Pelvic Magnetic Resonance Imaging Research Articles

Necessity and impact of specialization of large foundation model for medical segmentation tasks.

Large foundation models, such as the Segment Anything Model (SAM), have shown remarkable performance in image segmentation tasks. However, the optimal approach to achieve true utility of these models for domain-specific applications, such as medical image segmentation, remains an open question. Recent studies have released a medical version of the foundation model MedSAM by training on vast medical data, who promised SOTA medical segmentation. Independent community inspection and dissection is needed. Foundation models are developed for general purposes. On the other hand, stable delivery of reliable performance is key to clinical utility. This study aims at elucidating the potential advantage and limitations of landing the foundation models in clinical use by assessing the performance of off-the-shelf medical foundation model MedSAM for the segmentation of anatomical structures in pelvic MR images. We also explore the simple remedies by evaluating the dependency on prompting scheme. Finally, we demonstrate the need and performance gain of further specialized fine-tuning. MedSAM and its lightweight version LiteMedSAM were evaluated out-of-the-box on a public MR dataset consisting of 589 pelvic images split 80:20 for training and testing. An nnU-Net model was trained from scratch to serve as a benchmark and to provide bounding box prompts for MedSAM. MedSAM was evaluated using different quality bounding boxes, those derived from ground truth labels, those derived from nnU-Net, and those derived from the former two but with 5-pixel isometric expansion. Lastly, LiteMedSAM was refined on the training set and reevaluated on this task. Out-of-the-box MedSAM and LiteMedSAM both performed poorly across the structure set, especially for disjoint or non-convex structures. Varying prompt with different bounding box inputs had minimal effect. For example, the mean Dice score and mean Hausdorff distances (in mm) for obturator internus using MedSAM and LiteMedSAM were {0.251±0.110, 0.101±0.079} and {34.142±5.196, 33.688±5.306}, respectively. Fine-tuning of LiteMedSAM led to significant performance gain, improving Dice score and Hausdorff distance for the obturator internus to 0.864±0.123 and 5.022±10.684, on par with nnU-Net with no significant difference in evaluation of most structures. All segmentation structures benefited significantly from specialized refinement, at varying improvement margin. While our study alludes to the potential of deep learning models like MedSAM and LiteMedSAM for medical segmentation, it highlights the need for specialized refinement and adjudication. Off-the-shelf use of such large foundation models is highly likely to be suboptimal, and specialized fine-tuning is often necessary to achieve clinical desired accuracy and stability.

SwinUNeCCt: bidirectional hash-based agent transformer for cervical cancer MRI image multi-task learning

Cervical cancer is the fourth most common malignant tumor among women globally, posing a significant threat to women’s health. In 2022, approximately 600,000 new cases were reported, and 340,000 deaths occurred due to cervical cancer. Magnetic resonance imaging (MRI) is the preferred imaging method for diagnosing, staging, and evaluating cervical cancer. However, manual segmentation of MRI images is time-consuming and subjective. Therefore, there is an urgent need for automatic segmentation models to identify cervical cancer lesions in MRI scans accurately. All MRIs in our research are from cervical cancer patients diagnosed by pathology at Tongren City People’s Hospital. Strict data selection criteria and clearly defined inclusion and exclusion conditions were established to ensure data consistency and accuracy of research results. The dataset contains imaging data from 122 cervical cancer patients, with each patient having 100 pelvic dynamic contrast-enhanced MRI scans. Annotations were jointly completed by medical professionals from Universiti Putra Malaysia and the Radiology Department of Tongren City People’s Hospital to ensure data accuracy and reliability. Additionally, a novel computer-aided diagnosis model named SwinUNeCCt is proposed. This model incorporates (i) A bidirectional hash-based agent multi-head self-attention mechanism, which optimizes the interaction between local and global features in MRI, aiding in more accurate lesion identification. (ii) Reduced computational complexity of the self-attention mechanism. The effectiveness of the SwinUNeCCt model has been validated through comparisons with state-of-the-art 3D medical models, including nnUnet, TransBTS, nnFormer, UnetR, UnesT, SwinUNetR, and SwinUNeLCsT. In semantic segmentation tasks without a classification module, the SwinUNeCCt model demonstrates excellent performance across multiple key metrics: achieving a 95HD of 6.25, an IoU of 0.669, and a DSC of 0.802, all of which are the best results among the compared models. Simultaneously, SwinUNeCCt strikes a good balance between computational efficiency and model complexity, requiring only 442.7 GFLOPs of computational power and 71.2 M parameters. Furthermore, in semantic segmentation tasks that include a classification module, the SwinUNeCCt model also exhibits powerful recognition capabilities. Although this slightly increases computational overhead and model complexity, its performance surpasses other comparative models. The SwinUNeCCt model demonstrates excellent performance in semantic segmentation tasks, achieving the best results among state-of-the-art 3D medical models across multiple key metrics. It balances computational efficiency and model complexity well, maintaining high performance even with the inclusion of a classification module.

Rare Seminal Vesicle Cystadenoma: Case Report and Literature Review

Abstract Introduction/Objective Primary neoplasms of seminal vesicles (SV) are rare, with the majority being metastatic tumors, often from prostatic carcinoma. SV cystadenoma is an exceedingly rare benign epithelial tumor that arises from the remnants of the Mullerian duct. The tumor formed of cysts of variable sizes lined by bland cuboidal epithelium. Herein we present a case of SV cystadenoma in a 38-year-old male, underscoring its rarity and risk of progression to higher grades, as outlined in literature review. Methods/Case Report A 38-year-old male with a history of left atrophic kidney and intermittent pelvic pain due to recurrent obstruction of the SV. Pelvic Magnetic Resonance Imaging revealed a 5.3 cm benign unilocular cyst within the SV, along the posterior aspect of the urinary bladder. The patient underwent successful laparoscopic excision of the left SV. Gross examination of the excised SV demonstrated a 3.5X 2.7X 1.5 cm cyst within the SV. Microscopic examination displayed a benign cyst lined by single to multiple layers of cuboidal epithelium, surrounded by unremarkable SV stroma. The epithelial lining cells exhibited round nuclei with inconspicuous nucleoli, lacking dysplasia. Immunohistochemistry revealed positive staining for cytokeratin 7 and PAX 8 in the epithelial cells, whereas prostatic specific antigen staining was negative. Results (if a Case Study enter NA) NA Conclusion Cystadenoma and mixed epithelial stromal tumors of the SV (MEST) are rare entities, with approximately 30 reported cases. This case demonstrates classic histologic features consistent with low-grade MEST, as per recently proposed grading criteria. Notably, a recent case report has suggested a potential for malignant transformation to high-grade dysplasia and adenocarcinoma in SV cystadenoma, as evidenced by focal epithelial dysplasia.

A dynamic approach for MR T2-weighted pelvic imaging

T2-weighted 2D fast spin echo sequence serves as the standard sequence in
clinical pelvic MR imaging protocols. However, motion artifacts and blurring caused
by peristalsis present significant challenges. Patient preparation such as administering
antiperistaltic agents is often required before examination to reduce artifacts, which
discomfort the patients. This work introduce a novel dynamic approach for T2
weighted pelvic imaging to address peristalsis-induced motion issue without any patient
preparation.
Approach: A rapid dynamic data acquisition strategy with complementary sampling
trajectory is designed to enable highly undersampled motion-resistant data sampling,
and an unrolling method based on deep equilibrium model is leveraged to reconstruct
images from the dynamic sampled k-space data. Moreover, the fix-point convergence of
the equilibrium model ensures the stability of the reconstruction. The high acceleration
factor in each temporal phase, which is much higher than that in traditional static
imaging, has the potential to effectively freeze pelvic motion, thereby transforming
the imaging problem from conventional motion prevention or removal to motion
reconstruction.
Main results: Experiments on both retrospective and prospective data have
demonstrated the superior performance of the proposed dynamic approach in reducing
motion artifacts and accurately depicting structural details compared to standard static
imaging.
Significance: The proposed dynamic approach effectively captures motion states
through dynamic data acquisition and deep learning-based reconstruction, addressing
motion-related challenges in pelvic imaging.

Limited utility of subendometrial enhancement in assessing the interface between the endometrium and myometrium

This study was conducted to re-evaluate the utility of subendometrial enhancement (SEE) in assessing the interface between the endometrium and myometrium. In total, 110 women who underwent pelvic magnetic resonance imaging (MRI) for non-endometrial gynecologic diseases were enrolled in this prospective study. Two radiologists independently assessed the presence or absence of subendometrial enhancement (SEE) on dynamic contrast-enhanced (CE) MRI. A subgroup analysis was performed to evaluate the impact of menstrual status on the detection of SEE. Identified areas of SEE were rated using a 4-point Likert scale to determine their reliability in assessing the interface between the endometrium and myometrium. SEE was identified in 44.5% (49/110) of cases by radiologist 1 and in 39.1% (43/110) by radiologist 2. A subgroup analysis indicated no significant differences in the detection of SEE based on menstrual status. The identified areas of SEE were deemed reliable for assessing the interface between the endometrium and myometrium in 24.5% (12/49) of the cases evaluated by radiologist 1 and in 32.6% (14/43) of those evaluated by radiologist 2. Among the 110 women studied, reliable areas of SEE for assessing the interface between the endometrium and myometrium were observed in 10.9% (n = 12) by radiologist 1 and 12.7% (n = 14) by radiologist 2. The evaluation of SEE using dynamic CE MRI may be limited in its ability to assess the interface between the endometrium and myometrium.

Building a pelvic organ prolapse diagnostic model using vision transformer on multi-sequence MRI.

Although the uterus, bladder, and rectum are distinct organs, their muscular fasciae are often interconnected. Clinical experience suggests that they may share common risk factors and associations. When one organ experiences prolapse, it can potentially affect the neighboring organs. However, the current assessment of disease severity still relies on manual measurements, which can yield varying results depending on the physician, thereby leading to diagnostic inaccuracies. This study aims to develop a multilabel grading model based on deep learning to classify the degree of prolapse of three organs in the female pelvis using stress magnetic resonance imaging (MRI) and provide interpretable result analysis. We utilized sagittal MRI sequences taken at rest and during maximum Valsalva maneuver from 662 subjects. The training set included 464 subjects, the validation set included 98 subjects, and the test set included 100 subjects (training set n=464, validation set n=98, test set n=100). We designed a feature extraction module specifically for pelvic floor MRI using the vision transformer architecture and employed label masking training strategy and pre-training methods to enhance model convergence. The grading results were evaluated using Precision, Kappa, Recall, and Area Under the Curve (AUC). To validate the effectiveness of the model, the designed model was compared with classic grading methods. Finally, we provided interpretability charts illustrating the model's operational principles on the grading task. In terms of POP grading detection, the model achieved an average Precision, Kappa coefficient, Recall, and AUC of 0.86, 0.77, 0.76, and 0.86, respectively. Compared to existing studies, our model achieved the highest performance metrics. The average time taken to diagnose a patient was 0.38s. The proposed model achieved detection accuracy that is comparable to or even exceeds that of physicians, demonstrating the effectiveness of the vision transformer architecture and label masking training strategy for assisting in the grading of POP under static and maximum Valsalva conditions. This offers a promising option for computer-aided diagnosis and treatment planning of POP.

Benign Cystic Mesothelioma of the Uterus: Myth or Reality?

Mesothelioma is a very rare tumor of mesodermal origin that covers the surface of body organs such as the peritoneum, pleura and pericardium. This tumour in the majority of cases presents in its malignant form where it represents some characteristics: increased cellularity, cytological atypia, papillary formations, even invasion. We report the case of Mrs AB, 37 years old, blood group A positive with no particular pathological history, nulli gesture nulli pare, consulted for pelvic pain and abdominal bloating. The clinical examination showed a distended bloated abdomen with a 20 centimetre pelvic mass with regular contours and painlessness. Abdominal and pelvic ultrasound showed a globular uterus increased in size by 200 millimetres with a multilocular cystic image intra myometrial (corporal anterior and fundial) of 188*79 millimetres. Intraoperatively, a globular uterus was found to be enlarged with a 15 centimetre parovascular cystic mass, dependent on the anterior aspect of the uterus, with a rock water fluid content, without any other associated abnormalities The postoperative course was simple. To conclude, Benign cystic mesothelioma of the uterus is a tumour of diagnostic value. This tumour is spleen. The preoperative evaluation allows the diagnosis to be suspected, especially by pelvic magnetic resonance imaging.

Uterine Sarcoma or Degenerating Fibroid? Validating the New Consensus Magnetic Resonance Imaging Algorithm for Evaluating Atypical Uterine Masses.

The aim of the study is to assess the validity of a recently published consensus magnetic resonance imaging (MRI) diagnostic algorithm for differentiating degenerating leiomyomas from uterine sarcomas and other atypical appearing uterine malignancies. Atypical uterine masses on pelvic MRI were identified using a radiology report search engine and teaching files with the keywords "atypical leiomyoma," "atypical fibroid," and "sarcoma." All cases were pathology-proven. Two radiologists blinded to clinical, surgical, and pathologic reports retrospectively and independently reviewed 40 pelvic MRI examinations dated 1/2007-9/2022 to determine whether the masses appeared benign or malignant, using the 2022 consensus atypical uterine mass flow chart. Imaging features assessed included intermediate/high signal intensity (SI) at T2-weighted imaging, high diffusion weighted imaging SI (equal or higher SI than endometrium or lymph nodes on high b value imaging), apparent diffusion coefficient (ADC) value ≤0.905 × 10-3 mm2/s, peritoneal metastases, and abnormal lymph nodes. Among the 40 atypical uterine mass cases reviewed, 24 masses were benign (22 leiomyomas, 1 adenomyoma, and 1 borderline ovarian tumor) and 16 masses were malignant (6 leiomyosarcomas, 6 carcinosarcomas, 2 endometrial stromal sarcomas, 1 high-grade adenosarcoma, and 1 low-grade uterine sarcoma). Sensitivity, specificity, positive predictive value, and negative predictive value of whether a mass was benign or malignant were 75%, 95.8%, 92.3%, and 85% for reader 1, and 81.2%, 91.7%, 86.7%, and 88% for reader 2, respectively. Interrater agreement was strong, with a kappa statistic of 0.89. When excluding nonleiomyosarcoma uterine malignancies, sensitivity and negative predictive value improved to 100%. The new consensus pelvic MRI algorithm for evaluating atypical uterine masses has good specificity, sensitivity, positive predictive value, and negative predictive value for determining malignancy, particularly for uterine sarcomas that are leiomyosarcomas. However, if ADC value is near but not below 0.905 × 10-3 mm2/s, the mass may still be malignant, especially if a b value lower than 1000 is used. If the atypical uterine mass is predominantly endometrial, morphological features on T2 and postgadolinium sequences should guide suspicion, as some atypical appearing nonleiomyosarcoma uterine malignancies may have an ADC value greater than 0.905 × 10-3 mm2/s.

Prevalence, incidence, and treatment trends of adenomyosis in South Korean women for 15 years: A national population-based study.

Adenomyosis is associated with female infertility worldwide. With improvements in imaging methods, such as pelvic magnetic resonance imaging, the diagnosis and treatment of adenomyosis have changed. This study aimed to evaluate the overall prevalence, incidence, and treatment trends of adenomyosis in South Korea using data from the Korean National Health Insurance Service Database (NHIS). Data were collected from the Korean NHIS, a population-based complete enumeration database. A total of 678 641 women aged 11-55 years diagnosed with adenomyosis (N80.0 ICD-10 code) from the database from 2002 to 2016 were enrolled. After applying a one-year look-back method, 629 592 patients were analyzed to estimate the prevalence, incidence, and treatment trends of adenomyosis. The overall prevalence during the study period was 3.86 per 1000 people. The prevalence of adenomyosis has increased from 1.42 per 1000 individuals in 2002 to 7.50 per 1000 individuals in 2016. The crude annual incidence rate of adenomyosis was 1.62 per 1000 people in 2003, which increased to 4.12 per 1000 people in 2016. In addition, the proportion of uterus-preserving surgeries in adenomyosis treatments has increased from 7.51% to 21.29% over 15 years. The prevalence and incidence of adenomyosis in South Korea increased between 2002 and 2016. Furthermore, the proportion of uterus-preserving surgeries and progestin prescriptions for adenomyosis treatment has increased. We expect that our findings will raise awareness of the necessity for fertility preservation through earlier diagnosis and proper management of patients with adenomyosis.

A novel pelvic magnetic resonance imaging measurement for pelvic organ prolapse evaluation

BackgroundPelvic magnetic resonance imaging has been proven effective for quantifying the extent of prolapse. The pubococcygeal line is used universally as a reference line in measuring pelvic organ prolapse, however, it focuses solely on three lowest points in the anterior, middle, and posterior pelvic compartments, without taking into account other pelvic floor structures and their interactions. ObjectivesThis study aimed to introduce and validate the area under the pubococcygeal line, a novel measurement method for evaluating pelvic organ prolapse, to examine its correlation with clinical Pelvic Organ Prolapse Quantification staging, and assess its reliability across different raters. Study DesignThis study recruited 225 women who underwent evaluations involving both magnetic resonance imaging measurements and clinical Pelvic Organ Prolapse Quantification staging. A comprehensive statistical approach involving descriptive analysis, correlation analysis, reliability assessment, and ordinal logistic regression analysis was adopted to evaluate the applicability and reliability of the area under the pubococcygeal line measurement. ResultsAnalysis of participant characteristics across different POP-Q stages revealed a significant association between increased values of the area under the pubococcygeal line and severity of Pelvic Organ Prolapse Quantification staging. Correlation analysis was performed to identify and quantify the strength of the associations between the variables. The area under the pubococcygeal line showed a strong positive correlation with Pelvic Organ Prolapse Quantification stages (Spearman's r = 0.878, p < 0.001), outperforming the pubococcygeal line grades (Spearman's r = 0.777, p < 0.001). Reliability assessments yielded excellent intra- and inter-rater reliability, with intraclass correlation coefficient values of 0.980 and 0.906, respectively. Ordinal logistic regression analysis was used to determine the association between these variables and POP severity, highlighting significant associations between the area under the pubococcygeal line and Pelvic Organ Prolapse Quantification stages. ConclusionThe area under the pubococcygeal line measurement method is a novel and comprehensive magnetic resonance imaging technique for evaluating pelvic organ prolapse. This method strongly correlates with clinical Pelvic Organ Prolapse Quantification stages and exhibits excellent intra- and inter-rater reliability, holding a potential for enhanced diagnostic accuracy, optimized treatment strategies, and improved patient outcomes.

Adenomatoid tumor of the uterus: analysis of misdiagnosed cases and a literature review.

Adenomatoid tumors are rare, specific, benign tumors of the reproductive tract that originate from mesenchymal tissue. A patient was diagnosed with uterine fibroids 1 year previously when a mass of approximately 30 mm was found in the left adnexal region during a physical examination. At 1 year of follow-up, ultrasound showed that the mass in the left adnexal area had greatly increased to 61 × 45 × 50 mm. Contrast-enhanced pelvic magnetic resonance imaging (MRI) was performed before surgery and suggested a borderline tumor. Histopathology suggested signet ring cell carcinoma, and an immunohistochemical examination suggested a uterine adenomatoid tumor. Our suspicion of a borderline tumor was based mainly on the following features: the mass had increased in size within 1 year, the cancer antigen 125 concentration had increased, and several lymph nodes in the pelvic and groin regions showed positive signals on MRI enhancement. Uterine adenomatoid tumors are challenging to diagnose, especially adenomatosis with signet ring cells. However, the accuracy of diagnosing this disease can be greatly improved by combining ultrasound and MRI. This article describes the most comprehensive and reliable imaging features of ultrasound and MRI, which play an important role in diagnosing uterine adenomatoid tumors and provide useful information for clinicians.

The "Ins and Outs" of Dynamic Magnetic Resonance Imaging for Female Pelvic Organ Prolapse.

Concurrent pelvic organ and rectal prolapse have an incidence of 38%. Dynamic pelvic magnetic resonance imaging (MRI) is the modality of choice for workup. We discuss dynamic pelvic MRI indications, interpretation, and clinical application to pelvic floor disorders. The pubococcygeal line (PCL) extends from the pubic symphysis to the last coccygeal joint. The "H line" demonstrates the levator hiatus size, drawn from the inferior pubic symphysis to the posterior rectal wall at the anorectal junction. The "M line" represents vertical descent of the levator hiatus and extends perpendicularly from the PCL to the posterior aspect of the H line. With rectovaginal fascial defects, the small bowel, the peritoneum, and the sigmoid colon can prolapse. Posterior compartment abnormalities include rectocele, rectal prolapse, and descending perineal syndrome. Pelvic MRI can evaluate functional disorders such as anismus, where the anorectal angle is narrowed and associated with lack of pelvic floor descent and incomplete evacuation. Particularly for patients with concurrent urogynecological and colorectal complaints, previous pelvic reconstructive surgery, or when clinical symptomatology does not correlate with physical examination, dynamic pelvic MRI can impact management. It is critical for pelvic reconstructive surgeons to be familiar with this imaging modality to counsel patients and interpret radiographic findings.

The role of MRI in the diagnosis of aseptic loosening following total hip arthroplasty.

The role of advanced imaging in diagnosing aseptic implant loosening following total hip arthroplasty (THA) remains unclear. This study aimed to assess the diagnostic value of magnetic resonance imaging (MRI) in detecting aseptic loosening. This was a retrospective review of 342 consecutive patients who underwent revision THA between July 2011 and April 2023 and had a pelvis MRI as part of the preoperative diagnostic evaluation. Among them, 62 patients had an intraoperative diagnosis of aseptic loosening of either the femoral or acetabular component. Patients were stratified based on the concordance between their MRI and radiographs findings. Preoperative MRI showed signs of aseptic loosening in 25/62 patients (sensitivity = 40.3%). Similarly, preoperative radiographs demonstrated signs of aseptic loosening in 27 patients (43.5%). Twelve patients (19.4%) had both MRI and radiographs predictive of aseptic loosening, 22 patients (35.5%) did not show signs of aseptic loosening in either MRI or radiographs, and for 28 patients (45.2%), the results were discordant. Among the patients with a negative radiograph for aseptic loosening (n = 35), 13 patients (37.1%) showed signs of aseptic loosening on MRI. Aseptic loosening remains an elusive diagnosis, and the findings of this study suggest that the utility of MRI and radiographs as part of the diagnostic process is limited. However, in cases of presumed aseptic loosening with inconclusive radiographs findings, MRI may play a role in improving the diagnostic process. III.

Imaging of Ovarian Metastases (OM) from Breast Cancer: A Review

The ovary is a common site of metastases from other primary malignancies, and 5-30% of ovarian cancers are metastatic malignancies [1-16]. The most common primary origins are the breast, colon, and stomach[24]. Although imaging cannot always differentiate between secondary and primary ovarian neoplasms, and pathologic confirmation is generally required, it is important to recognize suggestive imaging features on pelvic US, CT and MR imaging [5,8-10,16,18-20]. OM from breast cancers is frequently asymptomatic until the masses have grown to certain size, and the metastatic tumors are frequently manifested as bilateral, solid, hypervascular, small ovarian masses [2]. Even though the Immunohistochemistry plays a key role in distinguishing between primary ovarian tumors and OM, and it was also important for confirming the metastatic nature of the ovarian lesion and diagnosing the primary tumor, imaging is vital to guide radiologists to include metastases in their differential diagnosis for atypical adnexal masses and in some cases avoid unnecessarie mutilative surgery [2-24]. In this review i will analize the main radiology features of OM from breast cancer to direct the surgery planning including referral practice, selection of candidates for primary chemotherapy by demonstration of non resectable disease, and tissue sampling in case of peritoneal carcinomatosis.

Efficacy of compressed sensing and deep learning reconstruction for adult female pelvic MRI at 1.5 T

BackgroundWe aimed to determine the capabilities of compressed sensing (CS) and deep learning reconstruction (DLR) with those of conventional parallel imaging (PI) for improving image quality while reducing examination time on female pelvic 1.5-T magnetic resonance imaging (MRI).MethodsFifty-two consecutive female patients with various pelvic diseases underwent MRI with T1- and T2-weighted sequences using CS and PI. All CS data was reconstructed with and without DLR. Signal-to-noise ratio (SNR) of muscle and contrast-to-noise ratio (CNR) between fat tissue and iliac muscle on T1-weighted images (T1WI) and between myometrium and straight muscle on T2-weighted images (T2WI) were determined through region-of-interest measurements. Overall image quality (OIQ) and diagnostic confidence level (DCL) were evaluated on 5-point scales. SNRs and CNRs were compared using Tukey’s test, and qualitative indexes using the Wilcoxon signed-rank test.ResultsSNRs of T1WI and T2WI obtained using CS with DLR were higher than those using CS without DLR or conventional PI (p < 0.010). CNRs of T1WI and T2WI obtained using CS with DLR were higher than those using CS without DLR or conventional PI (p < 0.003). OIQ of T1WI and T2WI obtained using CS with DLR were higher than that using CS without DLR or conventional PI (p < 0.001). DCL of T2WI obtained using CS with DLR was higher than that using conventional PI or CS without DLR (p < 0.001).ConclusionCS with DLR provided better image quality and shorter examination time than those obtainable with PI for female pelvic 1.5-T MRI.Relevance statementCS with DLR can be considered effective for attaining better image quality and shorter examination time for female pelvic MRI at 1.5 T compared with those obtainable with PI.Key PointsPatients underwent MRI with T1- and T2-weighted sequences using CS and PI.All CS data was reconstructed with and without DLR.CS with DLR allowed for examination times significantly shorter than those of PI and provided significantly higher signal- and CNRs, as well as OIQ.Graphical

Recent trends in AI applications for pelvic MRI: a comprehensive review.

Magnetic resonance imaging (MRI) is an essential tool for evaluating pelvic disorders affecting the prostate, bladder, uterus, ovaries, and/or rectum. Since the diagnostic pathway of pelvic MRI can involve various complex procedures depending on the affected organ, the Reporting and Data System (RADS) is used to standardize image acquisition and interpretation. Artificial intelligence (AI), which encompasses machine learning and deep learning algorithms, has been integrated into both pelvic MRI and the RADS, particularly for prostate MRI. This review outlines recent developments in the use of AI in various stages of the pelvic MRI diagnostic pathway, including image acquisition, image reconstruction, organ and lesion segmentation, lesion detection and classification, and risk stratification, with special emphasis on recent trends in multi-center studies, which can help to improve the generalizability of AI.

Preoperative prediction model of lymph node metastasis in the inguinal and femoral region based on radiomics and artificial intelligence

ObjectiveTo predict preoperative inguinal lymph node metastasis in vulvar cancer patients using a machine learning model based on imaging features and clinical data from pelvic magnetic resonance imaging (MRI).Methods52 vulvar...

Assessment of perianal fistulizing Crohn's disease activity with endoanal ultrasound: A retrospective cohort study.

Perianal fistulas pose dual challenges to Crohn's disease (CD) patients. Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD. To determine the accuracy of endoanal ultrasound (EUS) and shear wave elastography (SWE) for evaluating perianal fistulizing CD (PFCD) activity. This was a retrospective cohort study. A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups: Non-anal fistula group (n = 23), low-activity perianal fistulas [n = 19, perianal disease activity index (PDAI) ≤ 4], high-activity perianal fistulas (n = 25, PDAI > 4) based on the PDAI. All patients underwent assessments including EUS + SWE, pelvic magnetic resonance [pelvic magnetic resonance imaging (MRI)], C-reactive protein, fecal calprotectin, CD activity index, PDAI. The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%, and there was good consistency in the classification of perianal fistulas (Kappa = 0.752, P < 0.001). Significant differences were observed in the blood flow Limberg score (χ 2 = 8.903, P < 0.05) and shear wave velocity (t = 2.467, P < 0.05) between group 2 and 3. Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD (Magnifi-CD) score (r = -0.676, P < 0.001), a weak negative correlation with the PDAI score (r = -0.386, P < 0.05), and a weak correlation between the Limberg score and the PDAI score (r = 0.368, P < 0.05). EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients. It may be the ideal tool to assess PFCD activity objectively for management strategies.

Sciatica secondary to deep venous thrombosis of the persistent sciatic vein: the first case in the literature. Illustrative case.

Sciatica usually results from lumbar nerve compression due to factors like disc herniations or lumbar canal stenosis. Despite its common causes, sciatic pain in a 52-year-old man following a coronavirus disease 2019 infection highlighted the importance of considering less common factors. Initially, minor disc protrusions were suspected as the cause of the symptoms, leading to the offer of surgery at another facility. The patient sought a second opinion, and our evaluation revealed a unique finding. Pelvic magnetic resonance imaging uncovered varicose structures displacing the left sciatic nerve. Subsequent pelvic computed tomography angiography identified a remarkable finding-the lack of opacification in a left persistent sciatic vein ascending toward a left internal iliac vein, originating from a common internal iliac venous trunk-confirming a suspicion for deep venous thrombosis. These findings represented not 1, but 2, extremely rare and distinct variants in the venous anatomy. The authors promptly initiated anticoagulant therapy and tailored pain management strategies, observing progressive thrombosis resolution on follow-up imaging. This report highlights the need for comprehensive diagnostics when symptoms and imaging differ. Misdiagnosis could lead to unnecessary surgeries and potential risks for the patient. https://thejns.org/doi/10.3171/CASE23652.

Atypical presentation of herpes simplex virus 2 primary infection: a case report

BackgroundCervicitis, an infectious or noninfectious inflammation of the cervix, encompasses a wide range of clinical conditions, from asymptomatic infections to severe lesions, making its diagnosis difficult. Acute cervicitis may develop into pelvic inflammatory disease. In patients with cervicitis, current guidelines recommend testing for herpes simplex virus when external genital lesions are present. Here, we present the case of a patient with an atypical primary herpes simplex virus 2 infection manifesting as cervicitis without genital lesions.Case presentationA 29-year-old Caucasian woman was hospitalized for pelvic inflammatory disease. The patient complained of severe suprapubic pain, fever, and heavy vaginal discharge. The external genitalia were unremarkable, so empirical antibiotic treatment was initiated. Despite 48 hours of well-administered antibiotic therapy, her complaints persisted. Polymerase chain reaction for possible microbial causes was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. There was no bacterial vaginosis. Repeat gynecological examinations with endovaginal ultrasound revealed an enlarged cervix, and pelvic magnetic resonance imaging supported a diagnosis of cervicitis. At this point, additional screening for other sexually transmitted infections and infectious disease-related etiologies of cervicitis was performed, and the polymerase chain reaction analysis of newly isolated samples was positive for herpes simplex virus 2. No antiviral treatment was initiated given the delay in diagnosing herpes simplex virus 2 infection and the slow but spontaneous abatement of symptoms.ConclusionHerpes simplex virus infection should be considered as a possible cause of cervicitis, even in the absence of typical genital lesions. Early detection of herpes simplex virus allows early treatment, helping to reduce the duration and severity of symptoms and therefore potentially reducing recurrences and improving disease control. These data and data from future cases might spur changes in the guidelines on cervicitis testing and treatment.