Pelvic MRI Research Articles

Introduction: Carcinoid heart disease (CHD), a rare cardiac manifestation of neuroendocrine tumors (NETs), predominantly affects right-sided valves due to fibrotic plaque deposition from serotonin and other vasoactive substances. We describe a rare case of CHD in an elderly female. Description of Case A 69-year-old female with worsening periorbital and bilateral leg edema was referred for cardiology evaluation. She also reported exertional dyspnea and orthopnea. She denied weight loss, abdominal pain, or diarrhea. Physical exam revealed a flushed appearance with a left sternal border holosystolic murmur. A transesophageal echocardiogram (TEE) showed LV ejection fraction 60%, asymmetric LV hypertrophy, severe tricuspid regurgitation (TR) with thickened and immobile leaflets, flow reversal in the IVC and hepatic veins, thickened pulmonic valve with moderate pulmonic insufficiency and a dagger-shaped Doppler profile, and moderate aortic regurgitation (Fig 1). Given the flushing and TEE findings, CHD was suspected. A 24-hour urine 5-HIAA was markedly elevated at 81 mg, confirming carcinoid syndrome. Right heart catheterization revealed elevated RH pressures, torrential TR, and normal cardiac index. PET-CT showed a large pelvic mass arising from the left ovary with Ga-68 DOTATATE uptake in mediastinal and hilar nodes, consistent with metastatic disease (Fig 2). Pelvic MRI confirmed the ovarian mass concerning for NET (Fig 3). She was started on octreotide LAR 20 mg every 4 weeks by Medical Oncology, evaluated by cardiothoracic surgery, and underwent surgical replacement of the aortic, tricuspid, and pulmonic valves. Her postoperative course was complicated by pneumomediastinum and upper GI bleeding due to a Mallory-Weiss tear. Discussion: CHD is a serious manifestation of carcinoid syndrome, caused by serotonin-induced fibrous plaque deposition on tricuspid and pulmonic valves, leading to immobile leaflets and severe regurgitation. Primary ovarian NETs causing CHD are exceedingly rare, with only isolated case reports. Clinicians should suspect CHD in patients with right-sided heart failure, flushing, or characteristic echocardiographic findings—such as thickened valves and hepatic vein flow reversal—and confirm with elevated 5-HIAA levels.

The mature teratoma or dermoid cyst of the ovary is a benign tumor with a good prognosis which constitutes less than 1% of ovarian tumors. Its association with pregnancy is rare. We report the case of a 30-year-old woman admitted for management of an abdominopelvic mass for which she underwent an ultrasound supplemented by a pelvic MRI followed by conservative treatment based on an adnexectomy with multiple biopsies, the anatomopathological result of which was in favor of a mature ovarian teratoma. Through the analysis of this observation and the data of the literature, we will discuss the different aspects of this association.

Background Autoimmune hemolytic anemia (AIHA) is a rare and potentially life-threatening condition in the pediatric population. While often associated with autoimmune or lymphoproliferative disorders, its occurrence in conjunction with benign ovarian tumors, such as mature cystic teratomas, is exceptionally rare. Case presentation A 13-year-old previously healthy female presented with a one-week history of progressive pallor, jaundice, and fatigue. Initial laboratory tests revealed severe anemia (Hb 5.6 g/dL), elevated LDH, indirect hyperbilirubinemia, undetectable haptoglobin, and a positive direct antiglobulin test (DAT) for IgG, confirming warm AIHA. Imaging studies, including pelvic ultrasound and MRI, identified a large complex cystic ovarian mass, consistent with a mature cystic teratoma. The patient underwent exploratory laparotomy with right salpingo-oophorectomy without requiring blood transfusions. Postoperatively, there was complete resolution of hemolysis, normalization of laboratory values, and no recurrence over a 2-month follow-up period. Conclusion This case highlights a diagnostic challenge and underscores the importance of recognizing paraneoplastic AIHA in children, even in the context of benign tumors. It also supports a potential autoimmune–tumor association, emphasizing the value of timely diagnosis and surgical intervention.

Zinner’s syndrome is a rare congenital malformation of the male genitourinary tract, classically defined by the triad of ipsilateral renal agenesis, seminal vesicle cyst, and ejaculatory duct obstruction. It typically presents with non-specific pelvic symptoms or infertility in early adulthood, and imaging plays a central role in its diagnosis. We report the case of a 23-year-old male presenting with chronic pelvic heaviness in the absence of urinary or systemic symptoms. Ultrasound revealed right renal agenesis and a right pelvic cystic mass. Contrast-enhanced CT confirmed renal agenesis and identified a seminal vesicle cyst. Pelvic MRI demonstrated an atypical signal pattern : T1 hyperintensity and T2 hypointensity, suggesting proteinaceous or hemorrhagic content, without diffusion restriction or enhancement. Based on embryological correlation and MRI findings, Zinner’s syndrome was diagnosed. A fertility evaluation was initiated. This case highlights the diagnostic value of MRI in detecting atypical signal characteristics of seminal vesicle cysts in Zinner’s syndrome. Awareness of such variations is essential to avoid misdiagnosis, guide appropriate clinical management, and assess reproductive implications. This case supports the role of MRI as a decisive tool in identifying complex cystic lesions and preventing unnecessary interventions.

Osteomyelitis of the pubic symphysis is a rare condition, often overlooked and a source of diagnostic error. We report the case of a 29-year-old patient, with no significant medical history, who presented with severe pelvic pain associated with functional discomfort and difficulty standing. Pelvic MRI revealed an abnormality of the parasymphyseal signal of the two iliopubic branches in STIR hypersignal, associated with an irregularity of the edges, suggestive of pubic osteomyelitis. This diagnosis should be considered in the presence of any persistent febrile pubic pain. MRI is the examination of choice, allowing early diagnosis and appropriate management.

Disclosure: I. Murta: None. J. Bicca: None. N. Cardoso: None.Background: Endometriosis is an estrogen-dependent clinical syndrome traditionally regarded as a premenopausal condition that tends to regress after menopause. Contrary to this assumption, it can affect up to 4% of postmenopausal women. Hormone replacement therapy (HRT) in this population is challenging due to the potential reactivation of endometriotic lesions, reported in 16-22% of women aged 49-55 and a 1% risk of malignant transformation in those receiving combined HRT. Estrogen deprivation is often preferred out of concern for these complications, raising issues related to bone, cardiovascular, and metabolic health. The efficacy of HRT in this context depends on the dose, route of estrogen administration, and the type, metabolism, and progestogenic potency of the progestin used for symptom control. Clinical Case: A 54-year-old woman, SF, with no prior diagnosis of endometriosis but a long-standing history of deep dyspareunia, started presenting with hot flashes at age 47, followed by persistent pelvic pain and menorrhagia. Bone densitometry revealed osteopenia. Pelvic MRI with bowel preparation identified deep infiltrating endometriosis. Initial treatment with conventional oral progestin therapy failed to alleviate pelvic pain. She underwent surgical intervention, followed by oral progestin therapy, again with no clinical improvement. She started GnRH analog therapy with Goserelin (Zoladex), but experienced worsening vasomotor symptoms and vaginal atrophy, making the treatment poorly tolerated. After multiple failed approaches, the patient began treatment with a novel progestin (R2323) combined with low-dose transdermal estradiol (50 mcg, three times per week), which led to complete resolution of clinical symptoms and improved bone mineral density after two years of HRT. Conclusion: Although oral progestins are considered first-line therapy for endometriosis, they have a reported failure rate of 33%. GnRH agonists serve as an alternative but often induce hypoestrogenic side effects such as vasomotor symptoms and concerns regarding bone loss, particularly in menopausal patients. In this case, the progestin demonstrated antiestrogenic and antiprogestogenic activity with mild androgenic potential. Its therapeutic use led to a modest increase in bone mineral density, possibly due to this androgenic effect. Some evidence suggests that bone receptors may respond differently to this progestin's antiestrogenic action. The addition of low-dose estrogen supported metabolic and cardiovascular health. Combined HRT in patients with endometriosis should be assessed individually, considering dose, route, and type of progestin. Clinical guidelines and further clinical evidence are still needed to support decision-making regarding HRT in this population.Presentation: Monday, July 14, 2025

Abstract Disclosure: M.G. Meirelles: None. R.D. Scalco: None. J.M. Moreira: None. S. Domenice: None. R.L. Batista: None. J. Mesia: None. N. Scalissi: None. J.P. Batatinha: None. J.V. Junior: None. C.B. Bueno: None. A. Narciso: None. A. Reis: None. A. Latronico: None. I.J. Arnhold: None. B.B. Mendonca: None. The luteinizing hormone/choriogonadotropin receptor (LHCGR) is essential for gonadal steroidogenesis and sexual differentiation. Loss-of-function variants in LHCGR lead to a spectrum of 46,XY disorders of sex development (DSD), with phenotypic variability depending on chromosomal sex and mutation type. We report two 46,XY sisters, from a consanguineous family, presenting with primary amenorrhea and absent secondary sexual characteristics. Both, aged 31 and 27, showed tall stature (184 cm and 188 cm; target height: 173 cm), and the elder sister also had obesity and metabolic comorbidities. Hormonal evaluation showed elevated gonadotropins (LH: 49–60 IU/L; FSH: 46–50.7 IU/L), low testosterone (<10 ng/dL), and undetectable estradiol (<17 pg/mL). Pelvic ultrasound and MRI confirmed absence of uterus and presence of bilateral intra-abdominal testes (3.5–4.0 cm AP). Histopathological analysis revealed Leydig cell hypoplasia and severe seminiferous tubule hyalinization. Genetic testing identified a novel homozygous LHCGR splice-site variant (c.384-2A>G; NM_000233.4), classified as pathogenic by ACMG guidelines (PM2, PVS1, PP4). In silico prediction tools indicated complete loss of the canonical AG acceptor site at intron 4. SpliceAI showed high probability of splice site loss (Δ score: 0.99), and MaxEntScan indicated a collapse in splice strength, suggesting exon skipping or intron retention. RNA secondary structure modeling (ViennaRNA Fold) revealed reduced thermodynamic stability (ΔG: –30.05 vs. –32.62 kcal/mol), lower frequency of the minimum free energy structure (0.60% vs. 1.96%), and increased structural diversity (35.3 vs. 23), supporting impaired splicing efficiency. This variant likely disrupts LHCGR expression through aberrant splicing and RNA instability, leading to Leydig cell hypoplasia and testosterone deficiency. The disproportionately high FSH in subject with LHCGR loss-of-function longstanding Sertoli cell damage due to undescended testes. These findings expand the mutational and phenotypic spectrum of LHCGR-related DSD and emphasize the relevance of considering LHCGR defects in 46,XY individuals with hypergonadotropic hypogonadism and female phenotype. Keywords:LHCGR variant, Leydig cell hypoplasia, 46,XY DSD, hypergonadotropic hypogonadism, LH resistance. Presentation: Sunday, July 13, 2025

Disclosure: V. Vadini: None. A. Matoso: None. N. Singla: None. R.R. Banerjee: None. A.H. Hamrahian: None. S.M. Chen Cardenas: None.Background: Urinary bladder paragangliomas (UBPGL) are exceedingly rare, constituting <1% of all paragangliomas (PGL). Clinical presentation ranges from asymptomatic to hyperadrenergic symptoms in relation to voiding. Despite the high sensitivity of Ga68-DOTATATE PET/CT, bladder PGL may be missed due to the accumulation and excretion of the tracer in the urinary system. We present a case of a urinary bladder PGL which was clinically and biochemically suspected but initially missed on Ga68 imaging. We also identified two previously unreported variants of unknown significance in this context.Clinical Case: 65-year-old woman with history of multiple (>20) colonic polyps, Hodgkin lymphoma, follicular thyroid carcinoma presented with resistant hypertension for 8 years. Prior lab evaluation was notable for: PRA 0.15 ng/ml/h, aldosterone 10 ng/dl, and normokalemia. Aldosterone was 5 ng/dl, 2 hours after saline infusion. Normal 24-hour urinary metanephrines 156ug/day (36-209ug/day) and elevated normetanephrines 1,254 ug/24 hour (131-512ug/day). Abdominal CT did not reveal adrenal lesions; AVS did not lateralize. Spironolactone therapy improved blood pressure (BP) control; however, BP spikes continued along with headaches occasionally associated with voiding/bowel movements. Medications were amlodipine 10 mg/day, eplerenone 50 mg BID, nebivolol 5 mg/day, doxazosin 2 mg nightly. Repeat labs showed normal free metanephrines 48 pg/ml (≤57pg/ml), but elevated normetanephrine 531 pg/ml (≤148pg/ml). Ga68-DOTATATE PET/CT was obtained due to suspicion of PGL, tracer avid lesion was not identified. However, a pelvic MRI revealed a 2.5 cm well defined anterior bladder dome mass. Retrospective review of the Ga-68 DOTATE PET/CT revealed well-defined uptake in the region corresponding to the mass. She underwent partial cystectomy with complete resolution of symptoms, and improved BP control requiring 2 agents rather than the 4 preoperatively, plasma normetanephrines normalized. Tumor IHC was positive for synaptophysin, chromogranin A and S100 indicating neuroendocrine origin. Tumor marker p63 was negative and SDHB expression was retained. Genetic testing showed variants of uncertain significance for POT1(p.Asp632Glu)and RECQL4 (p. Arg1004Gln). Repeat evaluation for primary aldosteronism was negative. POT1 or RECQL4 variants have not been described in relation to PGL. Germline variants in the POT1 gene have been implicated in other solid tumors (lymphomas, thyroid cancer).Conclusions: Bladder paragangliomas pose a diagnostic challenge. As illustrated in this case, Ga68-DOTATATE PET/CT initially missed this lesion due to the urinary excretion of the tracer highlighting the need for other imaging modalities when considering bladder PGLs. Further studies examining whether POT1 or REQL4 mutations might be pathogenic for (urinary) PGLs are warranted.Presentation: Sunday, July 13, 2025

Disclosure: E. Krishnaraju: None. S. Samarasinghe: None.Introduction: Ovarian hyperthecosis (OH) is a rare cause of hyperandrogenism typically seen in postmenopausal women. Severe hyperandrogenism with testosterone levels over 150 ng/dL but slowly progressive clinical signs of virtualization and metabolic complications characterize this disease. Clinical Case: A 62-year-old woman was being followed in the clinic for diabetes mellitus, atrial flutter, obstructive sleep apnea, hypertriglyceridemia, kidney stones, proteinuria, obesity, coronary artery disease, and a partial hysterectomy for uterine fibroids. She presented with symptoms of gradual but worsening hair loss in an androgenic pattern and hirsutism for 1-2 years. On exam, she had facial plethora, a dorsal hump, central obesity, thin yet muscled extremities, and male-pattern balding. She was also noted to have coarse facial hair and normal external genitalia. Lab work was remarkable for a high serum testosterone of 238 ng/dl, free testosterone of 24.2 pg/ml, FSH of 57.6 miu/ml, and LH of 51.6 miu/ml. She had a normal TSH, prolactin, estradiol DHEA-S, and SHBG level. Several late-night salivary cortisol levels were normal and a 1 mg DST showed a suppressed cortisol of 1.6 ug/dl. A CT adrenal demonstrated normal appearing adrenal glands while an MRI pelvis showed an absent uterus but noted an enlarged 2.7 cm right ovarian cyst. The right ovary measured 3.0 x 2.6 x 3.6 cm and the left ovary measured 2.4 x 1.7 x 1.9 cm with both glands exhibiting homogeneous enhancement and a normal T2 signal without solid lesions. Given the markedly elevated testosterone levels and the findings of an ovarian cyst, the patient underwent an exploratory laparotomy with bilateral salpingo-oophorectomy. The final histopathology revealed ovarian stromal hyperthecosis of both ovaries with positive immunohistochemical stains for inhibin and calretinin. Her postoperative testing confirmed normalization of testosterone at 21 ng/dl at four weeks and 29 ng/dl at one year after surgery. Her symptoms of hirsutism and hair loss gradually improved after surgery but her body weight and overall appearance remain unchanged. Conclusion: OH must be considered in the differential of severe hyperandrogenism. Other etiologies include hormonally active ovarian and adrenal tumors. OH classically causes ovarian enlargement, but should be suspected even with normal-sized ovaries on imaging. Prompt referral for oophorectomy and histopathologic diagnosis is the gold standard for management.Presentation: Sunday, July 13, 2025

Prostate-specific membrane antigen (PSMA) PET/CT has become a common staging modality for newly diagnosed high-risk and unfavorable intermediate-risk prostate cancer after showing improved sensitivity and specificity compared with conventional imaging in clinical trials. We aimed to assess the causal impact of PSMA PET staging on initial treatment selection in real-world practice. Methods: We used observational data from the U.S. Veterans Health Administration to emulate a randomized controlled trial in which patients with newly diagnosed, unfavorable intermediate-, high-, and very-high-risk prostate cancer from January 2022 to December 2023 would have been randomized to undergo either upfront 18F- or 68Ga-PSMA PET staging or conventional imaging (99mTc bone scan and pelvic CT or MRI). Outcomes of interest included use of frontline androgen deprivation therapy (ADT), second-generation androgen receptor pathway inhibitors (ARPIs), radiotherapy, and radical prostatectomy. Weighted univariable Cox regression was performed to assess the effect of treatment group on each outcome, and 95% CIs were generated from 1,000 bootstrap replicates. Results: In total, 9,049 patients met the criteria for inclusion. PSMA PET staging was associated with higher rates of any ADT use relative to conventional staging (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.19-1.44), higher rates of ARPI use (aHR, 1.52; 95% CI, 1.33-1.78), lower rates of prostatectomy (aHR, 0.69; 95% CI, 0.56-0.83), and no significant effect on the use of radiotherapy (aHR, 1.10; 95% CI, 0.99-1.25). Compared with patients with PSMA stage N0M0, ARPI use was more common in patients with PSMA stage N1M0 (aHR, 6.87; 95% CI, 5.41-8.73) and PSMA stage M1 (aHR, 10.13; 95% CI, 8.16-1.2.58). Patients with PSMA N1M0 disease were much less likely to undergo prostatectomy compared with PSMA N0M0. Conclusion: PSMA PET staging may be leading to fewer prostatectomies and higher use rates of ADT and ARPIs in the Veterans Health Administration.

To identify 3D MRI-derived biomarkers of the cardinal ligament (CL) and uterosacral ligament (USL) for pelvic organ prolapse (POP) risk and stress urinary incontinence (SUI), and to evaluate their correlations with prolapse severity. Female patients undergoing pelvic MRI at *** Hospital (2021-2023) were grouped into POP and control cohorts. MRI data underwent 3D reconstruction (Mimics software) and modeling (Geomagic/Solidworks) to precisely measure ligament parameters. Women with POP had longer postmenopausal intervals, and higher parity but similar age, Body Mass Index (BMI), Lean Body Mass (LBM) and Body Surface Area (BSA). CL volume, surface area, mass, and maximal thickness were significantly reduced in POP (all ); USL metrics did not differ. Total CL mass achieved the highest discrimination for POP (AUC 0.78; sensitivity 73%, specificity 80%). CL dimensions correlated inversely with prolapse severity and SUI ( to -0.442; ), whereas USL metrics showed no significant correlations. Bulbospongiosus muscle thickness was included due to its potential role in urethral support and continence mechanisms. Multivariate modeling retained parity (OR 4.5), CL thickness and bulbospongiosus muscle thickness (strong protective ), left levator ani defects (OR 0.13), and levator ani asymmetry (OR 24) as independent predictors. 3D MRI quantification of CL metrics (volume, area, mass) offers noninvasive biomarkers for POP and SUI risk prediction, unlike USL morphology. These markers improve pelvic floor failure understanding and enable early POP risk identification.

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Endometrial tumors are very common conditions and can be benign or malignant. These tumors generally occur during menopause. &amp;lt;i&amp;gt;The objective&amp;lt;/i&amp;gt; was to calculate the frequency of endometrial tumors, describe their radiological characteristics, identify their histological types, describe the therapeutic approach, and evaluate their prognosis. &amp;lt;i&amp;gt;Method:&amp;lt;/i&amp;gt; This was a retrospective, descriptive, and analytical study covering a five-year period from 1 January 2019 to 31 December 2023, focusing on the records of patients hospitalised during this period at the Ignace Deen Maternity Hospital. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; Endometrial tumors accounted for 13.1% of gynaecological tumors in the department. Ultrasound was the most commonly requested examination (81.6%), followed by blood tests and endometrial biopsy, at 89.8% and 77.5% respectively. Pelvic CT scans and MRI scans were rarely requested. Ultrasound showed 53.1% endometrial thickening and 20.4% endometrial hypertrophy. After pathological examination of the biopsies, there were 31 cases (72.1%) of endometrial adenocarcinoma and 12 cases (27.9%) of endometrial hyperplasia. The histological types found were endometrioid adenocarcinoma in 28 cases (80%) and clear cell carcinoma in 8 cases (20%). Treatment was surgical, with 30.6% undergoing total hysterectomy and 57.2% undergoing extended colpohysterectomy with lymphadenectomy. During the period, we recorded 18.4% mortality. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; Most tumors were endometrioid adenocarcinomas and treatment was mainly surgical.

ObjectiveTo investigate longitudinal changes in pelvic floor support in primiparous women with pelvic organ prolapse (POP) after vaginal delivery, focusing on single- and multiple-compartment involvement.MethodsTwo hundred primiparas after vaginal delivery were prospectively enrolled and underwent pelvic floor MRI at six weeks postpartum. POP was diagnosed and classified into subgroups (single or multiple compartments involved) based on MRI findings. Primiparas with POP underwent repeat MRI at four months postpartum. Pelvic floor measurements, including injury score and functional parameters of the levator ani muscle (puborectal hiatus line, H line; muscular pelvic floor relaxation line, M line; levator hiatus area, LHA; iliococcygeus angle, ICA; levator plate angle, LPA), were assessed on MRI. Measurements were compared among POP subgroups and a normal control group (without POP) at six weeks postpartum. Additionally, changes between six weeks and four months postpartum were analyzed within POP subgroups.ResultsBased on MRI criteria, approximately 41.5% of primiparas were diagnosed with POP, predominantly cystoceles commonly associated with uterine prolapse. Functional parameters of the levator ani, except for LPA at rest, were significantly increased in POP subgroups compared to controls. At four months postpartum, M line, H line, and LPA significantly decreased, and prolapsed organs were elevated in cases with multiple compartments involved, compared to six weeks postpartum. No significant changes were observed in cases with single-compartment involvement during follow-up.ConclusionA substantial proportion of primiparas experienced postpartum POP. Impaired levator ani function contributed to POP. Pelvic floor support improved during early postpartum in cases with multiple-compartment involvement.

Ischiofemoral Impingement: Morphologic Associations, Pelvic Asymmetry, and Clinical Correlates in a Retrospective Observational Study.

OBJECTIVES This study aimed to evaluate the diagnostic accuracy of the ultrasound O-RADS classification for distinguishing between malignant and benign ovarian lesions, using MRI of the pelvis as the reference standard. METHODOLOGY A cross-sectional study was conducted, enrolling 169 women with suspicious adnexal masses. All participants underwent standardised ultrasound examinations (with O-RADS scoring) and MRI of the pelvis (with O-RADS MRI scoring). Diagnostic performance metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and the area under the receiver operating characteristic curve (AUC), were calculated. RESULTSThe prevalence of malignancy was 29.0%. Ultrasound O-RADS demonstrated a sensitivity of 83.7% (95% CI: 76.2-89.5%), specificity of 85.0% (95% CI: 78.3-90.1%), PPV of 69.5%, NPV of 92.7%, and overall accuracy of 84.6%. The AUC was 0.91 (95% CI: 0.86-0.95). Performance was superior in postmenopausal women and for larger lesions (greater than 5 cm in diameter). False positives occurred primarily with hemorrhagic cysts and endometriomas. CONCLUSION Ultrasound O-RADS classification demonstrates high diagnostic accuracy, particularly an excellent NPV, for evaluating adnexal masses. It serves as a reliable first-line triage tool, potentially reducing unnecessary MRI referrals in settings with limited resources.

Retrograde intra-vesical plain film or CT cystography may not be feasible for patients with hypersensitivity towards iodinated contrast agents. This study evaluates whether retrograde gadoxetic acid-enhanced pelvic and liver MRI can detect intraperitoneal bladder rupture in a mouse model. Pelvic and liver MRI were obtained using a 7T micro-MRI scanner in 8-to-10-week-old female ICR mice (n = 28) before and after surgically induced bladder rupture. An angio-catheter was inserted into the urethra for intra-vesical injection of gadoxetic acid (0.3 mmol/kg) during MRI. Intraperitoneal contrast leakage and liver enhancement were assessed using T1 weighted images. Regions of interest were drawn on the liver and muscle (used as an internal reference) to measure signal intensity, which was then used to calculate the relative enhancement ratio and quantify the degree of liver enhancement. A paired t-test was used for statistical analysis. Intraperitoneal contrast leakage and liver enhancement were detected in all mice after bladder rupture. Some liver enhancement occurred in baseline mice but was significantly stronger under bladder rupture conditions at 30min (P < 0.001) and 75min (P < 0.001) post-enhancement MRI. MRI with intra-vesical gadoxetic acid injection enables detection of intraperitoneal bladder rupture by visualizing contrast leakage or selective liver enhancement. Retrograde MR cystography may serve as an iodine-free alternative to conventional retrograde cystography.

This study investigated pelvic floor anatomical variations impacting urinary continence in boys with epispadias. Preoperative pelvic floor MRI assessed 12 anatomical parameters in 16 boys. Long-term urinary continence outcomes categorized patients into continent (n = 12, median age 57.0 months) and incontinent (n = 4, median age 50.0 months) groups, with no significant age difference. The pubic diastasis was significantly wider in incontinent group (19.03 ± 11.14 mm vs. 5.04 ± 3.22 mm; p = 0.001); posterior anal distance (19.75 ± 1.94 mm vs. 14.64 ± 4.57 mm; p = 0.051) and posterior bladder neck distance (33.35 ± 2.58 mm vs. 29.13 ± 4.23 mm; p = 0.084) showed trends to increase. Binary logistic regression identified pubic diastasis as an independent risk factor for urinary incontinence (OR 1.292, 95% CI 1.005–1.663; p = 0.046). The findings indicate that wider pubic diastasis significantly increases urinary incontinence risk in epispadias. The greater posterior distances and puborectal angle observed in the incontinent group suggest that more levator ani muscle are distributed behind the anorectal canal, potentially contributing to urinary incontinence.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-18136-1.

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is an autosomal dominant disorder caused by germline fumarate hydratase (FH) pathogenic variants (PVs), characterized by cutaneous leiomyomas, early-onset uterine leiomyomas, and aggressive papillary renal cell carcinoma. While FH-deficient (FH-d) uterine leiomyomas have been proposed as a screening tool for identifying patients, prospective studies remain limited. Over a 6-yr study period, 1838 uterine smooth muscle tumors (uSMTs) were evaluated at our institution and prospectively screened for FH-d morphologic features. Seventy-one tumors (3.9%) showed features suggestive of FH-deficiency, prompting FH immunohistochemistry (IHC), which confirmed FH loss in 41 cases (58%). Among 41 patients with FH-d tumors, the median patient age was 43yr, and most underwent hysterectomy for symptomatic leiomyomas, abnormal vaginal bleeding, or pelvic pain. Thirty-six patients (88%) had 2 or more leiomyomas, while 5 had a single tumor. The cohort included 39 FH-d leiomyomas, 1 uterine smooth muscle tumor of uncertain malignant potential (STUMP), and 1 FH-d adenomyoma, a previously unreported entity. Genetic counseling was offered to 36 of 41 (88%) patients. Fifteen patients declined testing or did not follow up with the genetic counseling appointment. Among 19 patients tested for FH and other hereditary cancer-related genes, 5 (26%) had FH germline pathogenic mutations, and 1 patient had a variant of unknown significance. Pelvic MRI in mutation carriers showed no abnormalities. In conclusion, FH-d uSMTs represented 2.2% of all uSMTs in our series. A combined morphologic and IHC screening approach can effectively identify patients at risk for HLRCC, facilitating genetic counseling and family screening.

Pregnancy is associated with the presence of bone marrow edema (BME) in the sacroiliac joints during the postpartum period. The aim of this study is to evaluate the frequency and localization of sacroiliac joint edema during pregnancy. This retrospective, monocentric study included pregnant women who underwent pelvic MRI for any reason during their pregnancy. Women with a history of chronic inflammatory rheumatic diseases and minors were excluded. Two experienced readers independently evaluated the presence of bone marrow edema (BME) using a two-plane assessment method: axial and semi-coronal oblique views. Each sacroiliac joint was divided into four quadrants per slice and the presence of deep lesion was also scored. We included 28 women with a median age of 30.0 [27.0-33.0] years and a median gestational age of 27.5 [25.5-32.0] weeks of amenorrhea. Ten women (36%) presented with at least one BME in a sacroiliac joint, and 3 of these women had bilateral sacroiliac joint BME. BME was observed in 12 of 13 cases (92%) in the lower part of the sacroiliac joint. In 8 cases (66%), the edema was present on both the iliac and sacral sides, in 1 case (8%) only on the iliac side, and in 4 cases (33%) only on the sacral side. There were no correlation between gestational age and the presence of BME. BME in the sacroiliac joint is common during pregnancy and is typically located in the anterior and inferior parts of the joint, similar to the postpartum period.

The aim of this study was to summarize and analyze the incidence, underlying causes and related risk factors of misdiagnosis in patients with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. This is a single center, retrospective study conducted in a tertiary hospital, enrolling patients diagnosed with OHVIRA syndrome in our center between January 2000 and December 2023, with intact charts retrieved. We collected information related to misdiagnosis. The main outcome was the incidence of misdiagnosis in OHVIRA patients. Misdiagnosis related information, including the primary diagnosis and following management were displayed. We also analyzed the potential risk factors of misdiagnosis in OHVIRA patients by logistic regression. Among 164 cases enrolled, 27 (16.5%) patients had experienced misdiagnosis. The most frequent primary misdiagnoses were pelvic abscess (8/27, 29.6%) and ovarian cyst (7/27, 25.9%). Complicating with pelvic endometriosis was the potential risk factor of misdiagnosis (OR 3.267, 95% CI 1.010-10.660). Presenting with irregular bleeding (OR 0.193, 95%CI 0.047-0.800) and performing pelvic MRI prior to diagnosis (OR 0.157, 95% CI 0.050-0.486) were potential protective factors for misdiagnosis in patients with OHVIRA syndrome. Misdiagnosis is not uncommon in patients with OHVIRA syndrome. Alerting to related symptoms and optimizing various imaging modalities can effectively reduce the risk of misdiagnosis.