Comprehensive MR Imaging of Acute Gynecologic Diseases

Abstract

Rapid advances in techniques of magnetic resonance (MR) imaging have enabled diagnosis of acute gynecologic conditions, which are characterized by sudden onset of lower abdominal pain, fever, genital bleeding, intraperitoneal bleeding, or symptoms of shock. The chemical-selective fat-suppression technique not only helps establish the characteristics of lesions that contain fat components but also increases the conspicuity of inflammatory lesions. When a T2-weighted image is obtained with a very long effective echo time (>250 msec), even a small amount of ascites can be easily identified and the contrast between urine and complex fluid becomes more conspicuous. T2*-weighted images are useful for identification of hemorrhagic lesions by demonstrating deoxyhemoglobin and hemosiderin. Contrast material-enhanced dynamic subtraction MR imaging performed with a three-dimensional fast field-echo sequence and a rapid bolus injection of gadopentetate dimeglumine allows evaluation of lesion vascularity and the anatomic relationship between pelvic vessels and a lesion and allows identification of the bleeding point by demonstrating extravasation of contrast material. To optimize the MR imaging examination, attention should be given to the parameters of each pulse sequence and proper combination of the sequences.

Processing of radial fast spin‐echo data for obtaining T2 estimates from a single k‐space data set

“…T 2 -weighted imaging is a widespread and valuable method used routinely for the diagnosis of many pathologic disorders (1)(2)(3)(4)(5). Information from T 2 -weighted images in terms of pathology is typically analyzed in a qualitative manner by the radiologist by looking at differences in contrast between tissues in one (or two) T 2 -weighted image(s).…”

Spontaneously Ruptured Endometrioma Associated with Endometrioid Adenocarcinoma: MR Findings

“…Pregnancy increases tension when the uterus enlarges and alters the anatomical position of an ovarian tumor, and trauma will put pressure on its wall. 6,10,11 An endometrioma may develop adhesions, and changes in position from such dense adhesions and growth of a malignant ovarian tumor could induce spontaneous rupture of the cystic tumor, as noted by Vora's group. 10 In summary, we report a case of ruptured endometrioma associated with an endometrioid adenocarcinoma.…”

“…Previous studies using MR and CT imaging have reported representative features of ovarian rupture to include the absence of a tense, ‰abby, or depressed surface of the cystic lesion. 6,10,11 Cystic ruptured ovarian tumor with hemorrhage can sometimes be detected as well based on a ‰uid-‰uid level in the pelvic space, although this is uncommon because MR imaging of a hemorrhage shows varied signal intensity on T 1 -weighted and T 2 -weighted images. Detection of a ‰uid-‰uid level in the pelvic space enables diagnosis of a ruptured ovarian tumor with greater conˆdence on MR imaging.…”

“…1,2 However, to our knowledge, this is theˆrst case reported in the English literature of a ruptured endometrioma associated with endometrioid adenocarcinoma, and only a few cases of ruptured ovarian tumor of endometrioma and teratoma have been reported along with magnetic resonance (MR) imaging and computed tomographic (CT)ˆndings. [3][4][5][6] We describe the MRˆndings of a ruptured endometrioma with an endometrioid adenocarcinoma that presented with an irregular surface and a solid component in the ovarian tumor and with ‰uid-‰uid levels in the ovarian tumor and the pelvic space.…”

Hemoperitoneum from ruptured cyst in a hyperstimulated ovary: A sonographic mimic of ovarian hyperstimulation syndrome

“…The differential diagnosis of a hemoperitoneum in a patient with cystic ovaries includes ruptured tubal or ovarian pregnancy, ruptured corpus luteum cyst, ovarian endometrioma, and ovarian torsion with hemorrhagic infarction. [8][9][10] In addition, a patient with a ruptured ovarian teratoma can present with a cystic ovarian mass, intraperitoneal free fluid, and clinical signs of peritonitis.…”