Correlation between computed tomography and gross anatomy of the suspensory ligament of the ovary

Summary To assess the morphology of the suspensory ligament of the ovary on CT scan examination, an anatomic study of the suspensory ligament of the ovary was performed to demonstrate its morphology on CT and to facilitate the visualization of the ovaries. Twelve female cadavers were studied after intravascular injection of latex (venous: 2, arterial: 6, arterio-venous: 4). We first observed all the pelvises after their transection. Six dissections were then made to obtain optimal anatomic correlations on the content and relations of the infundibulo-pelvic ligament. The arterial opacifications were poor compared with to the good quality of the venous or arteriovenous opacifications. An upright correlation between CT slices and the anatomic study was made. This radio-anatomic study emphazises the importance of the veins, which really support the suspensory ligament of the ovary, as opposed to the involution of the arteries. This study points out the link between the infundibulo-pelvic ligament above and the utero-ovarian below, then with the superficial uterine vv. All these structures were well analyzed on CT and during the anatomic studies. A very well developed periovarian venous plexus which frequently concealed the ovaries was demonstrated. Some anatomic variations which were invisible on the CT scan examinations were displayed. The visualization of the suspensory ligament of the ovary should facilitate the visualization of the ovaries and could optimize the search for lymphadenopathies originating from ovarian cancers.

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Corrélation radioanatomique sur le ligament suspenseur de l'ovaire

Résumé Pour corréler les études tomodensitométrique (TDM) et anatomique du ligament suspenseur de l'ovaire pour en préciser son aspect en TDM et son rôle potentiel dans le repérage des ovaires, nous avons réalisé une étude radio-anatomique sur 12 cadavres féminins initialement étudiés par TDM après injection intra-vasculaire de latex (veineuse : 2, artérielle : 6, artérielle et veineuse : 4). L'observation initiale des pelvis après isolement des blocs pelviens puis la dissection de six sujets ont permis d'obtenir des corrélations anatomiques précises sur les rapports et le contenu du ligament suspenseur de l'ovaire. Les opacifications artérielles obtenues étaient de mauvaise qualité, par contre les injections veineuses ou artérielles et veineuses ont permis une bonne corrélation entre coupes TDM et l'ðude anatomique. Cela souligne l'importance du réseau veineux qui sous-tend réellement le ligament suspenseur de l'ovaire contrairement à l'involution artérielle notée habituellement. L'étude montre la continuité effective entre le ligament «infundibulo-pelvien» en haut et le ligament «utéroovarien» en bas prolongé par les veines utérines, structures parfaitement analysées en TDM. La fréquence du développement du plexus pampiniforme dans de nombreux cas masquant fréquemment les ovaires déja atrophiques est soulignée. Quelques variantes anatomiques non détectées en TDM ont pû être mises en évidence. La visualisation du ligament suspenseur de l'ovaire permet de faciliter le repérage de l'ovaire et pourrait optimiser la recherche d'adénopathies satellites des cancers ovariens.

     

Magnetic resonance imaging of the pelvic area. Preliminary results

Magnetic Resonance Imaging (MRI) is chiefly characterized by its natural contrast and by its capability of producing images in the three spatial directions. Although nearly all pathological tumors have prolonged T1 and T2 relaxation times and therefore it seems to be difficult to distinguish them one from another, significant pathological particularities can be obtained by comparing T1 and T2 weighted images. MRI is of particular interest to provide morphologic data and to demonstrate the relationship of tumors to vascular axes. Furthermore information in three dimensions (scans along transaxial, sagittal and coronal planes) is compared to produce a detailed morphological analysis of the tumor and of the adjacent structures. 0,5 T imaging was performed in 25 patients with pathologic pelvis and in 5 normal volunteers.     

Bladder endometriosis. Apropos of 4 cases and review of the literature

The aim of our study is to evaluate the diagnostic and therapeutic attitude toward endometriosis of the bladder. We have analysed four observations treated in the gynecologic service of Hotel-Dieu in Paris between January 1989 and January 1998, which represents 1.3% of all endometriosis operated during this period. Every patient underwent echography, RMN, UIV and cystoscopy. In all for cases a surgical treatment by laparotomy was realised. The choice of this way is explained by the multiple localisations of endometriosis in three cases and the impossibility of a coelioscopic treatment in the forth. The anatomopathologic exam found endometriosis in all of the cases.     

Contrast enhanced color Doppler endorectal sonography of prostate: efficiency for detecting peripheral zone tumors and role for biopsy procedure

PURPOSE: We evaluated the accuracy of contrast enhanced color Doppler endorectal ultrasound to guide biopsy for the detection of prostate cancer. MATERIALS AND METHODS: A total of 85 patients were evaluated with gray scale and color Doppler before and during intravenous injection of ultrasound contrast agent made of galactose based air microbubbles. Our biopsy protocol was performed during contrast injection. An additional 18 directed cores were obtained based on contrast enhanced imaging. Diagnostic efficiency with and without contrast medium injection for detecting prostate cancer were compared based on biopsy results. RESULTS: Cancer was identified in a total of 58 biopsy sites in 54 patients. Gray scale imaging revealed 96 abnormal hypoechoic nodules or irregular zones inside the outer gland, of which 48 were malignant on pathological evaluation. Contrast enhanced color Doppler had higher sensitivity (93%) than unenhanced color Doppler (54%), while specificity increased only 79% to 87% for enhanced imaging. Nine of 10 isoechoic suspicious zones were depicted with enhancement, while unenhanced Doppler detected 7 of them. There was no significant difference between the intensity of enhancement and tumor Gleason scores. CONCLUSIONS: Contrast enhanced color Doppler endorectal sonography increases the detection of prostate cancer. Improvement in sensitivity was high, while the difference in specificity was not as pertinent. It is accurate when using a common and routine application ultrasound unit. This technique is easy to perform and not time-consuming. Obtaining additional biopsy cores of suspicious enhancing foci significantly improves the detection rate of cancer.     

Sclerosing stromal tumor of the ovary: color Doppler findings.

The sclerosing stromal tumor (SST) of the ovary is a distinct benign neoplasm that differs from fibromas, thecomas, luteinized tumors and lipoid cell tumors. It accounts for 6% of ovarian stromal tumors and tends to occur at an earlier age. On gray-scale ultrasound examination, SSTs of the ovary are solid or cystic and multilocular. We describe here, we believe for the first time, the findings on color Doppler imaging of an SST of the ovary. A 29-year-old woman presented with an organic ovarian mass. She underwent a transvaginal ultrasound examination that revealed an echogenic cyst with acoustic shadowing. Color Doppler demonstrated marked peripheral vascularization. Findings on computed tomography and magnetic resonance imaging strongly suggested the preoperative diagnosis of SST of the ovary, which was confirmed at pathology. Association of an echogenic ovarian mass with acoustic shadowing and a high degree of peripheral vascularization may strongly suggest the diagnosis of SST of the ovary.     

Value and limitations of puncture guided by x-ray computed tomography in hematology

Interpretable cytologic data were obtained in 63% of a series of 68 punctures, for biopsy of hematologic affections, guided by CT scanning. The frequency of puncture of post-therapy residual masses (44 cases) explains the high incidence of non-significant examination results after lymph node puncture. The technique was most effective (78% of punctures exploitable) when used for thoracic masses and visceral localizations. The method is very safe: lack of serious incidents and minor reactions, mainly during thoracic puncture, in only 4.4%. The method is simple in use and should be employed, within certain limits that should be recognized, very widely in hematologic diseases.     

Computed tomography of retained abdominal sponges and towels

The diagnosis of retained sponges and towels a year or more after surgery is often very difficult. We describe the computed tomographic (CT) findings in 4 patients with this complication; 2 cases of retained sponges and 2 cases of retained towels. While the CT appearance of the retained sponges was not specific, the particular appearance of the retained towels had not been previously described. This appearance is characteristic enough to suggest the correct diagnosis before reoperation.     

Cystic teratoma of the ovary: CT detection

Computed tomography (CT) was performed in 38 patients with 41 benign cystic teratomas of the ovary and two patients with malignant transformation. CT depicted all tumors. The presence of fat in 40 of 43 cases (93%), tooth or calcification in 24 of 43 (56%), Rokitansky protuberance in 35 of 43 (81%), tufts of hair in 28 of 43 (65%), and a fat-fluid level in five of 43 (12%) allowed a definite diagnosis of ovarian cystic teratoma in 42 of 43 cases (98%). In the two cases of malignancy, single large (greater than 10 cm) plugs (with uptake of contrast medium in one) with a cauliflower appearance and an irregular border forming an obtuse angle with the inner wall of the cyst suggested malignant transformation. In three cases of benign cystic teratoma, a mucinous tumor (one benign, one borderline, one malignant) arising in the same ovary was seen at pathologic examination but was only diagnosed with the help of CT in two of three cases. Thickening of the tube was noted in two cases of torsion of the adnexa. CT findings were compared with findings at radiography of the abdomen and hysterosalpingography in 30 cases, ultrasound in 31, and magnetic resonance imaging in three. This study demonstrated that CT was the best procedure for imaging cystic teratomas of the ovary.     

Acute torsion of uterine leiomyoma: CT features

Acute torsion of a subserosal leiomyoma is a rare acute condition that is infrequently diagnosed preoperatively. It is a recognized surgical emergency, especially when additional systemic symptoms are associated. There are two main differential diagnoses: ovary/adnexal torsion and massive infarct inside a common leiomyoma. The diagnosis can be established by computed tomographic features. Ultrasound examination is less sensitive.     

Treatment of symptomatic para-articular intraosseous cysts by percutaneous injection of bone cement

Purpose

To describe the technique and clinical outcome of percutaneous injection of bone cement in the treatment of symptomatic para-articular intraosseous cysts.

Materials and methods

Five patients (three men, two women; mean age 35?years) with painful para-articular intraosseous cysts were treated by percutaneous injection of bone cement under combined fluoroscopic and computed tomography (CT) guidance. The lesions were all located in weight-bearing bones, involving the acetabulum, proximal tibia, distal tibia, talus, and calcaneus, respectively.

Results

The average amount of bone cement injected was 2.1?ml (range, 0.6?C3.5?ml). Calcium phosphate cement was used in four cases and acrylic cement in one case. There were no immediate or delayed complications. Full pain relief was obtained between 1 and 4?weeks after treatment. All patients made a complete recovery and were pain-free at their last visit.

Conclusions

Percutaneous injection of bone cement was a safe and efficient technique in the management of symptomatic para-articular intraosseous cysts in our population.