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Comprehensive MR imaging of acute gynecologic diseases.

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.

Diagnosis, Differential↗
PubMed1979

The value of intravenous urography prior to abdominal hysterectomy for gynecologic disease.

Negligence and failure to "test timely" are the two most common charges in obstetric and gynecologic malpractice suits. Both charges are often made in cases involving urinary tract injury during gynecologic surgery. These injuries occur most commonly during abdominal hysterectomy. This report is a 6 year study of 170 consecutive abdominal hysterectomies to ascertain the value of routine preoperative urography in preventing urinary tract injuries. As a control, 260 consecutive abdominal hysterectomies were performed without preoperative urography. There was one ureteral transection in the control group, but unrecognized urinary tract injuries did not occur in either the study or control group. The risks, costs, and benefits of urography are analyzed.

Adult↗