Faculty Bibliography

Cross-sectional imaging modalities play a pivotal role in the diagnosis and multidisciplinary management of patients with endometrial and cervical carcinomas. Ultrasonography, including sonohysterography, permits evaluation of endometrial abnormalities and characterization of adnexal masses. Computed tomography, particularly in conjunction with (18)(F)-fluorodeoxyglucose positron emission tomography, is increasingly used to stage the cancers and to detect disease recurrence. Magnetic resonance imaging plays a major role in accurate locoregional staging of these cancers, and significantly influences treatment decisions and outcomes. This article discusses the role of imaging modalities in the diagnosis, management, and surveillance of these cancers.

Imaging plays a crucial role in diagnosis and management of gestational trophoblastic disease. Ultrasonography is the initial investigation of choice for the diagnosis. Pelvic magnetic resonance (MR) imaging is used as a problem-solving tool for assessment of degree of local invasion. Chest radiography is the recommended initial radiographic staging modality, and chest computed tomography is performed if the radiograph is negative. (18)F-Fluorodeoxyglucose positron emission tomography has been shown to be useful in assessing the active or viable sites of metastases, thereby determining the need for tumor resectability in chemoresistant disease.

Pregnancy predisposes women to a wide array of obstetric and gynecological complications which are often complex, challenging and sometimes life-threatening. While some of these are unique to pregnancy, a few that occur in nonpregnant women are more common during pregnancy. Imaging plays a crucial role in the diagnosis and management of pregnancy-related obstetric and gynecologic complications. Ultrasonography and magnetic resonance imaging confer the least risk to the fetus and should be the preferred examinations for evaluating these complications. Multidetector computed tomography should be used after carefully weighing the risk-benefit ratio based on the clinical condition in question. Interventional radiology is emerging as a preferred, noninvasive or minimally invasive treatment option that can obviate surgery and its antecedent short term and long term complications. Knowledge of appropriateness of imaging and image guided intervention is necessary for accurate patient management.

Chronic fibrosing conditions of the abdomen are relatively poorly understood and involve varied and often multiple organ systems. At histopathologic analysis, they share the unifying features of proliferative fibrosis and chronic inflammation. Different conditions in this group are often found in association with each other and with other fibrosing conditions outside the abdomen. Some of the confusion about these conditions stems from their complex nomenclature, which includes a gamut of alternate terms and eponyms. Many of them can be categorized within two large subgroups: the fibromatoses and immunoglobulin G4 (IgG4)-related disorders. While many of these entities are of uncertain etiology, some, especially the IgG4-associated conditions, appear to have an immune-mediated pathogenesis. Nephrogenic systemic fibrosis, sclerosing peritonitis, and retroperitoneal fibrosis have iatrogenic associations, while some of the fibromatoses are genetically inherited. Imaging differentiation of these conditions is difficult due to considerable overlap in their radiologic findings. However, certain conditions such as penile fibromatosis and sclerosing peritonitis may have unique imaging features that can help the radiologist make the diagnosis. Others such as deep fibromatoses and inflammatory pseudotumor demonstrate fibroproliferative mass formation and cannot be differentiated from neoplastic conditions at imaging. Thus, histopathologic correlation is often required to confirm their diagnosis.

This white paper describes adnexal (ovarian and paraovarian) incidental findings found on CT and MRI in nonpregnant postmenarchal patients in whom no adnexal disorder is clinically known or suspected. This represents the first of 4 such papers from the ACR Incidental Findings Committee II, which used a consensus method based on repeated reviews and revisions and a collective review and interpretation of relevant literature. Recommendations for the management of incidental adnexal findings are organized into 4 main categories: benign-appearing cysts, probably benign cysts, adnexal masses with characteristic features, and all other adnexal masses, with pathways on the basis of patient menstrual status or age (when last menstrual period is unknown). A table and flowchart are provided for reference.

Recent advances in genetics and pathology have improved our understanding of diagnosis and staging of uterine sarcomas. The major types of uterine sarcomas include leiomyosarcoma, low-grade endometrial stromal sarcoma, undifferentiated endometrial sarcoma, adenosarcoma and carcinosarcoma. The distinctive biological behavior and poor overall survival of uterine sarcoma create challenges in the management of these tumors. We herein present a comprehensive review of taxonomy, epidemiology, pathology, imaging findings and natural history of a wide spectrum of uterine sarcomas.

There is an increasing incidence of both intra- and extra-thoracic manifestations of tuberculosis, in part due to the AIDS epidemic. Isolated tubercular involvement of the solid abdominal viscera is relatively unusual. Cross-sectional imaging with ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) plays an important role in the diagnosis and post treatment follow-up of tuberculosis. Specific imaging features of tuberculosis are frequently related to caseous necrosis, which is the hallmark of this disease. However, depending on the type of solid organ involvement, tubercular lesions can mimic a variety of neoplastic and nonneoplastic conditions. Often, cross-sectional imaging alone is insufficient in reaching a conclusive diagnosis, and image-guided tissue sampling is needed. In this article, we review the pathology and cross-sectional imaging features of tubercular involvement of solid abdominopelvic organs with a special emphasis on appropriate differential diagnoses.

There is a broad spectrum of primary pelvic retroperitoneal masses in adults that demonstrate characteristic epidemiologic and histopathologic features and natural histories. These masses may be classified into five distinct subgroups using a pattern-based approach that takes anatomic distribution and certain imaging characteristics into account, allowing greater accuracy in their detection and characterization and helping to optimize patient management. The five groups are cystic (serous and mucinous epithelial neoplasms, pelvic lymphangioma, tailgut cyst, ancient schwannoma), vascular or hypervascular (solitary fibrous tumor, paraganglioma, pelvic arteriovenous malformation, Klippel-Trenaunay-Weber syndrome, extraintestinal GIST [gastrointestinal stromal tumor]), fat-containing (lipoma, liposarcoma, myelolipoma, presacral teratoma), calcified (calcified lymphocele, calcified rejected transplant kidney, rare sarcomas), and myxoid (schwannoma, plexiform neurofibroma, myxoma).Cross-sectional imaging modalities help differentiate the more common gynecologic neoplasms from more unusual masses. In particular, the tissue-specific multiplanar capability of high-resolution magnetic resonance imaging permits better tumor localization and internal characterization, thereby serving as a road map for surgery.