Quantitative MRI of uterine leiomyomas during triptorelin treatment: Reproducibility of volume assessment and predictability of treatment response

Magnetic resonance (MR) imaging is increasingly applied for the quantitative evaluation of uterine leiomyomas. MR is thought to be more accurate in comparison to ultrasound (US) techniques. MR signal intensity (SI) may prove to be predictive of myoma response to GnRH agonist treatment. This study aimed to evaluate the precision of uterine volume assessment by a parallel planimetric MR method and the accuracy of the ellipsoid formula based calculations from MR and US images. It was also attempted to analyze the precision of MR leiomyoma volume measurements and examine the relation between pretreatment myoma SI patterns and the response to agonist therapy. Twenty-seven women with a myomatous uterus were scanned three times during GnRH agonist treatment for 6 months. T₁- and T₂-weighted, as well as T₁ contrast-enhanced sequences of the uterus were obtained in the transverse and sagittal plane. Abdominal US of the uterus was performed with a conventional sector scanner. By the use of a software system for analysis of three-dimensional images obtained by MR, uterine volume was measured by a parallel planimetric method (MR-ROI) as well as the use of the ellipsoid formula (MR-ELL). Myoma volume was assessed by the MR-ROI method. SI of the myomas was estimated from selected tissue samples as well as from the integral myoma region of interest. By abdominal US, volume was assessed by the ellipsoid equation (US-ELL). Within- and between-observer and method reliability (Rw/Rb) was calculated from mean squares obtained by analysis of variance. For uterine volume assessment, reliability between observers and between methods when the MR-ROI and MR-ELL methods were analyzed was excellent. For the US-ELL measurements, the between-observer reliability was limited. Moreover, the reliability of the US-ELL was low when the MR-ROI method was used as the standard. Myoma volume assessment with the MR-ROI method showed high between-observer and between-method agreement. The myoma/fat SI ratio and the mean SI coefficient of variation failed to show a correlation with the degree of response to triptorelin treatment of individual myomas. In MR uterine volume assessment the MR-ELL method is very accurate compared with the more complicated MR-ROI method. The agreement between MR and US is limited. Therefore, the ellipsoid method on MR images is to be regarded as the method of choice for quantitative assessment of uterine volume response to hormonal treatment. Myoma SI patterns were shown to be of no value in the response prediction of myomas to treatment with GnRH agonists.     

Abnormal uterine cavity: differential diagnosis with MR imaging

The objective of the study was to assess the usefulness of magnetic resonance (MR) imaging in distinguishing malignant from benign conditions in patients with an abnormal uterine cavity. Fifty-four patients that were suspected of having abnormal uterine cavities were retrospectively evaluated by using MR imaging. The diagnosis of an abnormal uterine cavity included a thickened endometrium, and/or a endometrial mass, and/or a submucosal mass. Threshold values to classify the uterine cavity as abnormal on sagittal T₂-weighted images were >10 mm for premenopausal women and >5 mm for postmenopausal women. Malignancy was diagnosed when lesions invaded the myometrial/junctional zone, and/or lesion enhancement was lower than that of the adjacent myometrium. The results found that histology confirmed 18 malignant and 37 benign lesions. Twelve of 15 endometrial carcinomas and 3 malignant mixed mesodermal tumors (MMMT) were correctly characterized as malignant on enhanced T₁-weighted images; whereas 6 of 15 endometrial carcinomas and 3 MMMT were correctly characterized on T₂-weighted images. Thirty-four of 37 benign cases were correctly characterized as not malignant on enhanced T₁-weighted images. One of 14 submucosal leiomyomas, one endometrial stromal metaplasia, and one of ten pathologically normal endometria were misdiagnosed on enhanced T₁-weighted images but were correctly diagnosed on T₂-weighted images. The overall sensitivity, specificity, and accuracy for distinguishing malignant from benign central uterine masses were 83%, 92%, and 89% for enhanced T₁-weighted image, and 50%, 97%, and 82% for T₂-weighted image, respectively. We came to the conclusion that in diagnosing patients with abnormal uterine cavity, MR imaging may help differentiate malignant from benign disorders.     

MR imaging of the uterus: low-signal-intensity abnormalities of the endometrium and endometrial cavity

T2-weighted magnetic resonance (MR) images showing focal areas of low signal intensity involving the endometrium or endometrial cavity were analyzed retrospectively in 28 women. The causes of the hypointense foci were disclosed histologically in 25 patients and by follow-up MR examinations in the other 3. The low signal intensity foci were due to submucosal leiomyoma (11 patients), blood clot (7 patients), endometrial carcinoma (4 patients), early intrauterine pregnancy (3 patients), retained products of conception (2 patients), and endometrial hamartoma (1 patient). The correct diagnosis was made on the basis of MR findings alone in 9 of the 11 submucosal leiomyomas. MR findings were nonspecific in the remainder of the cases. The results indicate that, on MR images, hypointense foci within the endometrium or endometrial cavity can arise from a variety of causes. Often, a specific diagnosis is not possible, and correlation with clinical history is essential.     

Feature points extraction of different structure for industrial computed tomography image contour

In order to accurately obtain the physical structure and dimension, the feature points extraction must be carried out from the ICT (industrial computed tomography) image contour. Therefore, the discrete data could be transformed into CAD models, and different methods have been developed for the feature points extraction, according to geometric features, the function and shape of mechanical parts. We discussed the feature points extraction methods, and one method is not enough to all the structures, so we must first distinguish the structure as regular and irregular. For the regular structures, by using a positive–negative factor, the curvature estimation method was improved. This method was designed and verified for the actual part, and has an improved accuracy in the feature points extraction. While for the irregular structures we used the polygon approximation method in the feature points extraction. For a complex part composing of several regular structures and irregular structures in the same ICT contour, we divided the whole contour into the regular and irregular structures, then used the corresponding methods for each structure. Last all feature points were extracted. The actual examples showed that the used methods are practical and effective.     

High-field MRI and US evaluation of the pelvis in women with leiomyomas

Magnetic resonance imaging (MRI) and real-time transabdominal ultrasonography (US) were performed on 23 women with uterine leiomyomas. The uterus, ovaries, and cul de sac were evaluated. Accurate determination of uterine volume was possible in all cases by MRI, but was limited on US in uteri larger than 140 cc. Marked enlargement also prevented visualization of contour abnormalities in eight patients on US, but none on MRI. The endometrial stripe and junctional zone could not be adequately visualized in 21/23 US examinations, whereas they were identified in all 23 MRI (8 normal and 15 distorted). Individual leiomyomas were clearly depicted on 4 US and 19 MR scans, the smallest being 1.1 cm and 0.8 cm, respectively. Of the 31 fibroids present on MRI: 13 were intramural, 4 subserosal, and 14 submucosal. MRI successfully identified 44/46 ovaries as compared to 21/46 on US. Cul de sac fluid was noted in seven women by MRI alone. This data suggests that MRI is superior to US in examination of the entire pelvis in women with leiomyomas.     

Plexiform neurofibroma of the pelvis: CT and MRI findings

We present a case of plexiform neurofibroma of the pelvis in a patient with neurofibromatosis using magnetic resonance imaging (MRI) with computed tomography (CT) correlation. We discovered an extensive pelvic mass with a slightly greater signal intensity than muscle in T1-weighted images and a marked increased signal intensity in T2-weighted images. Multiple hypointense septations were identified throughout the tumor, particularly in the T2-weighted images. The MR appearance of pelvic plexiform neurofibroma is identical to those found in spinal and paraspinal locations. In the presence of an extensive pelvic mass in a patient with neurofibromatosis, MRI is recommended in evaluating and diagnosing plexiform neurofibroma. Since the MRI appearance of this tumor is characteristic, other lesions can possibly be ruled out. In addition, MRI's multiplanar capability is ideally suited to demonstrate the extension of these large tumors.     

Determining uterine blood flow in pregnancy with magnetic resonance imaging

Objective

The purpose of this study is to determine the feasibility of measuring total uterine blood flow in pregnancy using magnetic resonance imaging (MRI) technique.

Methods

Uterine blood flow was determined in pregnant women in whom MRI was being carried out to assess a fetal anomaly. A two-dimensional time-of-flight magnetic resonance (MR) angiogram sequence was performed. Scout images and a peripherally gated phase contrast MR sequence were planned to study simultaneous blood flow in the uterine and ovarian arteries.

Results

The MR pelvic angiogram sequence was completed in 13 women. The uterine arteries were visualized and their cross-sectional area determined. The complexity of the pelvic blood supply prevented the calculation of blood flow velocity and, thus, total uterine blood flow.

Conclusion

The measurement of total uterine blood flow during pregnancy was not possible using our MR technique. The ovarian vessels were not consistently visualized. Doppler ultrasonography remains the best modality by which to estimate total uterine blood flow in pregnancy.     

An automatic cerebellum extraction method in T1-weighted brain MR images using an active contour model with a shape prior

Purpose

The objective of this paper was to automatically segment the cerebellum from T1-weighted human brain magnetic resonance (MR) images.

Materials and Methods

The proposed method constructs a cerebellum template using five sets of 3-T MR imaging (MRI) data, which are used to determine the initial position and the shape prior of the cerebellum for the active contour model. Our formulation includes the active contour model with shape prior, which thereby maintains the shape of the template. The proposed active contour model is sequentially applied to sagittal-, coronal- and transverse-view images. To evaluate the proposed method, it is applied to BrainWeb data and a 3-T MRI data set and compared with FreeSurfer with respect to performance assessment metrics.

Results

The segmented cerebellum was compared with the results from FreeSurfer. Using the manually segmented cerebellum as reference, we measured the average Jaccard coefficients of the proposed method, which were 0.882 and 0.885 for the BrainWeb data and 3-T MRI data set, respectively.

Conclusion

We presented the active contour model with shape prior for extracting the cerebellum from T1-weighted brain MR images. The proposed method yielded a robust and accurate segmentation result.     

Reproducibility of MRI-derived measurements of right ventricular volumes and myocardial mass

Magnetic resonance (MR) imaging has been shown to provide accurate measurements of right ventricular (RV) volumes and myocardial mass. The purpose of this study was to evaluate the reproducibility of MR imaging, which in clinical practice may be as important as its absolute accuracy. The reproducibility of MR imaging measurements of the right ventricle was assessed by analyzing 40 serial functional MR imaging examinations of the right ventricle with variance component analysis. Standard deviations and 95% ranges for change were: for RV myocardial mass, 5.9 and 16 g; and for RV ejection fraction, 6.0% and 16%, respectively. Reproducibility was similar for cine and spin-echo MR imaging. The intraobserver and interobserver errors were especially large, indicating that observer subjectivity is the limiting factor in the interpretation of the MR images. This study suggests that the reproducibility of RV measurements is adequate to detect RV hypertrophy and a low ejection fraction in the individual patient. For accurate follow-up examinations, whereby smaller changes are to be detected, the reproducibility of MR imaging measurements may not be sufficient. More effort is needed to improve the reproducibility of MR imaging measurements.     

Quantification of MRI lesion load in multiple sclerosis: A comparison of three computer-assisted techniques

Several computer-assisted techniques for measuring multiple sclerosis lesion load on MR images have been developed to provide a quantitative and sensitive means for monitoring disease activity, particularly in the context of treatment trials. We have evaluated three techniques: manual outlining (similar to that of the North American interferon β-1b trial), semiautomated lesion contouring (local lesion based threshold), and intensity-based thresholding for the whole brain. Contiguous, 5 mm-thick, axial, T₂-weighted images of the brain were obtained on a 1.5T MR imager in eight patients with clinically definite multiple sclerosis. Analyses of the scans were performed twice, independently by three operators, using the three different techniques. The coefficient of variation of the measurement technique; was: (a) intrarater precision, 9.0 ± 5.2 (mean ± SD) (range 0.4–18.5) for the manual outlining, 2.5 ± 2.1 (0.1–7.7) for the contour technique, and 7.5 ± 6.9 (0.2–22.0) for the global threshold technique; (b) interrater precision, 11.0 ± 5.8 (4.9–21.7) for the manual outlining, 4.5 ± 1.6 (1.8–6.6) for the contour technique, and 11.4 ± 4.9 (2.8–19.2) for the global threshold technique (0.0 = perfect precision). The absolute lesion loads measured were very similar using the manual outlining and the contour techniques but were significantly smaller using the global threshold technique. We conclude that the contour technique is a promising tool for use in treatment trials. Further studies are needed to assess sensitivity to changes in lesion load over time.     

Adaptive segmentation of magnetic resonance images with intensity inhomogeneity using level set method

It is a big challenge to segment magnetic resonance (MR) images with intensity inhomogeneity. The widely used segmentation algorithms are region based, which mostly rely on the intensity homogeneity, and could bring inaccurate results. In this paper, we propose a novel region-based active contour model in a variational level set formulation. Based on the fact that intensities in a relatively small local region are separable, a local intensity clustering criterion function is defined. Then, the local function is integrated around the neighborhood center to formulate a global intensity criterion function, which defines the energy term to drive the evolution of the active contour locally. Simultaneously, an intensity fitting term that drives the motion of the active contour globally is added to the energy. In order to segment the image fast and accurately, we utilize a coefficient to make the segmentation adaptive. Finally, the energy is incorporated into a level set formulation with a level set regularization term, and the energy minimization is conducted by a level set evolution process. Experiments on synthetic and real MR images show the effectiveness of our method.     

Hibernoma: MRI appearance of a rare tumor

We report the features of a hibernoma on magnetic resonance (MR) imaging. The MR characteristics of this lesion were consistent with a complex lipid-containing mass. The mass did not suppress on short tau inversion recovery (STIR) imaging and was clearly not a simple lipoma. Hibernoma should be considered in the differential diagnosis of complex fatty masses.     

Exvivo ultrasound attenuation coefficient for human cervical and uterine tissue from 5 to 10 MHz

Attenuation estimation and imaging in the cervix has been utilized to evaluate the onset of cervical ripening during pregnancy. This feature has also been utilized for the acoustic characterization of leiomyomas and myometrial tissue. In this paper, we present direct narrowband substitution measurement values of the variation in the ultrasonic attenuation coefficient in ex vivo human uterine and cervical tissue, in the 5-10 MHz frequency range. At 5 MHz, the attenuation coefficient values are similar for the different orientations of uterine tissue with values of 4.1-4.2 dB/cm, 5.1 dB/cm for the leiomyoma, and 6.3 dB/cm for the cervix. As the frequency increases, the attenuation coefficient values increase and are also spread out, with a value of approximately 12.6 dB/cm for the uterus (both parallel and perpendicular), 16.0 for the leiomyoma, and 26.8 dB/cm for the cervix at 10 MHz. The attenuation coefficient measured increases monotonically over the frequency range measured following a power law.     

Immunoblastic large B-cell lymphoma of the peripancreatic head region: MR findings

We report the magnetic resonance (MR) appearance of a large B-cell lymphoma in the peripancreatic head region, in a 38-year-old male who presented with a 1-month history of pruritus and jaundice. Routine laboratory examination at presentation revealed an elevated bilirubin. The tumor was a large, solitary well-defined mass with no evidence of necrosis, which showed mild diffuse heterogeneous enhancement. The tumor was closely applied to the lateral margin of the head of the pancreas. The constellation of MR findings was interpreted as consistent with the correct eventual diagnosis of lymphoma.     

MRI appearance of the pelvis in the post cesarean-section patient

Fever in the post-cesarean section patient may indicate the presence of a potentially life-threatening complication, including abscess, ovarian vein thrombosis, and uterine dehiscence. Imaging findings are often utilized to ascertain the presence or absence of such complications. Familiarity with the normal findings in the post-operative period is essential in making this determination. The purpose of this investigation is to describe the MRI appearance of the post-cesarean section pelvis. Over a 67-month period, 50 patients with persistent low-grade fevers following c-section were referred for MR imaging. Imaging was performed 3-10 days post-operatively. Axial T1-weighted and T2-weighted images were acquired in addition to sagittal T2-weighted images. Coronal images were obtained in some cases. Clinical correlation was obtained through the patients charts, confirming discharge of the patients in stable condition. The uterine incision site usually demonstrated findings consistent with subacute hematoma. The anterior uterine myometrium demonstrated enlargement relative to the posterior uterine wall. Bladder flap hematomas were seen in 64% of cases. Three cases (6%) demonstrated parametrial edema and none of these patients demonstrated ovarian vein thrombosis. Two cases of pelvic hematoma were noted. The normal post-c-section incision site may demonstrate increased or decreased signal intensity on T2-weighted images and intact endometrial and serosal layers mitigate against the diagnosis of incisional dehiscence. Bladder flap hematomas occurred in slightly more than half the cases. Parametrial edema and pelvic hematoma can be seen as post-surgical changes.     

Quantitative assessment of myositis in thigh muscles using magnetic resonance imaging

Magnetic resonance (MR) imaging has been suggested as a technique for diagnosing and monitoring myositis, an inflammatory muscle disease. To date, the assessment of disease from MR images has been by subjective visual analysis. We describe here an objective, semi-automatic, computer-based method for quantifying the degree of disease from MR images, without the need for a radiologist or physician trained in the visual assessment of the MR images. The method is based on analysis of the histogram of intensity values produced from the MR images. The analysis yielded measures of the intensity and extent of disease. These two measures were combined to produce a calculated myositis index (CMI) which described the degree of disease evident from the MR images. This index was compared with a clinical assessment of the patient's condition, based on currently accepted, invasive and non-invasive, non-imaging criteria. Receiver operating characteristic (ROC) curve analysis showed that calculated myositis index agreed at least as well with clinical assessment as did visual analysis (receiver operating characteristic area = 0.93 and 0.94, p = not significant (NS), respectively, for separating remission from disease). Even using only two central MR slices for each patient, the receiver operating characteristic area for calculated myositis index was 0.92, implying that very short acquisition times are possible. We conclude that quantitative histogram analysis of MR images can be successfully performed with minimal operator input and using few MR slices. Agreement with more invasive clinical assessment is good and the method has the advantages of repeatability, objectivity, and decreased scan and analysis time.     

Vascular morphology by three-dimensional magnetic resonance imaging

A three-dimensional examination of blood vessels is provided using MR data from seven cases. The vascular surfaces are constructed with an algorithm that automatically follows the selected artery or vein and generates a projected three-dimensional gradient shaded image. Fast 3DFT pulse sequences were optimized to enhance the time-of-flight contrast of the intravascular region. By increasing the surface threshold value in a three-dimensional head study, the flesh of a patient's face was peeled away to demonstrate the superfacial temporal artery. Gated cardiac images show the great vessels and cardiac chambers. A three-dimensional view of the aorta shows an irregular surface in the vicinity of an adrenal tumor. 3D MR exams provide a non-invasive technique for assessing vascular morphology in a clinical setting.     

A novel area measurement scheme based on a multi-resolution dynamic contour

A novel scheme for an object's surface area measurement is proposed, which is suitable for area computation of an object with smooth and irregular edges. A multi-resolution dynamic contour is applied and this scheme consists of four steps. Firstly, a photoelectric image collimation system is applied to obtain a target image of a detected object. An image pyramid for the target image is constructed by wavelet decomposition and reconstruction. Secondly, in the image pyramid, a multi-resolution dynamic contour converges to the target's contour edge from coarse to fine scale, via feature search and an iteration algorithm. Thirdly, for the convergent dynamic contour, two formulas for the area and centroid computation of a closed B-spline curve are applied to compute the image target's area and centroid exactly. Finally, a novel centroid self-calibration technology is applied, which measures the pixel's size equivalence with the computed centroid and a dual-frequency laser to measure the true object's surface area exactly. Experiments indicate that this scheme's single-measurement error decreases to ±0.2%, when the number of control points is 20. Compared to conventional measurement approaches, this scheme is robust for a target image with noises or complicated edges.     

Micromechanical thermal deformation analysis of unidirectional boron/aluminum metal-matrix composite

An experiment was conducted to document thermal deformation of a unidirectionally reinforced boron/aluminum metal-matrix composite. The specimen was subject to an isothermal loading of ΔT = − 100 °C and the deformation on a free surface perpendicular to the fibers was measured by microscopic moiré interferometry. The high sensitivity and spatial resolution made it possible to elucidate the micromechanical behavior of the specimen at the fiber level. Multiplied moiré fringe patterns with a contour interval of 35 nm/fringe contour were obtained for a hexagonal array of fibers and a square array of fibers. The stress-induced strains were determined from the fringe patterns by subtracting the free thermal contraction strains. The results revealed a free surface effect and showed asymmetrical and irregular strain distributions inherent in real (non-idealized) composite materials.     

Delayed myelination in a rhizomelic chondrodysplasia punctata case: MR spectroscopy findings

Rhizomelic chondrodysplasia punctata is a member of genetic peroxisomal disorders. Delayed myelination, which is probably related to the inadequacy of plasmalogens biosynthesis, is an important feature of this disorder. Direct assessment of neuropathologic aspects of RCDP syndrome such as neuronal degeneration and delayed myelination is possible with MR spectroscopy.In this report, MR spectroscopy findings (decreased Cho/Cr and increased Ins-Gly/Cr ratios and increased levels of mobile lipids) of a rhizomelic chondrodysplasia punctata case supporting delayed myelination are presented. This is the second report of MR spectroscopy examination of the specific brain metabolic changes associated with rhizomelic chondrodysplasia punctata.