Considering the increasing rate of cesarean delivery and the increased risk of CSEPs, sonologists should be familiar with the sonographic appearances of a pregnancy implanted into the cesarean scar. We show how to correctly diagnose scar implantation and describe how to perform sonographically guided transcervical injection of MTX.

Round ligament varices (RLV) are an important clinical

Object or purpose of study: As the field of view of cardiac magnetic resonance imaging (CMR) includes the thorax and upper abdomen, it is not surprising that these studies can reveal incidental extra-cardiac abnormalities. The purpose of this study is to determine the prevalence of these incidental findings.Materials, Methods and Procedures: 132 volunteer participants with a mean age of 74.2 years (range, 61-89 years; 127 males and 5 females) had CMR with 7 sequences. All images were retrospectively reviewed by a radiologist, specifically assessing for non-cardiac findings. Visualized abnormalities were noted and categorized according to significance. Clinically significant findings were defined as those requiring further clinical or radiological work-up, with moderately significant findings defined as those that may affect patient care depending on medical history or symptoms. Remaining findings were considered clinically insignificant.Results: Within the group, 107 participants (81%) had extra-cardiac findings, with 63 (48%) having multiple findings. A total of 224 incidental findings were visualized, with at least one clinically significant and moderately significant finding found in 23 (17%) and 43 (33 %) of the subjects, respectively. Potentially clinically significant findings included pulmonary nodules, solid or complex lesions of the solid abdominal viscera and thyroid, and aortic pathology including aneurysm. The most prevalent incidental findings were however benign appearing, including renal and hepatic cysts, hemangiomas, and atelectasis. The SSFP coronal localizer, SSFP axial localizer, and short axis SSFP cine oblique sequences were most sensitive at detecting incidental findings (p = 0.013 vs four other sequences) with 47%, 46%, and 41% detection respectively, with no significant difference between these three multislice sequences (p = 0.369). Significance of the conclusions:In total, 81% of our volunteers had extra-cardiac findings, of which 17% were potentially clinically significant, necessitating further work up. We believe that these numbers appear high compared to prior similar studies performed at Cardiac CT. This may be related to the relatively older cohort examined here. In conclusion it is important to look beyond the heart when reviewing cardiac MRI studies and carefully assess the entire field of view for abnormalities.

Purpose-To retrospectively determine if pretreatment endorectal magnetic resonance (MR) imaging findings are predictive of outcome in patients who undergo external-beam radiation therapy for prostate cancer.Materials and Methods-Committee on Human Research approval, with waiver of the requirement for informed consent, was obtained for this HIPAA-compliant study. Eighty men with biopsy-proved prostate cancer (mean age, 59 years; range, 47-75 years) who underwent endorectal MR imaging of the prostate prior to external-beam radiation therapy were retrospectively identified; details of baseline tumor characteristics, treatment, and outcome were recorded. Two experienced readers independently reviewed all MR imaging studies and recorded tumor T stage and the radial diameter of extracapsular extension (if present). Univariate and multivariate stepwise Cox regression analyses were used to investigate the relationship between baseline imaging and clinical predictive variables and the end point of metastatic failure.Results-At MR imaging, readers 1 and 2, respectively, considered 50 and 60 patients to have T1 or T2 disease (ie, organ-confined disease) and 30 and 20 patients to have T3 disease. After a mean follow-up of 43 months, four patients developed metastases. Univariate Cox analysis revealed that baseline serum prostate-specific antigen level, presence of extracapsular extension at MR imaging (according to either reader), and degree of extracapsular extension (according to either reader) were all significantly (P < .05) related to the development of metastases. Multivariate Cox analysis revealed that the sole independent predictive variable was mean diameter of extracapsular extension (relative hazard ratio, 2.06; 95% confidence interval: 1.22, 3.48; P = .007). In particular, three of five patients with extracapsular extension of more than 5 mm at pretreatment MR imaging developed metastases 24, 43, and 63 months after therapy. Conclusion-The presence and degree of extracapsular extension at MR imaging prior to external-beam radiation therapy are important predictors of posttreatment metastatic recurrence.

Purpose To evaluate whether pretreatment combined endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) findings are predictive of outcome in patients who undergo external beam radiotherapy for prostate cancer. Methods and Materials We retrospectively identified 67 men with biopsy-proven prostate cancer who underwent combined endorectal MRI and MRSI at our institution between January 1998 and October 2003 before whole-pelvis external beam radiotherapy. A single reader recorded tumor presence, stage, and metabolic abnormality at combined MRI and MRSI. Kaplan-Meier survival and Cox univariate and multivariate analyses explored the relationship between clinical and imaging variables and outcome, using biochemical or metastatic failure as endpoints. Results After a mean follow-up of 44 months (range, 3–96), 6 patients developed both metastatic and biochemical failure, with an additional 13 patients developing biochemical failure alone. Multivariate Cox analysis demonstrated that the only independent predictor of biochemical failure was the volume of malignant metabolism on MRSI (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.29–2.06; p < 0.0001). The two independent predictors of metastatic failure were MRI tumor size (HR 1.34, 95% CI 1.03–1.73; p = 0.028) and the finding of seminal vesicle invasion on MRI (HR 28.05, 95% CI 3.96–198.67; p = 0.0008). Conclusions In multivariate analysis, MRI and MRSI findings before EBRT in patients with prostate cancer are more accurate independent predictors of outcome than clinical variables, and in particular, the findings of seminal vesicle invasion and extensive tumor predict a worse prognosis.