The Study Of MR Findings In Tubo-ovarian Abscess

Magnetic resonance imaging (MRI), referred magnetic resonance, or NMR, was developed for a new imaging technology from 80's. The first MRI machine was income in 1985 in China, form then on, there were more than 1000 machines using for clinical application. Now more and more physicians recognized the diagnosis value of various diseases in MR. Its use became more and more widely. With its imaging characteristics, such as multi-parameter, multi-sequence, multi-dimensional, high resolution imaging in the soft tissue, and with its advantages at the other places, such as magnetic resonance hydrography, MR angiography, functional magnetic resonance imaging, and magnetic resonance spectroscopic imaging, MR had been widely used in the general system checking and disease diagnosis. For pelvic area in gynecologic, MRI is mainly used to inspect for uterine and ovarian cancer at present. It was least applied to the fallopian tube abscess. Therefore this study discussed the application of MRI for tubo-ovarian abscesses.Objective:Using the technique of magnetic resonance (MR) both in common and in contrast, and the methods of Multiplan imaging, to explore the characteristics of MR imaging, and the diagnostic value and limit of MR exam.1. Materials and methods:1.1 Clinical materials:In our study,20 patients with tubo-ovarian abscesses, examined by MR and confirmed by surgery and pathology, were collected from our hospital from January 2004 to September 2009, between 27 to 52 years old, with the mean age of 40.2 years old.1.2 Clinical representations:12 patients with hypogastria pain,6 of which in acute course and the other 6 in chronic course.3 patients with fever; 4 patients accompanied with frequency and urgency of micturition, or falling and swelling sense in the anus.3 patients had increased vaginal secretions, and 2 patients with smell. The other eight asymptomatic patients were found pelvic cavity masses in health examination.1.3 Physical examination:17 patients had been found masses in adnexa regions when palpated, with 4 cases in poor activity,8 cases pressing local pain; 5 patients pressing pain in adnexa region and cervical lifting pain.1.4 Laboratory examinations:Tumour markers elevated in 7 patients, including 2 cases of CEA and 2 cases of CA-125.1.5 Ultrasonography:Ultrasonography was done in 13 out of 20 cases in this study, with 4 cases of simple solitary cyst,9 cases of mixed echo or solid cystic masses.2. Equipments and methods:2.1 Equipments and contrast:Equipments:Siemens Symphony 1.5T superconducting MR machine (Siemens, German); high press inject with binocular tube (MEDRAD, US) Contrast:Gadolinium diethylene triaminepentha acetate (Gd-DTPA) (469.01mg/ml).2.2 Scanning techniques:MR in common:Cross section in Tl-weighted images (T1WI) and T2-weighted images (T2WI), sagittal plane and coronal plane in T2-weighted images were taken in the text. T1WI used spin echo (SE), T1WI-FS used inversion recovery-fast low angle shot imaging (Flash-3D), T2WI used fast spin echo (FSE). MR in contrast:T1-weighted images scans were performed in cross-section sagittal plane and axial plane with fat suppression in the same parameters as the common scans.2.3 Indicators of evaluation:Mainly observe the location, number, size, morphology margin of lesions, signal changes, enhanced features, adjacent organs and tissue changes.3. Results:15 cases were diagnosed as tubo-ovarian abscess with MR before operation,2 cases suspected as benign adnexal neoplasm,3 cases misdiagnosed as ovarian tumor. 20 cases were confirmed by surgery.27 abscesses were found in pathology, including 10 abscesses in left fallopian tube and 17 abscesses in the right side (7 abscesses with bilateral ones).17 cases showed simple tubal empyema; 3 cases presented with complication of ovarian or pelvic abscess. Besides, abscess lessions in the contralateral adnexal regions were not detected by MR in 4 cases, but were confirmed by surgery and pathology.3.1 direct manifestation:The most cases showed one or more than one bead-like or tube-like, cystic or solid-cystic masses in the adnexal regions, with kinds of different sizes, the biggest about 8.2cm×5.6cm×7.2cm, and as small as about 0.5cm×0.3cm. A majority of components in the capsule showed low signal in T1-weighted images and a minority displayed high signal or mixed signals in Tl-weighted images, high signal in T2-weighted images in all. Walls of capsule had equal signals in both T1-weighted and T2-weighted, or slightly longer signals in T1-weighted and slightly shorter in T2-weighted. When reinforced, the components of capsules had no enhanced; Capsule wall of purely hydrosalpinx was thin and without enhancement. Capsule walls in purulent lesions showed uniform thickness, ranging from 0.3 to 1.4 cm and had significant enhancement.1 case showed soft tisuue signal in both T1-weighted and T2-weighted in the adnexal regions, showed obvious enhancement.3.2 indirect manifestations:Flocculation and cord-like exudation shadow was seen by the side of abscess, and could be enhanced when enhanced. Abscess was adhered to uterine and intestinal canal, and sometimes companied with abscesses in Douglas pouch and the ovary; the surrounding organs were displaced due to compression. Combined tubule hemorrhage.3.3 during surgery:hyperemia and swelling could be found in the fallopian tubes on the impaired side, which were adhered to and packed by intestinal canals and ovary. Posterial wall of uterine was adhered to rectum, with clausura in the fimbriated extremity of fallopian, expansion of tubal diameter, sauage-like effusion. When isolated, puris leaked from split fallopian tubes, and congestion was seen in the ovary on the impaired side, with pelvic cavity abscess and fluid collection.Conclusion:1. MRI examination has many advantages, including imaging at multi-direction and high resolving power in the soft tissue, so as to display the morphology, signal changes and signal characteristics. It can be used as the first diagnostic method for ovarian diseases.2. Characteristic manifestion of MR in tubo ovarian abscesses is the bead-like; cystic lesions in bilateral or monolateral adnexal regions.3. tumour markers could be auxiliary for the differential diagnosis of tumourous lesions and non-tumourous lesion, but they are not specific, since some gynecological diseases may also have the evlevated markers.4. laparoscope and pathological diangosis should be performed in the following situations:when slight inflammation doesn't change the morphological changes of fallopian tubes or causes slight changes;when MR doesn't show lesions;or when lesions are not so typical to differentiate with ovarian lesions.