Pelvis & Fetal
Monday 20 April 2009
Room 316A 14:00-16:00


Nandita de Souza and Patricia Noël

14:00  80.

Better Understanding Maturation Arrested Men Through HR-MAS Spectroscopy of Human Testicular Biopsy Tissue

    Rahwa Berhanu Iman1, Mark Swanson1, Thomas Walsh2, David Aaronson2, Shoujun Zhao, Ying Lu, John Kurhanewicz1
Radiology, University of California, San Francisco, San Francisco, CA, USA; 2Urology, University of California, San Francisco, USA
    1H high resolution magic angle spinning (HR-MAS) spectroscopy was used to determine metabolic profiles of normal, maturation arrested, and azoospermatic human testicular biopsy tissues. Twenty seven 1H HR-MAS spectra were acquired and quantified using the electronic standard ERETIC and the algorithm HR-QUEST. Phosphocholine (PC), phosphoethanolamine (PE), and glutamine were found to significantly differentiate between normal and azoospermatic tissue. This study further suggests that PC could serve as a specific in vivo marker for fertility in 1H MRSI studies of human testes and a model can be used to predict fertility of maturation arrested men.
14:12 81.  

31P Chemical Shift Imaging of Testicular Infertility at 3.0 Tesla

    Jonathan P. Dyke1,2, Darius A. Paduch3, Joseph Kiper3, Eric Aronowitz1, Peter N. Schlegel3, Douglas Ballon1,2
Citigroup Biomedical Imaging Center, Weill Cornell Medical College, New York, NY, USA; 2Radiology, Weill Cornell Medical College, New York, NY, USA; 3Urology, Weill Cornell Medical College, New York, NY, USA
    31P chemical shift imaging (CSI) at 3.0 Tesla provided localized metabolic information in the testes of subjects presenting with male infertility. Spectroscopic results were compared with testicular sperm extraction (TSE) which confirmed the presence of viable sperm. The PM/β-ATP ratio was decreased in subjects that lacked viable sperm compared to those containing viable sperm. This technique may provide information aiding clinicians in finding regions of viability in the testes during TSE. Future utility of 31P spectroscopic imaging may allow non-invasive serial assessment of testicular function that would allow for patient specific timing and tailoring of therapy.
14:24 82. 

Diffusion Weighted Imaging of Uterine Fibroids: Predicting Volumetric Response Following Uterine Artery Embolization

    Kinh Gian Do1, Stella Kang1, Timothy Clark1, Elizabeth Hecht1
Radiology, NYU Medical Center, New York, NY, USA
    In 8 patients with 21 uterine fibroids, higher apparent diffusion coefficient of uterine fibroids on pre-procedural MRI correlate with greater volumetric reduction following uterine artery embolization. Fibroid volume reduction did not correlate with fibroid size or relative enhancement.
14:36 83.

Diffusion-Weighted MR Hysterography: Initial Evaluation and Determination of Optimal Imaging Timing During the Menstruation Cycle

    Wenche M. Klerkx1, Taro Takahara2, Qvinny Leemans2, Thomas C. Kwee2, Peter Luijten2, Willem P. Mali2
Gynecology, University Medical Center Utrecht, Utrecht, Netherlands; 2Radiology, University Medical Center Utrecht, Utrecht, Netherlands
    Hysteroscopy, saline infusion sonohysterography, and hysterosalpingography are commonly used for the evaluation of uterine pathologies, but are invasive and operator-dependant procedures. MRI does not have these disadvantages, but evaluation of the shape of the uterine cavity is often difficult using conventional MRI. MR hysterography, using a diffusion-weighted sequence based on the concept of Diffusion weighted Whole body Imaging with Background body signal Suppression (DWIBS) may be an excellent alternative. In this study, we introduce the MR hysterography technique and show that the best visualization of the uterine cavity can be obtained in the follicular phase of the menstruation cycle.
14:48  84.

Staging of Ovarian Cancer with Continuously Moving Table MR Acquisitions: A Comparison to Computed Tomography

    Ute Ariane Ludwig1, Gregor Pache2, Tobias Baumann2, Jürgen Hennig1, Oliver Schäfer2
Department of Diagnostic Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany; 2Department of Diagnostic Radiology, University Hospital Freiburg, Freiburg, Germany
    Ovarian cancer is one of the most frequently occurring cancer diseases amongst women. Currently, whole body staging of ovarian cancer is performed with Computed Tomography (CT), but small peritoneal nodules are hardly detectable using this imaging modality. In this study a MRI protocol including high resolution pelvic and Sliding Multi Slice (SMS) imaging with continuously moving table was investigated for whole body staging of ovarian cancer and images were compared to CT. It could be demonstrated that MRI was superior to CT for staging of local tumor extent and showed excellent detection of peritoneal or metastatic spread from ovarian cancer.
15:00 85. 

The Role of 3 Tesla DWI in Evaluation of Primary and Metastatic Ovarian Cancer Before and After Neo-Adjuvant Chemotherapy

    Masako Yano Kataoka1, Andrew Nicholas Priest1, Martin J. Graves1, Ilse Joubert1, Robin Crawford2, Helena Earl3, James Brenton3,4, Mary A. McLean4, John R. Griffiths4, David J. Lomas1, Evis Sala1
Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK; 2Obstetrics & Gynaecology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK; 3Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK; 4Cancer Research UK, Cambridge Research Institute, Cambridge, UK
    We evaluated the ADC values of primary ovarian, omental and peritoneal lesions in 16 patients with advanced ovarian cancer before and after neo-adjuvant chemotherapy. Baseline ADC values of peritoneal implants were considerably lower than that of primary ovarian lesions and significantly lower than those of omental cake. The primary ovarian tumours tended to have the highest ADC values which increased significantly after treatment. Our findings may reflect mixed treatment response that frequently occurs clinically at different sites of disease. This may be explained by variable blood supply and hypoxia which limits delivery and efficacy of chemotherapy at certain anatomical sites.
15:12 86.

Tumour Necrosis Assessed by Magnetic Resonance Dynamic Contrast-Enhanced Subtraction Imaging Is a Predictor of Chemoradiotherapy Response in Advanced Cervical Cancer

    Lorenzo Mannelli1, Andrew N. Priest1, Martin J. Graves1, Ilse Joubert1, Li Tee Tan2, Robin Crawford3, James Brenton2,4, David J. Lomas1, Evis Sala1
Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; 2Oncology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; 3Obstetrics & Gynaecology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; 4Cambridge Research Institute, Cancer Research UK, Cambridge, UK
    Radiotherapy is usually effective in cervix cancer treatment. Imaging techniques that can predict treatment outcome would allow further treatment individualisation. There is a current lack of standardised and independently validated analysis of quantitative DCE-MRI parameters. Subtraction imaging is easy, widely available and it overcomes protocols variability. The pre-treatment percentage of non enhancing tumour was visually assessed in 13 patients using subtracted images. The tumour volume regression from pre-treatment to post-treatment was calculated. A strong correlation (r = -0.821; p < 0.001) was found between the pre-treatment percentage of non-enhancing tumour and the percentage of tumour volume regression.
15:24 87.  

Differentiation Between Malignant and Benign Cervical Tissue on the Basis of the Apparent Diffusion Coefficient Is Sensitive and Independent of the B-Value Combination Used for ADC Calculation.

    Jaap Hoogendam1, Wenche Margrethe Klerkx2, Gerard de Kort1, Ronald Zweemer1, Willem Mali1, Wouter Veldhuis1
University Medical Center Utrecht; 2Radiology, University Medical Center Utrecht, Utrecht, Netherlands
    In diffusion weighted imaging a variety of b-value combinations is used to calculate apparent diffusion coefficients (ADC) for malignancy discrimination. We scanned 35 patients with cervical cancer at 3T and investigated three b-value combinations used in the literature (b=0,1000 vs 0,150,500,1000 vs 150,500,1000 s/mm2) for their influence on ADC and the ability to identify cervical malignancies. Results show a significantly lower ADC in cervical malignancies compared to benign cervical tissue. A high sensitivity and specificity (all over 90%) was found at all optimal ADC cut-off values, independent of the b-value combination used to calculate ADC.
15:36 88.

High Resolution MR Imaging of the Fetal Heart with Cardiac Triggering: A Feasibility Study in the Sheep Fetus

    Jin Yamamura1, Bernhard Schnackenburg2, Hendrik Kooijman2, Michael Frisch1, Gerhard Adam1, Ulrike Wedegaertner1
Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; 2Philips Medical Systems
    Although the fetal MRI has already been applied to almost all fetal organs, the evaluation of the fetal heart has been omitted so far due to technical problems. Usually, cardiac imaging requires electro-cardiogram (ECG) triggering and breath holds of the patient during measurements. Since the fetal heart lies within the uterus, there is no possibility for a direct triggering of the fetal heart frequency. The visualization of anomalies both of the heart and the great vessels is actually of great importance for prenatal diagnostics, though not yet feasible.  In this here present study the attempt was to develop a fetal cardiac MRI by using a fetal sheep model and thus to improve the image quality of fetal cardiac imaging. This feasibility study is based on performing fetal cardiac MR imaging by triggering the fetal heart beat in utero in a sheep model.
15:48 89. 

In-Vivo MRI Measurement of Fetal Blood Oxygen Saturation in Cardiac Ventricles of Fetal Sheep: A Feasibility Study

    Ulrike Wedegärtner1, Hendrik Kooijman2, Jin Yamamura1, Michael Frisch1, Kurt Hecher1, Gerhard Adam1
University Hospital Hamburg Eppendorf, Hamburg, Germany; 2Philips Medical Systems, Germany
    T2-based MR oximetry might allow the assessment of fetal oxygen saturation non-invasively which is important for high risk pregnancies. However, for practical application of this method to detect fetuses at risk, measurements have to be more accurate. Therefore technical difficulties due to the fetal model have to be improved.