Magnetic resonance imaging (MRI) in the diagnosis of recurrences of ovarian cancer in the small pelvis

The paper provides the results of small pelvic magnetic resonance tomography (MRI) in 62 patients with ovarian cancer after primary special treatment. Out of them 50 patients were found to have recurrences and metastases of the underlying disease, 12 patients had clinical remission. The study yielded MR signs and MR semiotics of recurrences of ovarian cancer in the small pelvis. The capacities of MRI with low and high intensities of a magnetic field were comparatively studied in the diagnosis of recurrences and metastases of ovarian cancer.     

Magnetic resonance imaging in the diagnosis of different forms of endometriosis

The present paper examines the capacities of non-invasive MRI in the diagnosis of endometriosis. A standardized study algorithm is proposed, indications and methodology for MRI in different forms of endometriosis (EM) are specified. It is shown that in the diagnosis of different types of EM there are specific changes in the MR pattern of small pelvic organs, which allow one to make a differential diagnosis of this disease with a higher sensitivity (96%) and specificity (87%) as compared with ultrasound study. MRI makes it possible to assess the degree of invasion of endometrioid heterotopies into the wall of the intestine and cervix uteri with a high degree of accuracy and to judge the degree and extent of intestinal luminal narrowing. Diagnostic errors in solving these problems (as well as those associated with the detection of extragenital foci of EM in the small pelvis) are due first of all to movement artefacts a (respiration and intestinal motility) particularly in the presence of a significant adhesive process and/or after surgical intervention. MRI does not virtually yield false-negative conclusions in the diagnosis of different forms of genital endometriosis (less than 3%), which, in the authors' opinion, rather justifies some hyperdiagnosis (about 11%) made by this method in the diagnosis of endometriosis of the rectovaginal septum. MRI is a closing, specifying stage of instrumental diagnosis of not only EM, but also other small pelvic diseases.     

Distribution of neurons in the major pelvic ganglion of the rat which supply the bladder,colon or penis

Summary In male rats a large number of the postganglionic neurons which innervate the pelvic organs are located in the major pelvic ganglion. In the present study we have identified the location within this ganglion of neurons which project to either of three pelvic organs, the penis, colon or urinary bladder. Two fluorescent retrogradely-transported dyes, Fast Blue and Fluoro-Gold, were used. For most animals one dye was injected into the cavernous space of the penis, the wall of the distal colon or the wall of the urinary bladder. In a small number of animals two organs were injected, each with a different dye. One to six weeks after injection the major pelvic ganglia were fixed in buffered formaldehyde. The distribution of fluorescent dye-labelled cells was observed in whole mounts of complete ganglia and, in most cases, also in small accessory ganglia located between the ureter and the prostate. The studies showed a unique pattern of distribution for each organ-specific group of neurons. Most of the colon neurons are located in the major pelvic ganglion near the entrance of the pelvic nerve, whereas almost all of the penis neurons are near or within the penile nerve. Bladder neurons are relatively evenly distributed throughout the ganglion. These results demonstrate a distinct topographical organization of organ-specific neurons of the major pelvic ganglion of the male rat, a phenomenon which has also been observed in other peripheral ganglia.     

Cross-sectional anatomy of miniature "Shiba" goat]

The anatomical relations of visceral organs and other tissues in the thoracic, abdominal and pelvic cavities of the male miniature "Shiba" goat are illustrated as thirteen semi-diagramatic representations of cross sections.     

Lymphoprostatic scintigraphy in regional lymphatic mapping in patients with prostate cancer

The purpose of the investigation was to upgrade the diagnosis quality for metastatic lesion to the regional lymp nodes in prostate cancer. The results of the most widely used diagnostic techniques (computed tomography (CT), magnetic resonance Imaging, (MRI), radionuclide studies (RNS), and ultrasonography (USG)), which had been compared with those of histology of removed lymph nodes, were assessed. For this, 74 patients with prostate cancer were comprehensively examined and treated at the Central Research X-ray Radiolological Institute. The comparative assessment of radiodiagnostic techniques (USG, CT, MRI, and RNS) showed the high informative value of retroperitoneal lymph nodal MRI in the detection of structural-and-morphological and anatomic-and-topographic changes in the lymph nodes (87.5% sensitivity, 83.3% specificity, and 85.7% accuracy). The developed lymphoprostatic scintigraphy (LPSG) is an informative technique that allows the better diagnosis of prostate metastases to the regional lymph nodes (92.4% sensitivity, 91.7% specificity, and 92.1% accuracy; the prognostic value of a positive result is 90.7%). LPSG is superior in its informative value to small pelvic USG and CT and inferior to indirect lymphoscintigraphy and yields valuable additional information on the physiological function of the small pelvic lymphatic collector.     

Filling of the lower segment of the large intestine with fluid to facilitate ultrasonic examination in diseases of the small pelvis]

Small pelvis space is difficult to examine ultrasonographically as several important organs are localized in relatively small area. The most difficult is the interpretation of the standard USG examination of the abdomen in case of pathologies of the end of large intestine, when filled with feces. In such cases repeated ultrasonographic examination is recommended. Authors propose, that this segment of the colon should previously be filled with fluid. Such a technique improves the level of diagnosis or exclusion of any pathology. Forty two patients were examined with the above technique. Authors think, that it is a progress in ultrasonography of pelvic organs.     

Combination of a model-deformation method and a positional MRI to quantify the effects of posture on the anatomical structures of the trunk

Understanding the postural effects on organs and skeleton could be crucial for several applications. This paper reports on a methodology to quantify the three-dimensional effects of postures on deformable anatomical structures. A positional MRI scanner was used to image the full trunk in four postures: supine, standing, seated and forward-flexed. The MRI stacks were processed with a custom toolbox, implemented using open source software. The semi-automated segmentation was based on the deformation of generic models of the pelvis, sternum, femoral heads, spine, liver, kidneys, spleen, skin, thoracic and abdominal cavities. The toolbox was designed to be easily extended by additional image filters, deformation schemes, or new generic models. Results obtained on one subject demonstrate that the method can be used to quantify the effects of postures on skeleton and organs. The spinal curvature, the pelvic parameters and the volume of the thoracic cavity were affected by the four postures. The volumes of the kidneys, spleen, liver and abdominal object were mostly unaffected. The movement of organs was coherent with the effect of gravity. The deformation of organs between postures was expressed using geometrical transformations. Investigations should be pursued on a larger population to confirm the patterns observed on the first subject.     

Modeling the contraction of the pelvic floor muscles

We performed numerical simulation of voluntary contraction of the pelvic floor muscles to evaluate the resulting displacements of the organs and muscles. Structures were segmented in Magnetic Resonance (MR) images. Different material properties and constitutive models were attributed. The Finite Element Method was applied, and displacements were compared with dynamic MRI findings. Numerical simulation showed muscle magnitude displacement ranging from 0 to 7.9 mm, more evident in the posterior area. Accordingly, the anorectum moved more than the uterus and bladder. Dynamic MRI showed less 0.2 mm and 4.1 mm muscle dislocation in the anterior and cranial directions, respectively. Applications of this model include evaluating muscle impairment, subject-specific mesh implant planning, or effectiveness of rehabilitation.     

Prediction of Nodal Involvement in Primary Rectal Carcinoma without Invasion to Pelvic Structures: Accuracy of Preoperative CT,MR, and DWIBS Assessments Relative to Histopathologic Findings

Objective

To investigate the accuracy of preoperative computed tomography (CT), magnetic resonance (MR) imaging and diffusion-weighted imaging with background body signal suppression (DWIBS) in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures.

Methods and Materials

Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS) were compared with the final histological findings.

Results

The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01) but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05). The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria.

Conclusion

MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.     

猕猴腹部及盆腔结构的CT影像学观察

目的应用CT技术对成年猕猴进行断层扫描,建立猕猴腹部及盆腔CT断层扫描图谱。方法选择普通级实验猕猴6只,雌雄各半,年龄5～8岁,取头前尾后仰卧位,采用增强扫描CT技术,对其腹部及盆腔进行断层扫描,采集容积数据及对原始数据重建。通过观察、确认,精选具有解剖意义的扫描图像:腹部7张、盆腔10张(雌雄各5张),对其每个层面的主要脏器进行标注。结果 CT影像能分辨出大部分组织器官的细微变化,较大器官、大血管界面清晰,但较小器官和细小血管、神经、肌肉组织等界面尚不清晰。结论获得了健康成年猕猴腹部及盆腔的影像学图谱,为CT技术在猕猴影像学研究、疾病的临床诊断及科学实验方面的应用,提供影像学的基础资料。     

Construction of digital three-dimensional reconstruction model of rabbit vascular network

In order to study the construction of digital three-dimensional model of rabbit vascular network and provide a powerful basis for the model construction and image processing of human vascular network, in this study, rabbit abdominal and pelvic vessels are perfused with latex-bismuth oxide contrast agent. After that, the internal fibrous structure of the abdominal and pelvic vascular network in rabbits is studied by micro-computed tomography (Micro-CT). Angiography and post-processing software are performed. Firstly, six female rabbits are selected as the study subjects and are anesthetized by intraperitoneal injection of 12% chloral hydrate. After complete anesthesia, laparotomy is performed on the rabbits. The abdominal wall of the rabbit is cut longitudinally to expose the pelvic and abdominal cavity completely. The posterior peritoneum is found and opened. The catheter is inserted into the abdominal aorta and renal artery to complete the abdominal aorta and arterial intubation. Latex, bismuth oxide and potassium hydroxide are mixed in a ratio of 1:1:1 to form latex-bismuth oxide mixed solution as a mixed contrast agent for blood vessel perfusion. After the rabbit is perfused with mixed contrast medium, four organs, including bladder, uterus, small intestine and kidney, are selected as the research organs to construct the three-dimensional model of vascular network in this study. Finally, the above organs are scanned in vitro by micro-CT technology, and the original images of each organ are processed. Then, Mimics 17.0 software is used to build a digital three-dimensional model of the abdominal and pelvic vascular network in rabbits, obtain the information parameters of each network, and analyze the classification and diameter of blood vessels. The results show that the classification of bladder vascular network can only be divided into two levels, uterine vascular network can be divided into three levels, and small intestine and kidney vascular network can be divided into four levels. Therefore, the combination of micro-CT scanning and contrast agent can successfully construct a digital three-dimensional model of rabbit vascular network, which provides a new idea and method for the study of human abdominal and pelvic organs and physiological characteristics.     

Measurement of tumour volume by MRI to evaluate risk of pelvic nodal metastases in early cervical carcinoma patients

BackgroundApart from the FIGO staging system there are several other factors, including tumour volume and lymph node status, which considerably influence local tumour control and survival of cervical carcinoma patients.AimThe study aimed to determine the prognostic value of cervical tumour volume measured on the basis of MRI in terms of pelvic nodal metastases prediction in early cervical carcinoma patients.MethodsThe records of 49 early stage cervical carcinoma patients treated with preoperative brachytherapy and radical hysterectomy were analyzed. All patients underwent diagnostic MRI, which was the basis for tumour volume calculations as well as the evaluation of pelvic lymph nodes status and parametrial invasion. In each case the postoperative pathological diagnosis was obtained. The correlation between the occurrence of nodal metastases and such variables as tumour histology, grade and tumour volume, FIGOMRI stage IIB, and patients' age was evaluated. Logistic regression analysis was employed to determine correlations between tumour volume and histological pelvic nodal involvement.ResultsA statistically significant correlation between pelvic lymph node involvement and such parameters as tumour volume and parametrial invasion was proven. The probability of lymph node metastasis is 20% for tumour volume of 17 cm³ and increases up to 50% for tumour volume of 40 cm³. An increase of tumour volume by 1 cm³ increased the risk of lymph node disease by 6.2%.ConclusionsThe study demonstrates that tumour volume may be considered a predicting factor in early cervical carcinoma patients, since it strongly correlates with pelvic lymph node histological status.     

Location of radiosensitive organs inside pediatric anthropomorphic phantoms: Data required for dosimetry

PurposeThe aim of this study was to determine the location of radiosensitive organs in the interior of four pediatric anthropomorphic phantoms for dosimetric purposes.MethodsFour pediatric anthropomorphic phantoms representing the average individual as newborn, 1-year-old, 5-year-old and 10-year-old child underwent head, thorax and abdomen CT scans. CT and MRI scans of all children aged 0–16 years performed during a 5-year-period in our hospital were reviewed, and 503 were found to be eligible for normal anatomy. Anterior-posterior and lateral dimensions of twelve of the above children closely matched that of the phantoms' head, thoracic and abdominal region in each four phantoms. The mid-sagittal and mid–coronal planes were drawn on selected matching axial images of patients and phantoms. Multiple points outlining large radiosensitive organs in patient images were identified at each slice level and their orthogonal distances from the mid-sagittal and mid–coronal planes were measured. In small organs, the coordinates of organs' centers were similarly determined. The outlines and centers of all radiosensitive organs were reproduced using the coordinates of each organ on corresponding phantoms’ transverse images.ResultsThe locations of the following radiosensitive organs in the interior of the four phantoms was determined: brain, eye lenses, salivary glands, thyroid, lungs, heart, thymus, esophagus, breasts, adrenals, liver, spleen, kidneys, stomach, gallbladder, small bowel, pancreas, colon, ovaries, bladder, prostate, uterus and rectum.ConclusionsThe production of charts of radiosensitive organs inside pediatric anthropomorphic phantoms was feasible and may provide users reliable data for positioning of dosimeters during direct organ dose measurements.     

Growth of the fetus in the abdominal cavity

The ratio pelvic/abdominal cavity is 6.9% in samples of nonhuman mammals and nonhuman primates, and rises to approximately 30% in humans. This relative reduction of the abdomen and increase of the pelvis is associated with a partial or total shift of some organs from the abdomen to the pelvis: rectosigmoid colon, bladder, and genital organs, which are mostly abdominal in quadrupeds and are mostly pelvic in humans. Pregnancy, always abdominal in nonhumans, is pelvic during the first trimester and becomes abdominal later on in humans. Near term the pregnancy expands easily in nonhumans in view of relatively small fetus and relatively large abdominal cavity. But, for the opposite reasons (large fetus, small abdomen), the human pregnancy is limited space-wise during its abdominal expansion. Unlike that of nonhumans, human pregnancy is faced with multiple problems. These include: 1) “squeezing” between the anterior abdominal wall and the lordosis of the lumbar spine; 2) compression of the aortocaval vessels; and 3) forward expansion of the abdomen resulting in reorientation of the trunk during erect posture as the pregnant woman approaches term. All these conditions are responsible for numerous pathological entities that occur during human pregnancy and are almost unknown in nonhuman mammals. © 1993 Wiley-Liss, Inc.     

实时三维盆底超声对产后压力性尿失禁患者疗效评估作用及与尿动力学的相关性分析

摘要 目的：探讨实时三维盆底超声对产后压力性尿失禁（SUI）患者疗效评估作用及与尿动力学的相关性。方法：选择2020年4月至2022年12月石家庄市人民医院收治的139例产后SUI患者,均接受盆底生物反馈电刺激联合盆底肌锻炼治疗。治疗前后分别进行实时三维盆底超声检查和尿动力学检查。比较治疗前后实时三维盆底超声参数、尿动力学指标差异。Pearson法分析实时三维盆底超声参数与尿动力学指标的相关性。结果：实时三维盆底超声图像特征显示：治疗前盆膈裂孔内的结构疏松,回声变弱,盆腔器官结缔组织疏松,间隙增宽,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较大;治疗后盆膈裂孔两侧耻骨直肠肌对称,耻骨内脏肌呈带状高回声,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较治疗前降低。产后SUI患者治疗后静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度均较治疗前降低（P＜0.05）,腹压漏尿点压、最大逼尿肌压力均较治疗前增加（P＜0.05）。产后SUI患者静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度与最大逼尿肌压力、腹压漏尿点压呈负相关（P＜0.05）,与最大膀胱容量和残余尿量无关（P＞0.05）。结论：产后SUI患者经盆底生物反馈电刺激联合盆底肌锻炼治疗后实时三维盆底超声参数较治疗前降低,与尿动力学改善有关。临床可通过实时三维盆底超声检查,对产后SUI患者进行临床疗效评价,以指导临床治疗。     

Selective association of nerve fibres immunoreactive for substance P or bombesin with putative cholinergic neurons of the male rat major pelvic ganglion

The male rat major pelvic ganglion contains both sympathetic and parasympathetic neurons that supply the lower urinary and digestive tracts, and the reproductive organs. The aim of this study was to describe the distribution and identify potential targets of sensory and intestinofugal axons in this ganglion. Two putative markers of these projections were chosen, substance P for primary sensory axons and bombesin for myenteric intestinofugal projections. Varicose substance P-immunoreactive axons were associated only with non-noradrenergic (putative cholinergic) somata, and most commonly with those that contained vasoactive intestinal peptide. Immunoreactivity for substance P was also present in a small group of non-noradrenergic somata, many of which were immunoreactive for enkephalins, neuropeptide Y or vasoactive intestinal peptide. Bombesin immunoreactivity was found only in preterminal and terminal (varicose) axons, the latter of which were exclusively associated with non-noradrenergic somata that contain neuropeptide Y-immunoreactivity. Some varicose axons containing either substance P-or bombesin-immunoreactivity were intermingled with clumps of small, intensely fluorescent cells. These studies indicate that substance P-and bombesin-immunoreactive axons are likely to connect with numerically small, but discrete, populations of pelvic neurons.     

Prediction of the hip joint centre in adults, children, and patients with cerebral palsy based on magnetic resonance imaging

The location of the hip joint centre (HJC) is required for calculations of hip moments, the location and orientation of the femur, and muscle lengths and lever arms. In clinical gait analysis, the HJC is normally estimated using regression equations based on normative data obtained from adult populations. There is limited relevant anthropometric data available for children, despite the fact that clinical gait analysis is predominantly used for the assessment of children with cerebral palsy. In this study, pelvic MRI scans were taken of eight adults (ages 23-40), 14 healthy children (ages 5-13) and 10 children with spastic diplegic cerebral palsy (ages 6-13). Relevant anatomical landmarks were located in the scans, and the HJC location in pelvic coordinates was found by fitting a sphere to points identified on the femoral head. The predictions of three common regression equations for HJC location were compared to those found directly from MRI. Maximum absolute errors of 31 mm were found in adults, 26 mm in children, and 31 mm in the cerebral palsy group. Results from regression analysis and leave-one-out cross-validation techniques on the MRI data suggested that the best predictors of HJC location were: pelvic depth for the antero-posterior direction; pelvic width and leg length for the supero-inferior direction; and pelvic depth and pelvic width for the medio-lateral direction. For single-variable regression, the exclusion of leg length and pelvic depth from the latter two regression equations is proposed. Regression equations could be generalised across adults, children and the cerebral palsy group.     

Possible harmful effects of high intra-abdominal pressure on the pelvic girdle

The present study explores the hypothesis that a high intra-abdominal pressure (IAP) loads the ligaments of the pelvic girdle to such an extent that frequent periods of high IAP might cause pain and/or interfere with recovery of patients with pelvic girdle pain (PGP). In a theoretical model the size of the load of IAP on the pelvic girdle was computed. The diameters of abdomen and pelvis needed for the calculations were measured on MRI scans; the IAP values during activities were gained from literature. In slim, healthy subjects the calculated load on the pelvic ring during activities of daily living was 26.0-52.0 N with peaks to 135 N. During straining, vigorous work or heavy exercises the load could increase to values ranging from 104 to 520 N. The load is higher in subjects with pain or fatigue, or in case of a distended abdomen. When the load on the pelvic ring induced by IAP is larger than 100 N, the force exceeds the force at which a pelvic belt relieves complaints in PGP; at 90 N, the force is larger than the force at which isometric hip adduction provokes pain in PGP. We conclude that the size of the load induced by IAP on the pelvic girdle seems to be sufficient to cause pain in patients with PGP and might interfere with recovery. It seems worthwhile to give patients with PGP instructions to reduce IAP as much as possible during activities.     

MRI of the pelvis in comparison with CT scan

This study gives results of magnetic resonance imaging (MRI) in the evaluation of male (23 cases) and female (29 cases) pelvis. Thirty nine patients with abnormal pelvis were compared with CT and ultrasounds. MRI and CT have proven equally sensitive to the presence of disease, with a better visualization of calcified tumours or benign lesions with CT, and a superior display of soft tissue spreads and bone metastases with MRI. The signal characteristics from various uterine, bladder and ovarian tumours show an overlap. The same phenomenon is observed between benign and malignant prostatic hypertrophy. The best sequences for pelvic study are, in our experience, IR or short TR spin-echo for T1-weighted images, and spin-echo with 1200 TR for T2 images. Calculated T1 and T2 maps may improve MRI results.     

Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality

BackgroundThe treatment of early stage cervical cancer has different therapeutic options. Adjuvant external beam radiotherapy for surgically treated intermediate risk cervical cancer patients has shown acceptable oncological outcomes with a low incidence of toxicity. The aim of this study was to analyze the oncological outcomes and safety of adjuvant small pelvic field radiotherapy in surgically treated stage IB1-2 cervical cancer patients who met the Sedlis intermediate-risk criteria.Materials and methodsA retrospective cohort study was carried out with 28 patients treated from 2007 to November 2019 with biopsy proven intermediate risk stage IB1–2 cervical cancer previously treated with radical hysterectomy and bilateral lymphadenectomy who received adjuvant small pelvic field radiotherapy. The primary endpoints were local and distant control and overall survival. Secondary endpoints were acute and late gastrointestinal and genitourinary toxicity. Survival curves were analyzed using the Kaplan-Meier method.ResultsAfter a median follow up period of 41.5 (27.5–80.5) months, adjuvant small pelvic field radiotherapy showed a 100% overall survival rate, 81.82% disease free survival and 86.36% local recurrence-free survival with no incidence of grade 3 or 4 acute or late toxicity. Three patients suffered from relapse, 1 in the vaginal cuff, 1 in the retrovesical area and 1 patient in the retroperitoneal area.ConclusionsAdjuvant small pelvic field radiotherapy is an efficient and safe treatment option that offers excellent oncological outcomes to surgically treated intermediate-risk stage IB1–2 cervical cancer patients with an excellent toxicity profile.