Pelvis imaging

Fig. 1. Bone scan of a 75-year-old woman presented with acute onset of low back pain employing either Tc-medronate [25681-89-4] or Tc-oxidronate [14255-61-9]. The bone scan of (a) the anterior and (b) the posterior pelvis shows increased uptake in the region of the sacral bone (arrows). The bladder (arrowheads) is a normal route of tracer excretion and is also prominently identified in the image.

Fig. 5. Standard fast spin-echo imaging of the pelvis and the lower leg. Typical contrasts between musculature and other tissues are demonstrated. Bl = bladder, Fe = femur. Gluteus = gluteus muscle. Original recording parameters matrix 192 x 256, slice thickness 6 mm, a-c field of view (fov) = 380 mm, d-f fov = 180 mm. (a) and (d) Proton density weighting TR = 5000 ms, TE = 12 ms. (b) and (e) Ti-weighting TR = 500 ms, TE = 12 ms. (c) and (f) 7 2-weighting TR = 5000 ms, TE = 100 ms.

In osteomalacia, the bone matrix is quantitatively and qualitatively normal, while the bones show a reduced content of minerals. There is ostalgia and muscle weakness as well as arcuation of the long tubular bones. X-ray imaging shows band-shaped zones of decalcification, usually in symmetrical arrangement, particularly at the ribs, femoral neck and pelvis (so-called Looser-Milkman s syndrome). 

Radiographic imaging studies evaluate the extent of disease involvement. A chest x-ray should be performed to rule out the presence of metastatic spread to the lungs. A CT scan of the abdomen and pelvis is often performed to evaluate hepatic and retroperitoneal involvement and occult abdominal and pelvic disease, and to determine the depth of tumor penetration into the bowel wall and/or invasion to adjacent organs. Detection of lymph node involvement with either smdy is limited by the difficulty of distinguishing inflammatory or reactive lymph nodes from those infiltrated with tumor. Because CT scans may not adequately detect peritoneal seeding, small distant lymph node metastasis, or liver metastasis in colon cancer, an occasional patient may... 

A PACS is maintained by a server that provides storage, informatics, etc. for communication among members of the PACS, and also as many workstations as necessary to connect to the server. As already mentioned, at workstations one can retrieve reports and images of patients from the PACS and manipulate them to interpret as needed. A PACS is run by software designed for a particular operating system, such as Windows, Mac OS, Unix, or Linux, although most PACS workstations run on a PC platform. All PACS software can perform some standard functions, but ease of operation may vary. They differ at times in limitation of the number of the patient studies that can be displayed on a monitor screen. The software provides different protocols to access the PACS at the workstation. For example, a protocol may be based on a modality and body part combination, such as CT abdomen/pelvis, or on a secondary descriptor such as gallbladder stone... 

Ak et al. analyzed the relationship between the [ Tc]MIBI uptake and the expression levels of Pgp in 26 patients with newly diagnosed leukemia [104]. The patients underwent a [ Tc]MIBI whole-body planar imaging prior to chemotherapy. Planar images of pelvis and thorax were acquired 20 min postinjection of [ Tc]MIBI. The T/B ratio in bone marrow was compared with the Pgp expression in blast cells from bone marrow aspiration samples determined by flow cytometry. The results of [ TcjMIBI imaging were concordant with the Pgp expression levels found in blast cells. The bone marrow uptake of [ Tc]MIBI was significantly (p<0.001) higher in Pgp-negative patients than in those with Pgp-positive blast cells. Such observations indicate that in vivo... 

Fig. 10.2.3. T2-weighted sagittal non-breath hold image of the pelvis shows a 53-year-old female with focal adenomyoma (asterisk) and concurrent fibroids...

My technique for embolization of uterine fibroids starts with placing a flush catheter that allows a contralateral approach (VCF or Omni Flush catheter) into the aorta and positioning it just below the level of the renal arteries. The image intensifier is centered over the pelvis and a angiogram is performed which allows for visualization of ovarian artery collaterals, and provides visualization of the iliac anatomy (Fig. 10.3.6a). The flush catheter is then positioned... 

Heye, T., Davenport, M.S., Horvath, J.J., Feuerlein, S., Breault, S.R., Bashir, M.R., et al. ReproducibUity of dynamic contrast-enhanced MR imaging. Part I. Perfusion characteristics in the female pelvis by using multiple computer-aided diagnosis perfusion analysis solutions. Radiology 266(3), 801—811 (2013)... 

Anatomy. Refers to the anatomy being imaged. This can be the head (brain, skull, teeth, nasal cavities), the thorax (heart, breast, ribs), the abdomen (kidney, liver, intestines), the pelvis and the perineum, or the limbs (femur, tibia, humerus, hand). 

As with other scanners, the liver should be scanned during the portal venous phase, immediately followed by scanning of the pelvis. When a continuous scan from top to bottom is performed with a delay of 60 s, the pelvis tends to be scanned too early. Here, the examiner must decide whether the advantage of an uninterrupted scan with the option of creating continuous coronal reconstructions is more important than scanning of the pelvis during the optimal imaging window. 

When planning the CT scan, care should be taken to include the entire pelvis to below the pubic bone. The field of view should be chosen such that all pelvic bone structures and the gluteal muscles are depicted. Too small a field of view impairs spatial resolution if the reconstructed images are optically magnified for better documentation. 

Fig. 3.6a-d. CT of the female pelvis, a CT transversal unenhanced. b CT transversal after CM and reformatted coronal (c) and sagittal CT images (d)... 

Togashi K,Nakai A,Sugimura K (2001) Anatomy and physiology of the female pelvis MR imaging revisited. J Magn Reson Imaging 13 842-849... 

Masui T, Katayama M, Kobayashi S, Sakahara H, Ito T, Nozaki A (2001) T2-weighted MRl of the female pelvis comparison of breath-hold fast-recovery fast spin-echo and nonbreath-hold fast spin-echo sequences. J Magn Reson Imaging 13 930-937... 

Schwartz LB, Panageas E, Lange R, Rizzo J, Comite F, McCarthy S (1994) Female pelvis impact of MR imaging on treatment decisions and net cost analysis. Radiology 192 55-60... 

Yamashita Y, Tang Y, Abe Y, Mitsuzaki K, Takahashi M (1998) Comparison of ultrafast half-Fourier singleshot turbo spin-echo sequence with turbo spin-echo sequences for T2-weighted imaging of the female pelvis. J Magn Reson Imaging 8 1207-1212... 

Zawin M, McCarthy S, Scoutt LM, Comite F (1990) High-field MRl and US evaluation of the pelvis in women with leiomyomas. Magn Reson Imaging 8 371-376... 

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