before the procedure and at 3 months and 1 year after the procedure. Questionnaires were obtained at regular intervals after the procedure to assess patient outcome. RESULTS: All procedures but one were technically successful. Mean clinical follow-up was 8.7 months. Minor complications occurred in five patients during the follow-up period. All were treated without permanent sequelae. Menstrual bleeding was improved in 89%, with 81% of patients moderately to markedly improved. Pelvic pain and pressure was improved in 96% of patients, with moderate to marked improvement in 79%. At initial imaging follow-up (mean, 4.4 months postprocedure), median uterine volume decreased 34% (P = .0001) and the median dominant fibroid volume decreased 50% (P = .0001). Imaging at 1 year (mean, 12.3 months) after the procedure showed continued reduction with a median uterine volume reduction of 48% (P = .0002) and median dominant fibroid volume decrease of 78% (P = .0002). CONCLUSION: In the authors' initial clinical experience, UFE appears effective in controlling symptoms and substantially reducing fibroid volume with few complications.

Adult↗

PubMed1998

Serendipity in diagnostic imaging: magnetic resonance imaging of the breast.

BACKGROUND: Magnetic resonance imaging (MRI) of the breast has been proposed as a noninvasive diagnostic test for evaluation of suspicious ("index") lesions noted on mammography and/or clinical breast examination (CBE). However, women may have incidental ("serendipitous") lesions detected by MRI that are not found on mammography or CBE. To understand better whether or not biopsy procedures should be performed to evaluate serendipitous lesions, we estimated the breast cancer risk for women with this type of lesion. METHODS: A decision analysis model was used to estimate the positive predictive value (i.e., the chance that a woman with a serendipitous lesion has cancer) of MRI for serendipitous lesions in women who had an abnormal mammogram and/or CBE suspicious for cancer (where a biopsy procedure is recommended). We restricted the analysis to data from women whose index lesions were noncancerous and used meta-analysis of published medical literature to determine the likelihood ratios (measures of how test results change the probability of having cancer) for MRI and the combination of CBE and mammography. The positive predictive value of MRI was calculated using the U.S. population prevalence of cancer (derived from registry data) and the likelihood ratios of the diagnostic tests. RESULTS: Under a wide variety of assumptions, the positive predictive value of MRI was extremely low for serendipitous lesions. For instance, assuming sensitivity and specificity values for MRI of 95.6% and 68.6%, respectively, approximately four of 1000 55- to 59-year-old women with serendipitous lesions would be expected to have cancer (positive predictive value = 0.44%, 95% confidence interval = 0.24%-0.67%). CONCLUSION: In women with a suspicious lesion discovered by mammography and/or CBE that is found to be benign, serendipitous breast lesions detected by MRI are extremely unlikely to represent invasive breast cancer. Immediate biopsy of such serendipitous lesions may, therefore, not be required.

Adult↗

PubMed1998

Bowel-related abscesses: MR demonstration preliminary results.

The purpose of this study is to describe the appearance of bowel-related abscesses on magnetic resonance (MR) images. Sixteen consecutive patients who had bowel-related abscesses underwent MR examination at 1.5T. MR sequences included T1-weighted fat-suppressed imaging pre- and post-intravenous gadolinium chelate administration (all patients) and breathing-independent single-shot T2-weighted half Fourier turbo (fast) spin echo (6 patients). Patients with pelvic abscesses also underwent sagittal imaging with post-gadolinium T1-weighted images (9 patients) and T2-weighted turbo (fast) spin echo (8 patients). Abscesses were confirmed by open surgery or surgical drainage (6 patients), percutaneous drainage (8 patients), or combined physical examination, fluoroscopic fistulogram, and clinical follow-up (2 patients). Oval-shaped fluid collections were identified in all of the patients, which ranged in diameter from 2 cm to 18 cm, mean: 8 cm. Abscesses were low to intermediate in signal on T1-weighted images, heterogenous and moderately high signal on T2-weighted images, and low signal on post-gadolinium images. A layering effect of lower signal material in the dependent portion of the abscess was noted in abscesses in 6 of 14 patients on T2-weighted images. Post-gadolinium images demonstrated a definable 3- to 7-mm thick abscess wall, which enhanced substantially with contrast. Definition of the wall was best shown on fat-suppressed images post-gadolinium. Substantial enhancement of surrounding periabscess tissues was demonstrated in all cases and was most clearly defined on fat-suppressed images. Image acquisition in two orthogonal planes was of value to demonstrate that fluid collections were oval, and separate from bowel. Image acquisition in the sagittal plane was useful in the evaluation of pelvic abscesses. The results from this preliminary study show that bowel-related abscesses are demonstrable on MR images using gadolinium-enhanced fat-suppressed T1-weighted and turbo (fast) spin-echo T2-weighted sequences. The presence of a thickened, enhancing lesion wall and enhancement of perilesional tissues on T1-weighted fat-suppressed images were observed in all abscesses. A layering effect of low signal intensity material in the dependent portion of the abscess was an important ancillary feature.

Abscess↗

PubMed1998

Hepatocellular carcinoma in North America: a multiinstitutional study of appearance on T1-weighted, T2-weighted, and serial gadolinium-enhanced gradient-echo images.

OBJECTIVE: The purpose of this study was to define the common appearances of hepatocellular carcinoma (HCC) in patients in North America by analyzing T1-weighted, T2-weighted, and serial gadolinium-enhanced gradient-echo images interpreted by radiologists at multiple institutions in North America. MATERIALS AND METHODS: One hundred thirteen consecutive patients with HCC from eight institutions were included in this retrospective case series. Inclusion criteria included MR imaging examinations performed on 1.5-T MR imagers using T1-weighted breath-hold spoiled gradient-echo images, T2-weighted images, and serial gadolinium-enhanced spoiled gradient-echo images. Diagnosis was established by histology in all patients. Images were analyzed retrospectively for lesion count, lesion diameter as less than or equal to 1.5 cm and greater than 1.5 cm, and signal intensity, by individual experienced radiologists at each institution. RESULTS: We found 354 HCC lesions in the 113 patients. Tumors were solitary in 63 patients, multifocal in 45 patients, and diffuse in five patients. Lesion appearance on combined T1-weighted, T2-weighted, and immediate gadolinium-enhanced spoiled gradient-echo images was as follows: 102 lesions (29%) were hypointense on T1-weighted images, were hyperintense on T2-weighted images, and exhibited diffuse heterogeneous enhancement; 52 lesions (15%) were isointense on both T1- and T2-weighted images and exhibited diffuse homogeneous enhancement (all of these lesions measured < or = 1.5 cm in diameter); 50 lesions (14%) were hypointense on T1-weighted images, were hyperintense on T2-weighted images, and exhibited diffuse homogeneous enhancement; 33 lesions (9%) were hypointense on T1-weighted images, were hyperintense on T2-weighted images, and exhibited predominantly peripheral rim enhancement; and 27 lesions (8%) were hypointense on T1-weighted images, were isointense on T2-weighted images, and exhibited diffuse homogeneous enhancement. The remaining 90 lesions showed less common patterns. The appearance of HCCs greater than 1.5 cm and of HCCs less than or equal to 1.5 cm was significantly different (p = .001). The appearance of histologically proven HCCs is separately described. CONCLUSION: The combination of hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and diffuse heterogeneous enhancement was the most common appearance of HCC on MR images in a multiinstitutional patient population in North America. Small HCCs measuring less than or equal to 1.5 cm were frequently isointense on both T1-weighted and T2-weighted images and may be detected on immediate gadolinium-enhanced images only as diffuse homogeneously enhancing lesions.

Adolescent↗

PubMed1998

Endometrial polyps: a comparison study of patients receiving tamoxifen with two control groups.

Many reports describe an increased frequency and unusual features of endometrial polyps and carcinomas in women treated with tamoxifen (TMX) for breast cancer. Postmenopausal women with endometrial polyps were identified by computer search of pathology files from 1990 to 1996. Medical records were reviewed, and patients were divided into three groups: 28 receiving TMX for breast cancer, 23 receiving hormone replacement therapy (HRT), and 28 untreated controls (UC). Cumulative doses (CDs) of TMX were calculated. Histologic slides of polyps were reviewed blindly and evaluated for size, metaplasias, vascularity, fibrosis, and inflammation. Carcinomas were found in 3 TMX, no HRT, and 1 UC patient. Atypical hyperplasias were found in 1 TMX, 0 HRT, and 1 UC patient. Mean polyp size was larger in the TMX group (2.9 cm) than in the HRT (1.05 cm) and UC (1.35 cm) groups, and stromal fibrosis was more prominent in TMX-related and larger polyps. Mucinous metaplasias were observed more frequently in the patients receiving TMX. No other differences were noted. The two TMX patients in whom low-grade carcinomas developed and the one with atypical hyperplasia had independent risk factors. CDs for these patients were 32.9, 36.5, and 17.6 g, respectively. A high-grade carcinoma developed in a TMX patient without constitutional risk factors at a CD of 94.9 g. On the basis of a literature review and these results, low-grade carcinomas developing after relatively low CDs of TMX may be at least partially attributable to other risk factors. The association between poorly differentiated and nonendometrioid tumors with higher TMX CDs is still speculative, but the current study suggests that they may be related to TMX. A statistically significant increase in the frequency of thyroid replacement use by TMX patients is also noted.

Aged↗

PubMed1997

Small (< 1.5 cm) angiomyolipomas of the kidney: characterization by the combined use of in-phase and fat-attenuated MR techniques.

The purpose of this study was to evaluate the ability of in-phase spoiled gradient echo combined with chemically selective fat suppression or out-of-phase spoiled gradient echo MR images to characterize small renal masses as angiomyolipomas. Eleven patients with a total of 35 small (< 1.5 cm) angiomyolipomas underwent MR examination at 1.5T. Eight patients had solitary and three patients had multiple angiomyolipomas. One of the patients with multiple angiomyolipomas had tuberous sclerosis and the number of angiomyolipomas were quantified as 20. MR examinations included in-phase spoiled gradient echo (all patients), chemically selective fat suppressed spin echo (six patients), chemically selective fat suppressed spoiled gradient echo (three patients), selective water excitation spoiled gradient echo (one patient) and out-of-phase spoiled gradient echo (seven patients). Angiomyolipomas were minimally (4 lesions) or moderately (31 lesions) high in signal intensity relative to renal cortex on in-phase spoiled gradient echo images. On out-of-phase spoiled gradient echo images, demonstration of signal void fat-water phase cancellation was present in all eight lesions in the seven patients who were imaged with this sequence. Small lesion size rendered the entire angiomyolipoma signal void in seven of these eight lesions due to phase cancellation artifact. Signal void phase cancellation of lesion border or signal void of the entire angiomyolipoma resulted in high lesion conspicuity in all lesions. Mild loss of signal intensity was observed in 7 lesions and moderate loss of signal intensity noted in 25 lesions on chemically selective fat suppressed images. On chemically selective fat-suppressed images, seven lesions were difficult to identify due to limited signal differences between medium intensity cortex and low intensity angiomyolipomas (six lesions in two patients) and moderate breathing artifact (one lesion in one patient). Characterization of small renal masses as angiomyolipomas may be reliably performed using the combination of in-phase and fat-attenuating MR sequences. Consistent image quality and high conspicuity of fat-water phase cancellation interfaces renders out-of-phase imaging a reliable fat attenuating method to demonstrate the presence of fat in small angiomyolipomas. Breath-hold fat-suppressed spoiled gradient echo is also effective; however, this technique demonstrates less signal loss in fatty lesions and is subject to problems with inhomogeneity of fat suppression.

Adult↗

PubMed1997

Focal hepatic lymphoma: magnetic resonance demonstration using current techniques including gadolinium enhancement.

This study demonstrates the appearance of focal hepatic lymphoma using current magnetic resonance techniques including gadolinium enhancement. Fifteen patients with hepatic lymphoma were imaged at 1.5T. T1-weighted, T2-weighted, immediate, and 5-10-min delayed T1-weighted spoiled gradient echo images were acquired in all patients. Determination was made of lesion size, number, morphology, and signal intensity of lesions on all sequences. Seven patients had solitary lesions and 8 patients had multiple lesions. Focal lesions of hepatic lymphoma ranged in size from 5 mm to 15 cm. They were well defined masses with mild to moderate low signal intensity relative to liver on T1-weighted images. Lymphoma lesions in 6 patients were moderately high in signal intensity on T2-weighted images compared with liver (Type I lesions), and enhancement of lesions was intense on early post-gadolinium images in 5 of these patients. Lymphoma lesions in 6 patients were mildly hypointense to mildly hyperintense on T2-weighted images compared to liver (Type II lesions), and lesions in 5 of these patients enhanced minimally on the early post-gadolinium spoiled gradient echo images. The remaining 3 patients had received chemotherapy before the magnetic resonance examination, and the imaging findings varied reflecting presumed differences in treatment responses. Transient ill defined perilesional enhancement on immediate post-gadolinium spoiled gradient echo images was observed in 9 patients including patients with either type of lesion. Focal lesions of hepatic lymphoma are usually low in signal intensity on T1-weighted images but have variable signal intensity on T2-weighted images. In general, lesions that are mildly hypointense to minimally hyperintense in signal intensity on T2-weighted images enhance minimally, and lesions moderately high in signal intensity of T2-weighted images enhance intensely. Transient increased perilesional enhancement is common.

Adult↗

PubMed1997

Splenic hemangiomas and hamartomas: MR imaging characteristics of 28 lesions.

PURPOSE: To determine the magnetic resonance (MR) imaging features of splenic hemangiomas and hamartomas, including their pattern of dynamic contrast material enhancement. MATERIALS AND METHODS: The appearance of 28 lesions in 18 patients was retrospectively reviewed on T2-weighted images (16 patients), unenhanced T1-weighted images (18 patients), and dynamic contrast-enhanced T1-weighted images (17 patients). Seventeen of 23 hemangiomas and all five hamartomas were proved at pathologic examination. RESULTS: Of the 22 hemangiomas imaged with T2-weighting, 19 were hyperintense, two were isointense, and one was hypointense relative to the spleen. Dynamic gadolinium-enhanced imaging demonstrated a progressive centripetal pattern of enhancement in 19 of 22 hemangiomas. On delayed images, 19 hemangiomas demonstrated uniform enhancement. Of the five hamartomas, four were imaged with T2-weighting; three were hyperintense and one was hypointense relative to the spleen. All hamartomas demonstrated diffuse heterogeneous enhancement on images obtained early after administration of contrast material and became more uniformly enhanced on delayed images. CONCLUSION: Splenic hemangiomas showed signal intensity characteristics and enhancement patterns similar to those described for hepatic hemangiomas. Since these features have been shown to reliably distinguish hemangiomas from other benign and malignant liver lesions, it may be reasonable to consider without histologic verification that lesions in the spleen with these imaging features represent hemangiomas.

Adolescent↗

PubMed1997

Primary amenorrhea: evaluation with MR imaging.

PURPOSE: To determine the accuracy of magnetic resonance (MR) imaging in the evaluation of patients with a history of primary amenorrhea. MATERIALS AND METHODS: Twenty-nine patients with primary amenorrhea underwent T2-weighted MR imaging in the axial and sagittal planes. Contrast material-enhanced and unenhanced T1-weighted MR imaging was performed in selected cases. MR imaging findings were correlated with surgical findings in 23 patients and with clinical findings in six patients. RESULTS: Surgical correlation was available in 14 of 17 patients with female anatomic anomalies (Mayer-Rokitansky-Küster-Hauser syndrome [n = 9], transverse vaginal septum [n = 3], imperforate hymen [n = 1], cervical agenesis [n = 1]), which confirmed MR imaging findings. In nine of 12 patients with congenital disorders of sexual differentiation (testicular feminization [n = 5], true hermaphrodite [n = 2], gonadal dysgenesis [n = 2]) who underwent surgical correlation, 13 of 16 (81%) gonads were correctly localized with MR imaging. Overall, there was excellent correlation between the classification of patients with MR imaging versus classification with the combination of surgical and laboratory findings (K = 0.88). CONCLUSION: MR imaging is useful in the work-up of patients who present with primary amenorrhea both for accurate diagnosis of pathologic conditions and for surgical planning.

Adolescent↗

PubMed1997

Hepatosplenic fungal disease: diagnostic accuracy and spectrum of appearances on MR imaging.

OBJECTIVE: We describe our 6-year experience in the prospective examination of patients with suspected hepatosplenic fungal disease to show the diagnostic accuracy of MR imaging and the spectrum of appearances on MR images. SUBJECTS AND METHODS: All patients who underwent MR examination for suspected hepatosplenic fungal disease from January 1990 to January 1997 in three university institutions were included in the study. Patients presented with persistent fever or no response to antibacterial antibiotics. Patients were grouped as acute, subacute treated, and chronic treated, according to the duration of their symptoms. Patients with 2 weeks or fewer of possible infection were acute presentation, patients on antifungal therapy longer than 2 weeks but shorter than 3 months were subacute treated presentation, and patients on antifungal therapy for 3 months or longer or who had completed antifungal therapy and had a history of hepatosplenic fungal disease were chronic treated presentation. MR studies were prospectively interpreted for the presence of hepatosplenic fungal lesions. The appearances of fungal lesions in patients in each category were determined. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detecting lesions in patients with acute presentation were also determined. RESULTS: Sixty-nine patients were included in the study. MR imaging revealed signs consistent with hepatosplenic fungal lesions in 22 (32%) of 69 patients and no demonstration of hepatosplenic lesions in 47 (68%) of 69 patients. In the 60 patients with acute presentation, MR imaging in 13 patients revealed hepatosplenic lesions that were interpreted as fungal disease. True-positive lesions were present in 11 of these 13 patients. These lesions measured less than 1 cm in diameter and were best shown as well-defined high-signal-intensity foci on T2-weighted images. The remaining two of the 13 patients had false-positive lesions; one was shown to have tuberculosis, and the other had graft-versus-host disease. For acute presentation, MR sensitivity was 100%, specificity was 96%, positive predictive value was 85%, negative predictive value was 100%, and accuracy was 97%. In the five patients with subacute presentation, lesions were present that measured less than 1 cm in diameter and were best shown as mildly hyperintense on T1-weighted images. A perilesional ring nearly void of signal intensity was seen on unenhanced and gadolinium-enhanced T1-weighted images in all five patients. The four patients with chronic healed lesions all had lesions that were 1-3 cm in diameter with irregular, angular polygonal margins. These lesions, which were best shown on images obtained immediately after gadolinium administration, appeared as regions of diminished enhancement with no perilesional changes. CONCLUSION: MR imaging has high diagnostic accuracy for the diagnosis of acute hepatosplenic fungal disease. Patients with acute, subacute treated, and chronic healed presentations may have lesions that can be distinguished by their MR appearances.

Acute Disease↗

PubMed1996

MR imaging appearance of the uterus in postmenopausal women receiving tamoxifen therapy for breast cancer: histopathologic correlation.

PURPOSE: To describe the spin-echo and dynamic gadolinium-enhanced magnetic resonance (MR) imaging appearance of the uterus in women receiving tamoxifen. MATERIALS AND METHODS: Thirty-five postmenopausal women with breast carcinoma receiving tamoxifen therapy underwent pelvic MR imaging. T1-weighted, T2-weighted, and dynamic gradient-echo T1-weighted sequences were used. Twenty-seven patients underwent uterine sampling within 3 months of MR imaging. RESULTS: Endometrial width on T2-weighted images ranged from 0.1 to 7.5 cm (mean thickness, 1.1 cm). Two uterine imaging patterns were noted. Patients with pattern 1 findings had homogeneous high signal intensity of the endometrium on T2-weighted images (mean, 0.5 cm) and enhancement of the endometrial-myometrial interface and a signal void in the lumen on gadolinium-enhanced images (18 patients). Patients with pattern 2 findings had heterogeneous endometrial signal intensity on T2-weighted images (mean, 1.8 cm) with enhancement of the endometrial-myometrial interface and latticelike enhancement traversing the endometrial canal on gadolinium-enhanced images (17 patients). Other imaging findings included subendometrial cysts, nabothian cysts, leiomyoma, and adenomyosis. Ten patients with pattern 1 findings had atrophic or proliferative endometria at histopathologic analysis; 12 of the 17 patients with pattern 2 findings had polyps, one of which had a focus of endometrial carcinoma. CONCLUSION: MR imaging of the uterus showed two distinct patterns in women receiving tamoxifen therapy.

Adult↗

PubMed1995

Spontaneous preoperative internal jugular and subclavian vein thrombosis associated with an early-stage synchronous ovarian/endometrial malignancy.

A case of preoperative spontaneous internal jugular/subclavian vein thrombosis documented with magnetic resonance imaging associated with a synchronous stage II ovarian/stage I endometrial malignancy is presented. This unusual deep venous thrombosis site is classically associated with trauma, infection, head and neck malignancies, or central venous catheterization and is rarely associated with distant malignancies. Neck pain and swelling in a gynecologic oncology patient should prompt consideration of this diagnosis.

Carcinoma, Endometrioid↗

PubMed1995

The nonsurgical diagnosis of adenomyosis.

OBJECTIVE: To survey the nonsurgical diagnostic techniques for distinguishing adenomyosis, and to determine whether one technique offers diagnostic advantages. DATA SOURCES: We conducted a thorough search of the MEDLINE data base and identified English-language papers on adenomyosis published during the last 28 years. Reference lists of retrieved articles were also examined for additional source documents. METHODS OF STUDY SELECTION: We reviewed 238 articles. Papers on nonsurgical diagnostic techniques published in peer-reviewed journals were selected for inclusion. DATA EXTRACTION AND SYNTHESIS: We determined nonsurgical diagnostic techniques for distinguishing adenomyosis to be hysterosalpingography, abdominal ultrasound, transvaginal sonography, and magnetic resonance imaging (MRI). Studies were divided into these four categories, reviewed, and summarized accordingly. Recent reports suggest that noninvasive modalities, eg, transvaginal sonography and MRI, have, made possible the nonsurgical diagnosis of adenomyosis. CONCLUSION: Because of its widespread availability and patient tolerance, transvaginal sonography remains the primary screening modality for imaging the female pelvis. However, for cases in which sonography cannot detect adenomyosis, MRI provides a viable alternative and should be the definitive diagnostic modality of choice.

Abdomen↗

PubMed1995

Biliary tract: three-dimensional helical CT without cholangiographic contrast material.

Bile duct anatomy depicted with a three-dimensional (3D) model developed with helical computed tomography (CT) data was compared with cholangiographic depiction. The ductal system was completely displayed from all angles in four of six patients, as well as the stricture and length of bile duct between strictures and the bifurcation in five of six cases. 3D rendering can depict preoperative ductal anatomy.

Adult↗