Uterine contrast-enhanced

Zhou XD, Ren XL, Zhang J, He GB, Zheng MJ, Tian X, Li L, Zhu T, Zhang M, Wang L, Luo W (2007) Therapeutic response assessment of high intensity focused ultrasound therapy for uterine fibroid utility of contrast-enhanced ultrasonography. European Journal of Radiology 62 289-294. 

Marret H, Tranquart F, Sauget S, Alonso AM, Cottier JP, Herbreteau D (2004a) Contrast-enhanced sonography during uterine artery embolization for the treatment of leiomyomas. Ultrasound Obstet Gynecol 23 77-79... 

It is our goal to perfect our technique in order to get more consistent results, reduce complications, and establish uterine fibroid embolization for a durable time period. Large calibrated microspheres are equally effective to smaller non-calibrated particles to target the peri-fibroid arterial plexus. Calibrated microspheres are so easy to deliver through microcatheters that one may predict the progressive replacement of non-spherical particles in the near future. MRI has become the reference imaging tool before and after embolization. The use of contrast-enhanced studies allows early detection... 

Fig. 3.9a,b. MRI of a healthy woman during secretory phase. The T2-weighed TSE image (a) as well as the contrast-enhanced Tl-weighted TSE image (b), both in sagittal orientation demonstrate a blood clot (arrow) in the uterine cavity... 

Fig. 5.10. CT of uterine leiomyoma. Contrast-enhanced CT of the pelvis in a 39-year-old women with a known uterine leiomyoma shows a large oval mass within the uterus with heterogenous enhancement (asterisk) which displaces the hypodense right ovary (arrow) and distends the abdomen...

Fig. 5.15. Bridging vascular sign in a pedunculated leiomyoma. Tl-weighted contrast-enhanced fat-suppressed sagittal image depicts a large pedunculated subserosal leiomyoma originating from the uterine fundus. Flow-voids are seen within the vessel stalk (arrow). A second intramural leiomyoma in the anterior wall is seen displacing the endometrial stripe. (Reproduced with permission from [223])...

Fig. 5. 27. CT of uterine leiomyomas of the uterus. Contrast-enhanced CT shows subsero-sal leiomyomas distorting the uterine contour (arrows). The fibroids show similar enhancement to adjacent myometrium...

Fig. 5.29. Contrast-enhanced MRA prior to UAE. Maximum intensity projection of a Tl-weighted contrast-enhanced MR angiography depicts the uterine arteries long white arrows) as well as an enlarged the right ovarian artery thick white arrow)...

Kroencke TJ, Scheurig C, Khmer C, Taupitz M, Schnorr J, Hamm B (2006) Contrast-enhanced magnetic resonance angiography to predict ovarian artery supply of uterine fibroids - initial experience. Radiology 241 181-189... 

Postema S, Pattynama PM, Broker S, van der Geest RJ, van Rijswijk CS, Baptist Trimbos J (1998) Fast dynamic contrast-enhanced colour-coded MRI in uterine cervix carcinoma useful for tumour staging Clin Radiol 53 729-734... 

Fig. 9.33a,b. Ovarian fibroma in CT. Transaxial pelvic CT at the uterine level (a) and above (b) in a 55-year-old woman with abdominal fullness. A large lesion (asterisk) is found in the mid pelvis above the level of the uterus and bladder (b). It is well demarcated and displays a slightly inhomogeneous solid structure. Contrast enhancement is distinctly less than that of the myometrium (arrow). No calcifications were found throughout the lesion. Minimal ascites was seen. Histopathology revealed a 9-cm fibroid of the left ovary... 

Differential diagnosis includes solid ovarian tumors in younger age, e.g., granulosa cell tumors and teratomas. In MRI, uterine fibroma and fibrothecoma may display a similar appearance on T2-weighted images however, contrast enhancement in these tumors is less and delayed. Especially in CT, differentiation of subserosal uterine fibroids from solid dysgerminomas is not possible. 

Incompetent and dilated ovarian veins are frequently seen on CT in asymptomatic parous women (Fig. 17.11) [31]. Congenital or acquired vascular malformations of the uterus or parametria present also as vascular lesions. Contrast-enhanced CT or MRI may aid in the differentiation by the early enhancement of arteriovenous malformations in contrast to a more delayed enhancement in varicosities [32]. Adnexal masses with torsion or rare uterine tumors, especially choriocarcinomas may also be surrounded by thick, tortuous, well-enhanced vessels. The clinical background and imaging findings of an adnexal or uterine mass aid in the differential diagnosis. 

To allow the distinction of an ovarian vs uterine origin of a mass, dynamic contrast injection might be helpful to better delineate the early enhancing normal myometrium [6]. This type of sequence is acquired once before and three times after IV contrast injection and corresponds to a 2D TSE sequence with 18 slices of 4 mm at a FOV of 300 mm, a matrix of 202x512, a TSE factor of 5, a TR/TE of 550/14 with two numbers of signal acquisition and a total acquisition time of 6 min. 

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