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Radiographics : a Review Publication of... 2017Soft-tissue sarcomas occurring in the abdomen and pelvis are an uncommon but important group of malignancies. Recent changes to the World Health Organization... (Review)
Review
Soft-tissue sarcomas occurring in the abdomen and pelvis are an uncommon but important group of malignancies. Recent changes to the World Health Organization classification of soft-tissue tumors include the movement of gastrointestinal stromal tumors (GISTs) into the soft-tissue tumor classification. GIST is the most common intraperitoneal sarcoma. Liposarcoma is the most common retroperitoneal sarcoma, and leiomyosarcoma is the second most common. GIST, liposarcoma, and leiomyosarcoma account for the majority of sarcomas encountered in the abdomen and pelvis and are discussed in part 1 of this article. Undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma), dermatofibrosarcoma protuberans, solitary fibrous tumor, malignant peripheral nerve sheath tumor, rhabdomyosarcoma, extraskeletal chondro-osseous sarcomas, vascular sarcomas, and sarcomas of uncertain differentiation uncommonly arise in the abdomen and pelvis and the abdominal wall. Although these lesions are rare sarcomas and their imaging features overlap, familiarity with the locations where they occur and their imaging features is important so they can be diagnosed accurately. The anatomic location and clinical history are important factors in the differential diagnosis of these lesions because metastasis, more-common sarcomas, borderline fibroblastic proliferations (such as desmoid tumors), and endometriosis have imaging findings that overlap with those of these uncommon sarcomas. In this article, the clinical, pathologic, and imaging findings of uncommon soft-tissue sarcomas of the abdomen and pelvis and the abdominal wall are reviewed, with an emphasis on their differential diagnosis.
Topics: Abdomen; Diagnosis, Differential; Humans; Pelvis; Sarcoma
PubMed: 28493803
DOI: 10.1148/rg.2017160201 -
Medical Physics Apr 2022Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver,...
Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion-weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal-to-noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.
Topics: Abdomen; Artifacts; Diffusion Magnetic Resonance Imaging; Humans; Male; Pelvis; Reproducibility of Results
PubMed: 34554579
DOI: 10.1002/mp.15246 -
American Journal of Obstetrics and... Mar 2024It seems puzzling why humans have evolved such a small and rigid birth canal that entails a relatively complex process of labor compared with the birth canal of our... (Review)
Review
It seems puzzling why humans have evolved such a small and rigid birth canal that entails a relatively complex process of labor compared with the birth canal of our closest relatives, the great apes. This study reviewed insights into the evolution of the human birth canal from recent theoretical and empirical studies and discussed connections to obstetrics, gynecology, and orthopedics. Originating from the evolution of bipedality and the large human brain million years ago, the evolution of the human birth canal has been characterized by complex trade-off dynamics among multiple biological, environmental, and sociocultural factors. The long-held notion that a wider pelvis has not evolved because it would be disadvantageous for bipedal locomotion has not yet been empirically verified. However, recent clinical and biomechanical studies suggest that a larger birth canal would compromise pelvic floor stability and increase the risk of incontinence and pelvic organ prolapse. Several mammals have neonates that are equally large or even larger than human neonates compared to the size of the maternal birth canal. In these species, the pubic symphysis opens widely to allow successful delivery. Biomechanical and developmental constraints imposed by bipedality have hindered this evolutionary solution in humans and led to the comparatively rigid pelvic girdle in pregnant women. Mathematical models have shown why the evolutionary compromise to these antagonistic selective factors inevitably involves a certain rate of fetopelvic disproportion. In addition, these models predict that cesarean deliveries have disrupted the evolutionary equilibrium and led to new and ongoing evolutionary changes. Different forms of assisted birth have existed since the stone age and have become an integral part of human reproduction. Paradoxically, by buffering selection, they may also have hindered the evolution of a larger birth canal. Many of the biological, environmental, and sociocultural factors that have influenced the evolution of the human birth canal vary globally and are subject to ongoing transitions. These differences may have contributed to the global variation in the form of the birth canal and the difficulty of labor, and they likely continue to change human reproductive anatomy.
Topics: Animals; Infant, Newborn; Humans; Pregnancy; Female; Biological Evolution; Hominidae; Pelvis; Cesarean Section; Labor, Obstetric; Pelvic Floor; Mammals
PubMed: 38462258
DOI: 10.1016/j.ajog.2022.09.010 -
Investigative Radiology Dec 2019Balanced steady-state free precession-based quiescent-interval slice-selective (bSSFP QISS) magnetic resonance angiography (MRA) is accurate for the noncontrast...
Free-Breathing Fast Low-Angle Shot Quiescent-Interval Slice-Selective Magnetic Resonance Angiography for Improved Detection of Vascular Stenoses in the Pelvis and Abdomen: Technical Development.
OBJECTIVES
Balanced steady-state free precession-based quiescent-interval slice-selective (bSSFP QISS) magnetic resonance angiography (MRA) is accurate for the noncontrast evaluation of peripheral arterial disease (PAD); however, drawbacks include the need for breath-holding when imaging the abdomen and pelvis, and sensitivity to off-resonance artifacts. The purpose of this study was to evaluate the image quality and diagnostic accuracy in the pelvis and abdomen of free-breathing fast low-angle shot-based QISS (FLASH QISS) techniques in comparison to bSSFP QISS in patients with PAD, using computed tomographic angiography as the reference.
MATERIALS AND METHODS
Twenty-seven patients (69 ± 10 years, 17 men) with PAD were enrolled in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study between April and December 2018. Patients underwent noncontrast MRA using standard bSSFP QISS and prototype free-breathing radial-FLASH and Cartesian-FLASH QISS at 3 T. A subset of patients (n = 22) also underwent computed tomographic angiography as the reference standard. Nine arterial segments per patient were evaluated spanning the abdomen, pelvis, and upper thigh regions. Objective (signal intensity ratio and relative standard deviation) and subjective image quality (4-point scale) and stenosis (>50%) were evaluated by 2 readers and compared using one-way analysis of variance, Wilcoxon, and McNemar tests, respectively.
RESULTS
A total of 179 vascular segments were available for analysis by all QISS techniques. No significant difference was observed among bSSFP, radial-FLASH, and Cartesian-FLASH QISS techniques in signal intensity ratio (P = 0.428) and relative standard deviation (P = 0.220). Radial-FLASH QISS demonstrated the best image quality (P < 0.0001) and the highest interreader agreement (κ = 0.721). The sensitivity values of bSSFP, radial-FLASH, and Cartesian-FLASH QISS for the detection of greater than 50% stenosis were 76.0%, 84.0%, and 80.0%, respectively, whereas specificity values were 97.6%, 94.0%, and 92.8%, respectively. Moreover, FLASH QISS consistently reduced off-resonance artifacts compared with bSSFP QISS.
CONCLUSIONS
Free-breathing FLASH QISS MRA techniques provide improved image quality and sensitivity, high specificity, and reduced off-resonance artifacts for vascular stenosis detection in the abdomen and pelvis.
Topics: Abdomen; Aged; Arterial Occlusive Diseases; Artifacts; Constriction, Pathologic; Female; Humans; Magnetic Resonance Angiography; Male; Pelvis; Prospective Studies; Reproducibility of Results; Respiration; Sensitivity and Specificity
PubMed: 31299678
DOI: 10.1097/RLI.0000000000000592 -
Journal of Orthopaedics and... Oct 2021Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the...
INTRODUCTION
Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the seventies in neurosurgery and spine surgery. Nowadays, IONM has gained popularity in other surgical specialities including orthopaedic and trauma surgery. Aim of this systematic review is to resume the literature evidences about the effectiveness of intraoperative monitoring of sciatic nerve during pelvic and hip surgery.
METHODS
Two reviewers (GC and MD) independently identified studies by a systematic search of PubMed and Google Scholar from inception of database to 10 January 2021. Inclusion criteria were: (a) English written papers, (b) use of any type of intraoperative nerve monitoring during traumatic or elective pelvic and hip surgery, (c) comparison of the outcomes between patients who underwent nerve monitoring and patient who underwent standard procedures, (d) all study types including case reports. The present review was conducted in accordance with the 2009 PRISMA statement.
RESULTS
The literature search produced 224 papers from PubMed and 594 from Google Scholar, with a total amount of 818 papers. The two reviewer excluded 683 papers by title or duplicates. Of the 135 remaining, 72 were excluded after reading the abstract, and 31 by reading the full text. Thus, 32 papers were finally included in the review.
CONCLUSIONS
The use of IONM during hip and pelvis surgery is debated. The review results are insufficient to support the routine use of IONM in hip and pelvis surgery. The different IONM techniques have peculiar advantages and disadvantages and differences in sensitivity and specificity without clear evidence of superiority for any. Results from different studies and different interventions are often in contrast. However, there is general agreement in recognizing a role for IONM to define the critical maneuvers, positions or pathologies that could lead to sciatic nerve intraoperative damage.
LEVEL OF EVIDENCE
Level 2.
Topics: Humans; Monitoring, Intraoperative; Neurosurgical Procedures; Orthopedics; Pelvis; Retrospective Studies
PubMed: 34647237
DOI: 10.1186/s10195-021-00605-8 -
Journal of Visceral Surgery Dec 2017Severe pelvic traumatisms are associated with elevated mortality because of the high risk of exsanguination from multiple sources of bleeding. Treatment should encompass...
Severe pelvic traumatisms are associated with elevated mortality because of the high risk of exsanguination from multiple sources of bleeding. Treatment should encompass resuscitation, bone stabilization and hemorrhage control by arterio-embolization or surgery. Pre-peritoneal packing has been described in hemodynamically unstable patients who need damage control. The surgical technique of this simple and effective procedure is fully described by the authors with some complementary useful technical advices.
Topics: Hemostatic Techniques; Humans; Pelvis; Resuscitation; Wound Closure Techniques
PubMed: 28964845
DOI: 10.1016/j.jviscsurg.2017.08.006 -
Diagnostic and Interventional Radiology... 2017This pictorial review aims to discuss and illustrate the up-to-date use of preprocedural magnetic resonance imaging (MRI) in selecting patients and planning uterine... (Review)
Review
This pictorial review aims to discuss and illustrate the up-to-date use of preprocedural magnetic resonance imaging (MRI) in selecting patients and planning uterine artery embolization (UAE). The merits of magnetic resonance angiography (MRA) in demonstrating the pelvic vasculature to guide UAE are highlighted. MRI features of fibroids and their main differential diagnoses are presented. Fibroid characteristics, such as location, size, and enhancement, which may impact patient selection and outcome, are presented based on recent literature. Pelvic arterial anatomy relevant to UAE, including vascular variants are illustrated, with conventional angiography and MRA imaging correlation. MRA preprocedural determination of the optimal projection angles for uterine artery catheterization is straightforward and constitutes an important strategy to minimize ionizing radiation exposure during UAE. A reporting template for MRI/MRA preassessement of UAE for fibroid treatment is provided.
Topics: Diagnosis, Differential; Female; Humans; Leiomyoma; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Pelvis; Treatment Outcome; Uterine Artery Embolization
PubMed: 28163256
DOI: 10.5152/dir.2016.16623 -
European Spine Journal : Official... Sep 2011The role of the pelvic area in sagittal balance is evident for spinal surgeons, but the influence of the coxofemoral joint is underestimated and inadequately explained... (Review)
Review
INTRODUCTION
The role of the pelvic area in sagittal balance is evident for spinal surgeons, but the influence of the coxofemoral joint is underestimated and inadequately explained by conventional imagery. Comprehensive analysis of the pelvic and subpelvic sectors as part of the sagittal, frontal and cross-sectional balance of the trunk sheds new light on some spinal diseases and their relation to the pelvis.
METHODS
This analysis, based on innovative radiologic methods as the EOS(®) technology but also on a new look at conventional imaging makes it possible to better analyze standing lateral images and seated images.
RESULTS
Disturbances can come from atypical morphotypes or from unusual postures as in aging spine. The measurement of available extension and the concept of available flexion provide new information regarding individual's adaptation to the imbalance induced by disorders of the spine or lower limbs.
CONCLUSION
A comprehensive assessment of each patient and in particular of the complex comprising the spine and the pelvis, is essential for understanding each individual's adaptation to the imbalance induced by disorders of the spine or lower limbs.
Topics: Hip Joint; Humans; Pelvis; Postural Balance; Radiography; Spinal Diseases; Spine
PubMed: 21796392
DOI: 10.1007/s00586-011-1937-9 -
BMC Medical Informatics and Decision... Apr 2022There is progress to be made in building artificially intelligent systems to detect abnormalities that are not only accurate but can handle the true breadth of findings...
BACKGROUND
There is progress to be made in building artificially intelligent systems to detect abnormalities that are not only accurate but can handle the true breadth of findings that radiologists encounter in body (chest, abdomen, and pelvis) computed tomography (CT). Currently, the major bottleneck for developing multi-disease classifiers is a lack of manually annotated data. The purpose of this work was to develop high throughput multi-label annotators for body CT reports that can be applied across a variety of abnormalities, organs, and disease states thereby mitigating the need for human annotation.
METHODS
We used a dictionary approach to develop rule-based algorithms (RBA) for extraction of disease labels from radiology text reports. We targeted three organ systems (lungs/pleura, liver/gallbladder, kidneys/ureters) with four diseases per system based on their prevalence in our dataset. To expand the algorithms beyond pre-defined keywords, attention-guided recurrent neural networks (RNN) were trained using the RBA-extracted labels to classify reports as being positive for one or more diseases or normal for each organ system. Alternative effects on disease classification performance were evaluated using random initialization or pre-trained embedding as well as different sizes of training datasets. The RBA was tested on a subset of 2158 manually labeled reports and performance was reported as accuracy and F-score. The RNN was tested against a test set of 48,758 reports labeled by RBA and performance was reported as area under the receiver operating characteristic curve (AUC), with 95% CIs calculated using the DeLong method.
RESULTS
Manual validation of the RBA confirmed 91-99% accuracy across the 15 different labels. Our models extracted disease labels from 261,229 radiology reports of 112,501 unique subjects. Pre-trained models outperformed random initialization across all diseases. As the training dataset size was reduced, performance was robust except for a few diseases with a relatively small number of cases. Pre-trained classification AUCs reached > 0.95 for all four disease outcomes and normality across all three organ systems.
CONCLUSIONS
Our label-extracting pipeline was able to encompass a variety of cases and diseases in body CT reports by generalizing beyond strict rules with exceptional accuracy. The method described can be easily adapted to enable automated labeling of hospital-scale medical data sets for training image-based disease classifiers.
Topics: Abdomen; Deep Learning; Humans; Neural Networks, Computer; Pelvis; Tomography, X-Ray Computed
PubMed: 35428335
DOI: 10.1186/s12911-022-01843-4 -
Radiation Protection Dosimetry Feb 2024Projection radiography is the most common radiological modality, and radiation safety of it concerns both radiation workers and the public. We measured and generated a...
Projection radiography is the most common radiological modality, and radiation safety of it concerns both radiation workers and the public. We measured and generated a series of scattered radiation maps for projection radiography and estimated effective doses of the supporting person during exposure. Measured adult patient protocols included chest posterior-anterior, chest lateral, pelvis anterior-posterior (AP), abdomen AP and bedside chest AP. Maps concretise spatial distribution and the scattered radiation dose rates in different imaging protocols. Highest and lowest rates were measured in abdomen AP and bedside chest AP protocols, respectively. The effective dose of supporting person in abdomen AP examination at distance of 0.5 m was 300 nSv and in bedside supine chest AP examination at distance of 0.7 m was 0.5 nSv. The estimated annual effective dose of emergency unit radiographer was 0.11 mSv. The obtained effective dose values are small compared to annual dose limits of radiation workers and the public.
Topics: Adult; Humans; X-Rays; Radiation Dosage; Radiography; Pelvis; Physical Examination; Radiography, Thoracic
PubMed: 37939724
DOI: 10.1093/rpd/ncad275