Pelvic Station Research Articles

The performance of the node reporting and data system 1.0 (Node-RADS) and DWI–MRI in staging patients with cervical carcinoma according to the new FIGO classification (2018)

PurposeTo evaluate the diagnostic accuracy of the Node-RADS score and the utility of apparent diffusion coefficient (ADC) values in predicting metastatic lymph nodes (LNs) involvement in cervical cancer (CC) patients using magnetic resonance imaging (MRI). The applicability of the Node RADS score across three readers with different years of experience in pelvic imaging was also assessed.Material and methodsAmong 140 patients, 68 underwent staging MRI, neoadjuvant chemotherapy and radical surgery, forming the study cohort. Node-RADS scores of the main pelvic stations were retrospectively determined to assess LN metastatic likelihood and compared with the histological findings. Mean ADC, relative ADC (rADC), and correct ADC (cADC) values of LNs classified as Node-RADS ≥ 3 were measured and compared with histological reports, considered as gold standard.ResultsSensitivity, specificity, positive and negative predictive values (PPVs and NPVs), and accuracy were calculated for different Node-RADS thresholds. Node RADS ≥ 3 showed a sensitivity of 92.8% and specificity of 72.5%. Node RADS ≥ 4 yielded a sensitivity of 71.4% and specificity of 100%, while Node RADS 5 yielded 42.9% and 100%, respectively. The diagnostic performance of mean ADC, cADC and rADC values from 78 LNs with Node-RADS score ≥ 3 was assessed, with ADC demonstrating the highest area under the curve (AUC 0.820), compared to cADC and rADC values.ConclusionThe Node-RADS score provides a standardized LNs assessment, enhancing diagnostic accuracy in CC patients. Its ease of use and high inter-observer concordance support its clinical utility. ADC measurement of LNs shows promise as an additional tool for optimizing patient diagnostic evaluation.

A Case of Extrapulmonary Tuberculosis

A 21 years old man immigrant from Nigeria came to our observation for swelling of the chest wall and fever. The laboratory tests showed neutrophilic leukocytosis and absence of HIV / others viruses’ infection. Chest X-ray was not conclusive. An abdomen echography showed diffuse lymphadenopathy. In the suspicion of a lymphoproliferative disease we performed a total body CT, that detected colliquated lymph nodes in the later cervical, abdominal and pelvic stations; at the left pectoral region there was an abscess collection (58x54mm) crossing the intercostal spaces until to the anterior pleura (Figure 1). Echocardiography showed mild pericardial effusion. The thoracic abscess was drained and a sample of PCR for Mycobacterium tuberculosis was positive. We started therapy with rifampicin, isoniazid, pyrazinamide, ethambutol and methyl prednisone, waiting for cultural examination The patient was discharged in good clinical status with diagnosis of disseminated lymph node tuberculosis (LNTB) fistulized to the chest wall abscess and he was referred to specialist follow-up

A Case of Extrapulmonary Tuberculosis

A 21 years old man immigrant from Nigeria came to our observation for swelling of the chest wall and fever. The laboratory tests showed neutrophilic leukocytosis and absence of HIV / others viruses’ infection. Chest X-ray was not conclusive. An abdomen echography showed diffuse lymphadenopathy. In the suspicion of a lymphoproliferative disease we performed a total body CT, that detected colliquated lymph nodes in the later cervical, abdominal and pelvic stations; at the left pectoral region there was an abscess collection (58x54mm) crossing the intercostal spaces until to the anterior pleura (Figure 1).

Measurement Repeatability of 18F-FDG PET/CT Versus 18F-FDG PET/MRI in Solid Tumors of the Pelvis

Knowledge of the within-subject variability of 18F-FDG PET/MRI measurements is necessary for proper interpretation of quantitative PET or MRI metrics in the context of therapeutic efficacy assessments with integrated PET/MRI scanners. The goal of this study was to determine the test–retest repeatability of these metrics on PET/MRI, with comparison to similar metrics acquired by PET/CT. Methods: This prospective study enrolled subjects with pathology-proven pelvic malignancies. Baseline imaging consisted of PET/CT immediately followed by PET/MRI, using a single 370-MBq 18F-FDG dose. Repeat imaging was performed within 7 d using an identical imaging protocol, with no oncologic therapy between sessions. PET imaging on both scanners consisted of a list-mode acquisition at a single pelvic station. The MRI consisted of 2-point Dixon imaging for attenuation correction, standard sequences for anatomic correlation, and diffusion-weighted imaging. PET data were statically reconstructed using various frame durations and minimizing uptake time differences between sessions. SUV metrics were extracted for both PET/CT and PET/MRI in each imaging session. Apparent diffusion coefficient (ADC) metrics were extracted for both PET/MRI sessions. Results: The study cohort consisted of 14 subjects (13 female, 1 male) with various pelvic cancers (11 cervical, 2 rectal, 1 endometrial). For SUVmax, the within-subject coefficient of variation (wCV) appeared higher for PET/CT (8.5%–12.8%) than PET/MRI (6.6%–8.7%) across all PET reconstructions, though with no significant repeatability differences (all P values ≥ 0.08) between modalities. For lean body mass-adjusted SUVpeak, the wCVs appeared similar for PET/CT (9.9%–11.5%) and PET/MRI (9.2%–11.3%) across all PET reconstructions, again with no significant repeatability differences (all P values ≥ 0.14) between modalities. For PET/MRI, the wCV for ADCmedian of 3.5% appeared lower than the wCVs for SUVmax (6.6%–8.7%) and SULpeak (9.2%–11.3%), though without significant repeatability differences (all P values ≥ 0.23). Conclusion: For solid tumors of the pelvis, the repeatability of the evaluated SUV and ADC metrics on 18F-FDG PET/MRI is both acceptably high and similar to previously published values for 18F-FDG PET/CT and MRI, supporting the use of 18F-FDG PET/MRI for quantitative oncologic treatment response assessments.

Perinatal and Maternal Morbidity and Mortality Among Term Singletons Following Midcavity Operative Vaginal Delivery Versus Cesarean Delivery

(BJOG. 2018;125:693–702) Recently, to reduce the cesarean delivery rate, the use of operative vaginal delivery has been advocated by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. There is uncertainty, however, in the balance of risks and benefits between cesarean delivery and operative vaginal delivery. Previous research has lacked information on pelvic station, a measure of the descent of the fetal head with respect to the maternal ischial spines. Operating at the midcavity station requires the greatest skill compared with outlet or lowcavity forceps procedures. This study aimed to quantify the effect of operative vaginal delivery at midcavity station on maternal and perinatal mortality and morbidity compared with cesarean delivery.

Morbidity and Mortality Associated With Forceps and Vacuum Delivery at Outlet, Low, and Midpelvic Station

ObjectiveThis study sought to quantify perinatal and maternal morbidity and mortality associated with forceps and vacuum delivery compared with Caesarean delivery in the second stage of labour and to estimate whether these associations differed by pelvic station. MethodsThe investigators conducted a population-based, retrospective cohort study of term singleton deliveries by operative delivery with prolonged second stage of labour in Canada (2003-2013) using national hospitalization data. The primary study outcomes were severe perinatal morbidity and mortality (i.e., seizures, assisted ventilation, severe birth trauma, and perinatal death) and severe maternal morbidity and mortality (i.e., severe postpartum hemorrhage, cardiac complication, and maternal death). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) after stratifying by indication (dystocia or fetal distress). The Breslow-Day chi-square test for heterogeneity in ORs was used to test effect modification by pelvic station (outlet, low, or midpelvic). ResultsThere were 61 106 deliveries included in the study. Among women with dystocia, forceps and vacuum deliveries were associated with higher rates of perinatal morbidity and mortality compared with Caesarean delivery (forceps: aOR 1.56; 95% CI 1.13–2.17; vacuum: aOR 1.44; 95% CI 1.06–1.97). Vacuum delivery was associated with lower rates of maternal morbidity and mortality compared with Caesarean delivery (dystocia: aOR 0.64; 95% CI 0.51–0.81; fetal distress: aOR 0.43; 95% CI 0.32–0.57). Pelvic station did not significantly modify the associations between forceps or vacuum and perinatal or maternal morbidity and mortality. ConclusionForceps and vacuum delivery is associated with increased rates of severe perinatal morbidity and mortality compared with Caesarean delivery among women with dystocia, whereas vacuum delivery is associated with decreased rates of severe maternal morbidity and mortality.

CT of suspected thoracic acute aortic injury in the emergency department: is routine abdominopelvic imaging worth the additional collective radiation dose?

This study aimed to determine the incidence of non-traumatic acute aortic injury (AAI) extending from the chest into the abdomen or pelvis in emergency department (ED) patients with acute aortic syndrome (AAS), to estimate the effective dose of the abdominopelvic portion of these CT exams, and to compare the number needed to screen (NNS) with the collective population radiation dose of imaging those stations. All patients (n=238) presenting to the ED with AAS between March 2014 and June 2015 who were imaged per CT AAI protocol (noncontrast and contrast-enhanced CT angiography of the chest, abdomen, and pelvis) were retrospectively identified in this IRB-approved HIPAA-compliant study. The Stanford classification for positive cases of AAI was further subclassified based on chest, abdominal, or pelvic involvement. The dose length product (DLP) of each exam was used to estimate the dose of the abdominal and pelvic stations and the collective effective dose for the population. There were five cases of aortic dissection (AD) and two of intramural hematoma (IMH), with an AAI incidence of 2.9/100. Three cases of AAI were confined to the chest. Two cases of AAI were confined to the chest and abdomen, and two cases involved the chest, abdomen, and pelvis. There was only one case of AAI involving the ascending aorta that extended into the abdomen or pelvis. The number needed to screen to identify (a) AAI extending from the chest into the abdomen or pelvis was 59.5 and (b) Stanford A AAI extending into the abdomen or pelvis was 238. The estimated mean effective dose for the abdominopelvic stations were unenhanced abdomen 2.3mSv, unenhanced pelvis 3.3mSv, abdominal CTA 2.5mSv, and pelvic CTA 3.6mSv. The collective effective doses to the abdomen and pelvis with unenhanced CT and CTA in 59.5 patients and 238 patients were 761.6 and 3046.4mSv, respectively. While the estimated mean effective dose for imaging of the abdominopelvic stations are low, the collective effective dose should also be considered. It may be beneficial to modify or omit routine unenhanced CT and/or CTA of the abdomen/pelvis in this patient population in the absence of abdominal symptoms, and image the abdomen and pelvis in positive thoracic cases only.

Temporal and Regional Variations in Operative Vaginal Delivery in Canada by Pelvic Station, 2004-2012.

To describe temporal and regional variations in Canada in the use of operative vaginal delivery (OVD) at term for singleton pregnancies by pelvic station between 2004 and2013. Rates of OVD among term singleton pregnancies in Canada (excluding Quebec) were estimated using information from the Discharge Abstract Database of the Canadian Institute for Health Information for the years 2004-2012 (n= 2 284 109). Deliveries were stratified by pelvic station. Temporal trends were assessed using the Cochran-Armitage test for linear trend in proportions byyear. Geographic variation was assessed by calculating the rateand 95% confidence interval of each mode of delivery from 2010-2012 for each province and territory. Among singleton pregnancies at term, the OVD rate decreased from 12.0% in 2004 to 10.7% in 2012 (P < 0.001), whereas Caesarean section rates (excluding those following failed OVDs) increased from 24.9% to 26.7%. Forceps deliveries decreased from 3.1% to 2.5%, primarily due to decreases in midpelvic forceps delivery. Vacuum-assisted delivery increased significantly at outlet and low stations (by 26.0% and 15.1%, respectively) and remained stable at midpelvic station. The failed OVD rate was 0.3% and decreased by 23.7% (P < 0.001). There were large variations in OVD rates by province. Temporal trends in OVD rates varied by pelvic station, with rates of outlet and low OVD increasing and rates of midpelvic and failed OVD decreasing. Vacuum extraction is increasingly replacing forceps deliveries at outlet and low stations, whereas Caesarean sections are replacing forceps deliveries at midpelvic stations. Variations in OVD rates across provinces suggest differences in instrument preference and/or an evolution in standards of practice.

Comparison of non-contrast fresh blood imaging and quiescent inflow single-shot imaging at abdominal/pelvic station at 3T

Background Despite increasing application of non-contrast techniques Fresh Blood Imaging (FBI) and Quiescent Inflow Single-Shot (QISS) in the evaluation of peripheral arterial disease (PAD), imaging of abdominal/pelvic station remains a challenge. B0 and B1 inhomogeneity, motion artefacts and poor ECG trigger may diminish the image quality and reduce the diagnostic performance. In this study, we intend to compare the performance of the two non-contrast MRA techniques at the pelvic station at 3T and evaluate their MRA image quality.

Fetal head position during the second stage of labor: Comparison of digital vaginal examination and transabdominal ultrasonographic examination

Objective To study the correlation between digital vaginal and transabdominal ultrasonographic examination of the fetal head position during the second stage of labor. Methods Patients ( n = 110) carrying a singleton fetus in a vertex position were included. Every patient had ruptured membranes and a fully dilated cervix. Transvaginal examination was randomly performed either by a senior resident or an attending consultant. Immediately afterwards, transabdominal ultrasonography was performed by the same sonographer (OD). Both examiners were blind to each other's results. Sample size was determined by power analysis. Confidence intervals around observed rates were compared using chi-square analysis and Cohen's Kappa test. Logistic regression analysis was performed. Results In 70% of cases, both clinical and ultrasound examinations indicated the same position of the fetal head (95% confidence interval, 66–78). Agreement between the two methods reached 80% (95% CI, 71.3–87) when allowing a difference of up to 45° in the head rotation. Logistic regression analysis revealed that gestational age, parity, birth weight, pelvic station and examiner's experience did not significantly affect the accuracy of the examination. Caput succedaneum tended to diminish ( p = 0.09) the accuracy of clinical examination. The type of fetal head position significantly affected the results. Occiput posterior and transverse head locations were associated with a significantly higher rate of clinical error ( p = 0.001). Conclusion In 20% of the cases, ultrasonographic and clinical results differed significantly (i.e., >45°). This rate reached 50% for occiput posterior and transverse locations. Transabdominal ultrasonography is a simple, quick and efficient way of increasing the accuracy of the assessment of fetal head position during the second stage of labor.