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Radiographics : a Review Publication of... 2019Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors... (Review)
Review
Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors arise from gastrointestinal or genitourinary organs, with less common sites of origin including the connective tissues, nerves, and lymphovascular structures. Lesion evaluation usually starts with clinical assessment followed by imaging, or the lesion may be an incidental finding at imaging performed for other clinical indications. Since accurate diagnosis is essential for optimal management, imaging is useful for suggesting the correct diagnosis or narrowing the differential possibilities and distinguishing tumors from their mimics. Some masses may require histologic confirmation of the diagnosis with biopsy and/or up-front surgical resection. In this case, imaging is essential for presurgical planning to assess mass size and location, evaluate the relationship to adjacent pelvic structures, and narrow differential possibilities. Pelvic US is often the first imaging modality performed in women with pelvic symptoms. While US is often useful to detect a pelvic mass, it has significant limitations in assessing masses located deep in the pelvis or near gas-filled organs. CT also has limited value in the pelvis owing to its inferior soft-tissue contrast. MRI is frequently the optimal imaging modality, as it offers both multiplanar capability and excellent soft-tissue contrast. This article highlights the normal anatomy of the pelvic spaces in the female pelvis and focuses on MRI features of common tumors and tumor mimics that arise in these spaces. It provides an interpretative algorithm for approaching an unknown pelvic lesion at MRI. It also discusses surgical management, emphasizing the value of MRI as a road map to surgery and highlighting anatomic locations where surgical resection may present a challenge. RSNA, 2019.
Topics: Female; Genital Neoplasms, Female; Humans; Magnetic Resonance Imaging; Ovarian Neoplasms; Pelvic Neoplasms; Pelvis; Peritoneal Neoplasms; Rectal Neoplasms; Sigmoid Neoplasms; Urinary Bladder Neoplasms
PubMed: 31283453
DOI: 10.1148/rg.2019180173 -
Colorectal Disease : the Official... Dec 2023
Topics: Humans; Dissection; Lymph Node Excision; Laparoscopy; Pelvis; Rectal Neoplasms
PubMed: 37872883
DOI: 10.1111/codi.16793 -
American Journal of Obstetrics and... May 2019Urinary and pelvic floor symptoms often are attributed to size and location of uterine fibroid tumors. However, direct supporting evidence that links increased size to...
BACKGROUND
Urinary and pelvic floor symptoms often are attributed to size and location of uterine fibroid tumors. However, direct supporting evidence that links increased size to worsening symptoms is scant and limited to ultrasound evaluation of fibroid tumors. Because management of fibroid tumors is targeted towards symptomatic relief, the identification of fibroid and pelvic characteristics that are associated with worse symptoms is vital to the optimization of therapies and prevention needless interventions.
OBJECTIVE
We examined the correlation between urinary, pelvic floor and fibroid symptoms, and fibroid size and location using precise uterine fibroid and bony pelvis characteristics that were obtained from magnetic resonance imaging.
STUDY DESIGN
A retrospective review (2013-2017) of a multidisciplinary fibroid clinic identified 338 women who had been examined via pelvic magnetic resonance imaging, Pelvic Floor Distress Inventory questionnaire (score 0-300), and a Uterine Fibroid Symptoms questionnaire (score 1-100). Multiple linear regression analysis was used to assess the influence of clinical factors and magnetic resonance imaging findings on scaled Pelvic Floor Distress Inventory and Uterine Fibroid Symptoms scores. Data were analyzed with statistical software.
RESULTS
Our cohort of 338 women had a median Pelvic Floor Distress Inventory of 72.7 (interquartile range, 41-112.3). Increased Pelvic Floor Distress Inventory score was associated with clinical factors of higher body mass index (P<.001), noncommercial insurance (P<.001), increased parity (P=.001), and a history of incontinence surgery (P=.003). Uterine volume, dominant fibroid volume, dimension and location, and fibroid tumor location relative to the bony pelvis structure did not reach significance when compared with pelvic floor symptom severity. The mean Uterine Fibroid Symptoms score was 52.0 (standard deviation, 23.5). An increased Uterine Fibroid Symptoms score was associated with dominant submucosal fibroid tumors (P=.011), body mass index (P<.0016), and a clinical history of anemia (P<.001) or any hormonal treatment for fibroid tumors (P=.009).
CONCLUSION
Contrary to common belief, in this cohort of women who sought fibroid care, size and position of fibroid tumors or uterus were not associated with pelvic floor symptom severity. Whereas, bleeding symptom severity was associated with dominant submucosal fibroid tumor and previous hormonal treatment. Careful attention to clinical factors such as body mass index and medical history is recommended when pelvic floor symptoms are evaluated in women with uterine fibroid tumors.
Topics: Adult; Anemia; Body Mass Index; Dysmenorrhea; Female; Humans; Leiomyoma; Magnetic Resonance Imaging; Menorrhagia; Parity; Pelvic Pain; Pelvimetry; Pelvis; Retrospective Studies; Severity of Illness Index; Surveys and Questionnaires; Urinary Incontinence, Urge; Uterine Neoplasms
PubMed: 30711512
DOI: 10.1016/j.ajog.2019.01.230 -
Seminars in Ultrasound, CT, and MR Jun 2017Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic... (Review)
Review
Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.
Topics: Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Pelvic Neoplasms; Pelvis
PubMed: 28705369
DOI: 10.1053/j.sult.2016.11.004 -
Acta Obstetricia Et Gynecologica... Jun 2018Levator trauma is a risk factor for the development of pelvic organ prolapse. We aimed to identify antenatal predictors for significant damage to the levator ani muscle...
INTRODUCTION
Levator trauma is a risk factor for the development of pelvic organ prolapse. We aimed to identify antenatal predictors for significant damage to the levator ani muscle during a first vaginal delivery.
MATERIAL AND METHODS
A retrospective observational study utilizing data from two studies with identical inclusion criteria and assessment protocols between 2005 and 2014. A total of 1148 primiparae with an uncomplicated singleton pregnancy were recruited and assessed with translabial ultrasound at 36 weeks antepartum and 871 (76%) returned for reassessment 3-6 months postpartum. The ultrasound data of vaginally parous women were analyzed for levator avulsion and microtrauma. The former was diagnosed if the muscle insertion at the inferior pubic ramus in the plane of minimal hiatal dimensions and within 5 mm above were abnormal on tomographic ultrasound imaging. Microtrauma was diagnosed in women with an intact levator and if there was a postpartum increase in hiatal area on Valsalva by >20% with the resultant area ≥25 cm .
RESULTS
The complete datasets of 844 women were analyzed. Among them, 609 delivered vaginally: by normal vaginal delivery in 452 (54%), a vacuum birth in 102 (12%) and a forceps delivery in 55 (6%). Levator avulsion was diagnosed in 98 and microtrauma in 97. On multivariate analysis, increasing maternal age, lower body mass index and lower bladder neck descent were associated with avulsion. Increased bladder neck descent and a family history of cesarean section (CS) were associcated with microtrauma.
CONCLUSIONS
Maternal age, body mass index, bladder neck descent and family history of CS are antenatal predictors for levator trauma.
Topics: Adolescent; Adult; Australia; Body Mass Index; Delivery, Obstetric; Female; Humans; Maternal Age; Middle Aged; Obstetric Labor Complications; Pelvic Floor; Predictive Value of Tests; Pregnancy; Retrospective Studies; Risk Factors; Ultrasonography; Ultrasonography, Prenatal
PubMed: 29393505
DOI: 10.1111/aogs.13315 -
Chirurgia (Bucharest, Romania : 1990) 2017The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults.... (Review)
Review
The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults. Fragility fractures of the pelvis are the consequence of a low-energy trauma which occurs in a patient with an important decrease of bone mineral density. Due to a consistent pattern of alteration of bone mass distribution in the sacrum, other fracture morphologies occur than in younger adults. The leading symptom is immobilizing pain in the lower back, in the buttocks, in the inguinal region and/or at the pubic symphysis. Conventional radiographs and CT will show the presence and localization of the fractures in the anterior and posterior pelvic ring. A new, comprehensive classification system distinguishes four categories of instability. This first criterion is most important, because it also gives hints for the preferred type of treatment. The second criterion, leading to the subtypes in the four categories, is the localization of the instability in the posterior pelvic ring. This criterion points the way towards the type of the surgical procedure to be used. When a surgical treatment is chosen, the procedure should be as minimal invasive as possible. Different techniques for percutaneous or less invasive fixation of the posterior pelvic ring have been developed. Their advantages and limitations are presented: sacroplasty, iliosacral screw osteosynthesis, cement augmentation, transiliac internal fixation, trans-sacral osteosynthesis, lumbopelvic fixation. Fractures of the anterior pelvic ring also need special attention. Retrograde transpubic screw fixation is recommended for pubic rami fractures. Fractures of the pubic body and instabilities of the pubic symphysis need bridging plate osteosynthesis. We do not recommend anterior pelvic external fixation in elderly because of the risk of pin track infection and pin loosening.
Topics: Aging; Bone Plates; Bone Screws; Fracture Fixation, Internal; Fracture Healing; Humans; Minimally Invasive Surgical Procedures; Osteoporotic Fractures; Pelvis; Treatment Outcome
PubMed: 29088552
DOI: 10.21614/chirurgia.112.5.524 -
Journal of Pediatric Orthopedics Apr 2023Apophyseal avulsion fractures of the pelvis and hip are common injuries in adolescent athletes. However, high volume comparative studies elucidating the spectrum of...
BACKGROUND
Apophyseal avulsion fractures of the pelvis and hip are common injuries in adolescent athletes. However, high volume comparative studies elucidating the spectrum of injuries are largely absent from the literature. The current study provides a comprehensive analysis of demographic, anatomic, pathophysiological, clinical, and athletic-related variables associated with such injuries in an extensive population of affected adolescents.
METHODS
A retrospective review was performed of records of patients presenting to a single tertiary care pediatric hospital between January 1, 2005, and July 31, 2020, collecting variables including patient sex, age, body mass index, fracture location, injury mechanism, sport at the time of injury, and duration of prodromal symptoms.
RESULTS
Seven hundred nineteen fractures were identified in 709 patients. The average patient age was 14.6, and 78% of the fractures occurred in male patients. The anterior inferior iliac spine (33.4%), anterior superior iliac spine (30.5%), and ischial tuberosity (19.4%) were the most common fracture sites. The most common injury mechanisms were running (27.8%), kicking (26.7%), and falls (8.8%). The most common sports at the time of injury were soccer (38.1%), football (11.2%), and baseball (10.5%). Fracture site was significantly associated with patient sex, age, body mass index, laterality, mechanism, sport, time from injury, and presence of prodromal symptoms. The annual volume of pelvic avulsion fractures treated at the institution increased significantly from n=17 in 2005 to n=75 in 2019.
CONCLUSIONS
Adolescent pelvic and hip avulsion fractures occur during a narrow window of age and skeletal maturation and are frequently sustained during sporting activities. Each fracture location is associated with certain demographic, mechanistic, and patient-specific characteristics. The associations between fracture site and patient-specific or injury-specific variables offer insights into the pathophysiology and possible underlying biomechanical risk factors that contribute to these injuries.
LEVEL OF EVIDENCE
This is a level III retrospective study.
Topics: Humans; Male; Adolescent; Child; Fractures, Avulsion; Retrospective Studies; Prodromal Symptoms; Fractures, Bone; Hip Fractures; Ischium; Pelvis; Athletic Injuries
PubMed: 36727766
DOI: 10.1097/BPO.0000000000002355 -
Physics in Medicine and Biology Apr 2021The delineation of the prostate and organs-at-risk (OARs) is fundamental to prostate radiation treatment planning, but is currently labor-intensive and...
The delineation of the prostate and organs-at-risk (OARs) is fundamental to prostate radiation treatment planning, but is currently labor-intensive and observer-dependent. We aimed to develop an automated computed tomography (CT)-based multi-organ (bladder, prostate, rectum, left and right femoral heads (RFHs)) segmentation method for prostate radiation therapy treatment planning. The proposed method uses synthetic MRIs (sMRIs) to offer superior soft-tissue information for male pelvic CT images. Cycle-consistent adversarial networks (CycleGAN) were used to generate CT-based sMRIs. Dual pyramid networks (DPNs) extracted features from both CTs and sMRIs. A deep attention strategy was integrated into the DPNs to select the most relevant features from both CTs and sMRIs to identify organ boundaries. The CT-based sMRI generated from our previously trained CycleGAN and its corresponding CT images were inputted to the proposed DPNs to provide complementary information for pelvic multi-organ segmentation. The proposed method was trained and evaluated using datasets from 140 patients with prostate cancer, and were then compared against state-of-art methods. The Dice similarity coefficients and mean surface distances between our results and ground truth were 0.95 ± 0.05, 1.16 ± 0.70 mm; 0.88 ± 0.08, 1.64 ± 1.26 mm; 0.90 ± 0.04, 1.27 ± 0.48 mm; 0.95 ± 0.04, 1.08 ± 1.29 mm; and 0.95 ± 0.04, 1.11 ± 1.49 mm for bladder, prostate, rectum, left and RFHs, respectively. Mean center of mass distances was within 3 mm for all organs. Our results performed significantly better than those of competing methods in most evaluation metrics. We demonstrated the feasibility of sMRI-aided DPNs for multi-organ segmentation on pelvic CT images, and its superiority over other networks. The proposed method could be used in routine prostate cancer radiotherapy treatment planning to rapidly segment the prostate and standard OARs.
Topics: Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Organs at Risk; Pelvis; Tomography, X-Ray Computed
PubMed: 33780918
DOI: 10.1088/1361-6560/abf2f9 -
Scientific Reports Jun 2023Previous research on the effects of body mass on the pelvic girdle focused mostly on adult females and males. Because the ontogenetic plasticity level in the pelvis...
Previous research on the effects of body mass on the pelvic girdle focused mostly on adult females and males. Because the ontogenetic plasticity level in the pelvis remains largely unknown, this study investigated how the association between body mass index (BMI) and pelvic shape changes during development. It also assessed how the large variation in pelvic shape could be explained by the number of live births in females. Data included CT scans of 308 humans from infancy to late adulthood with known age, sex, body mass, body stature, and the number of live births (for adult females). 3D reconstruction and geometric morphometrics was used to analyze pelvic shape. Multivariate regression showed a significant association between BMI and pelvic shape in young females and old males. The association between the number of live births and pelvic shape in females was not significant. Less plasticity in pelvic shape in adult females than during puberty, perhaps reflects adaptation to support the abdominopelvic organs and the fetus during pregnancy. Non-significant susceptibility to BMI in young males may reflect bone maturation accelerated by excessive body mass. Hormonal secretion and biomechanical loading associated with pregnancy may not have a long-term effect on the pelvic morphology of females.
Topics: Adult; Male; Pregnancy; Female; Humans; Infant; Pelvis; Lower Extremity; Body Mass Index; Body Size; Puberty
PubMed: 37322042
DOI: 10.1038/s41598-023-36703-2 -
Spine Deformity Nov 2019Retrospective review from a single institution. (Comparative Study)
Comparative Study Review
STUDY DESIGN
Retrospective review from a single institution.
OBJECTIVE
To investigate the effect of hip osteoarthritis (OA) on spinopelvic compensatory mechanisms as a result of reduced hip range of motion (ROM) between sitting and standing.
SUMMARY OF BACKGROUND DATA
Hip OA results in reduced hip ROM and contracture, causing pain during postural changes. Hip flexion contracture is known to reduce the ability to compensate for spinal deformity while standing; however, the effects of postural spinal alignment change between sitting and standing is not well understood.
METHODS
Sit-stand radiographs of patients without prior spinal fusion or hip prosthesis were evaluated. Hip OA was graded by Kellgren-Lawrence grades and divided into low-grade (LOA; grade 0-2) and severe (SOA; grade 3 or 4) groups. Radiographic parameters evaluated were pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), SVA, T1-pelvic angle (TPA), T10-L2, proximal femoral shaft angle (PFSA), and hip flexion (PT change-PFSA change). Changes in sit-stand parameters were compared between LOA and SOA groups.
RESULTS
548 patients were included (LOA = 311; SOA = 237). After propensity score matching for age, body mass index, and PI, 183 LOA and 183 SOA patients were analyzed. Standing analysis demonstrated that SOA had higher SVA (31.1 vs. 21.7), lower TK (-36.2 vs. -41.1), and larger PFSA (9.1 vs. 7.4) (all p < .05). Sitting analysis demonstrated that SOA had higher PT (29.7 vs. 23.3), higher PI-LL (21.6 vs. 12.4), less LL (31.7 vs. 41.6), less TK (-33.2 vs. -38.6), and greater TPA (27.9 vs. 22.5) (all p < .05). SOA had less hip ROM from standing to sitting versus LOA (71.5 vs. 81.6) (p < .05). Therefore, SOA had more change in PT (15.2 vs. 7.3), PI-LL (20.6 vs. 13.7), LL (-21.4 vs. -13.1), and T10-L2 (-4.9 vs. -1.1) (all p < .001), allowing the femurs to change position despite reduced hip ROM. SOA had greater TPA reduction (15.1 vs. 9.6) and less PFSA change (86.7 vs. 88.8) compared with LOA (both p < .001).
CONCLUSIONS
Spinopelvic compensatory mechanisms are adapted for reduced hip joint motion associated with hip OA in standing and sitting.
LEVEL OF EVIDENCE
Level III.
Topics: Aged; Arthroplasty, Replacement, Hip; Female; Hip Contracture; Humans; Kyphosis; Lordosis; Male; Middle Aged; Osteoarthritis, Hip; Pain; Pelvis; Postural Balance; Posture; Radiography; Range of Motion, Articular; Retrospective Studies; Sitting Position; Spinal Fusion; Spine; Standing Position; Thoracic Vertebrae
PubMed: 31732003
DOI: 10.1016/j.jspd.2019.03.007