Journal Highlights

The following are highlights from current issues of RSNA’s two peer-reviewed journals.

The Added Role of MR Imaging in Treatment Stratification of Patients with Gynecologic Malignancies: What the Radiologist Needs to Know

In patients with gynecologic malignancies, MR imaging plays an important role in the journey from initial evaluation of the extent of the disease to appropriate treatment selection and follow-up.

In a State-of-the-Art article in the March issue of Radiology (RSNA.org/Radiology), Evis Sala, M.D., Ph.D., of the Addenbrooke Hospital and University of Cambridge, England, and colleagues highlight the added role MR imaging plays in treatment stratification and overall care of patients with endometrial, cervical or ovarian cancer. The authors specifically describe MR imaging techniques used in evaluation of these patients, including:

• Anatomic MR imaging sequences (T1- and T2-weighted sequences)
• Pulse sequences that characterize tissue on the basis of physiologic features (diffusion-weighted MR imaging)
• Dynamic contrast agent-enhanced MR imaging
• MR spectroscopy

MR imaging findings corresponding to the 2009 revised International Federation of Gynecology and Obstetrics staging of gynecologic malignancies are also described in detail, highlighting possible pearls and pitfalls of staging. “Advances in MR imaging techniques, along with the growing role of the radiologist as part of a multidisciplinary treatment-planning team, have become central in tailoring treatment options and frequently lead to modifications in the therapeutic approach in patients with gynecologic malignancies,” the authors write.

Ovarian torsion secondary to serous cystadenoma in a 37-year-old woman. Coronal single-shot T2-weighted MR images demonstrate a large, complex cyst in the RUQ (arrow). The cyst arises from an enlarged, edematous right ovary (arrowhead) with small peripheral follicles. Note that the enlarged, fibroid uterus has pushed the right ovary into the upper abdomen, making this case potentially difficult to diagnose at pelvic US. Results of surgical exploration confirmed a twisted right ovary secondary to a large ovarian serous cystadenoma. (RadioGraphics 2013;InPress) ©RSNA, 2013. All rights reserved. Printed with permission.

MR Imaging for Acute Nontraumatic Abdominopelvic Pain: Practical, Methodologic, and Interpretive Considerations

While MR imaging holds promise as an alternative to evaluate acute abdominopelvic pain, current understanding of its diagnostic utility warrants continued study and increased use in the evaluation of emergency department (ED) patients with this condition.

In an article in the March-April issue of RadioGraphics (RSNA.org/RadioGraphics), Michael Lubarsky, M.D., of the Emory University School of Medicine, and colleagues discuss MR imaging of abdominopelvic pain in the ED in terms of rationale, imaging techniques, clinical applications, evolving indications and limitations. Specifically, the authors discuss:

• Use of different MR imaging sequences in the ED
• Importance of T2-weighted imaging with optimal fat suppression for the evaluation of ED patients with abdominopelvic pain
• MR imaging appearance of various abdominal and pelvic disease processes encountered in the ED

Accurate non-radiation-based techniques would be helpful in providing alternatives to CT, especially in younger patients or in patients who require repeated imaging, according to the authors. “MR imaging can provide rapid assessment of nearly all causes of acute abdominopelvic pain, plays an evolving role in the evaluation of vascular disease and right upper quadrant pain, and may be the optimal diagnostic test for many of these disease processes,” the authors write.