Susan M Ascher

• Chair at Georgetown University

Clinically Suspected Adnexal Mass, No Acute Symptoms: 2023 Update

Uterine fibroids (leiomyomas or myomas) are the most common neoplasm of the uterus. Though incompletely understood, fibroid etiology is multifactorial, a combination of genetic alterations and endocrine, autocrine, environmental, and other factors such as race, age, parity, and body mass index. Black women have greater than an 80% incidence of fibr...

Adenomyosis poses an important diagnostic and therapeutic challenge in women’s health because of a variety of clinical/imaging presentations and frequent coexistence with other benign gynecologic conditions. In recent years, uterine artery embolization (UAE) for the treatment of adenomyosis has shown encouraging and favorable outcomes and long-term...

Acute pelvic pain is a common presenting complaint in both the emergency room and outpatient settings. Pelvic pain of gynecologic origin in postmenopausal women occurs less frequently than in premenopausal women; however, it has important differences in etiology. The most common causes of postmenopausal pelvic pain from gynecologic origin are ovari...

This publication summarizes the relevant literature for the imaging of patients with symptoms of abnormal uterine bleeding, including initial imaging, follow-up imaging when the original ultrasound is inconclusive, and follow-up imaging when surveillance is appropriate. For patients with abnormal uterine bleeding, combined transabdominal and transv...

Postpartum hemorrhage (PPH) can be categorized as primary or early if occurring in the first 24 hours after delivery, whereas late or delayed PPH occurs between 24 hours and 6 weeks. Most of the causes of PPH can be diagnosed clinically, but imaging plays an important role in the diagnosis of many causes of PPH. Pelvic ultrasound (transabdominal an...

The most common known causes of female infertility are male factor (26%), ovulatory failure (21%), and tubal damage (14%), while in 28% a couple’s infertility remains unexplained. Female-specific causes of infertility include deterioration of oocyte quality with increasing maternal age; ovulatory disorders, most notably polycystic ovarian syndrome;...

The ACR Incidental Findings Committee (IFC) presents recommendations for managing adnexal masses incidentally detected on CT and MRI. These recommendations represent an update of those provided in our previous JACR 2013 white paper. The Adnexal Subcommittee, which included six radiologists with subspecialty expertise in abdominal imaging or ultraso...

Magnetic resonance imaging (MRI) plays an increasingly important role in the evaluation of patients with adnexal disease. This chapter describes the MRI appearance of a variety of benign and malignant adnexal disease. Congenital abnormalities of the ovaries include complete and mixed gonadal dysgenesis as well as true and pseudohermaphroditism. The...

To determine the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis during pregnancy in a multi-institutional study. In this multicenter retrospective study, pregnant females who underwent MRI evaluation of abdominal or pelvic pain and had clinical suspicion of acute appendicitis between June 1, 2009 a...

Endometriosis is defined as the presence of endometrial tissue outside of the uterus. It is a common cause of pelvic pain and infertility among reproductive age women. Although laparoscopy remains the reference standard for diagnosis, this invasive procedure provides little information on subperitoneal extent of disease or areas hidden by adhesions...

Although magnetic resonance imaging is often able to distinguish between adenomyosis and fibroids, occasionally the imaging features of focal adenomyosis and fibroids overlap. Diffusion-weighted imaging (DWI) may provide useful information in differentiating pathologies. Therefore, the purpose of our study was to evaluate differences, if any, in th...

To compare uterine peristalsis between symptomatic fibroid patients and normal subjects and to determine the possible effect of fibroid characteristics on uterine peristalsis at high-field magnetic resonance imaging (MRI). The present study included 20 symptomatic fibroid patients (age range 39-53 years) and 20 normal subjects (age range 19-46 year...

This white paper describes adnexal (ovarian and paraovarian) incidental findings found on CT and MRI in nonpregnant postmenarchal patients in whom no adnexal disorder is clinically known or suspected. This represents the first of 4 such papers from the ACR Incidental Findings Committee II, which used a consensus method based on repeated reviews and...

LEARNING OBJECTIVES 1) To analyze published studies on uterine artery embolization (UAE) for women with symptomatic fibroids to include symptomatic relief, durability, fertility and cost effectiveness. 2) To comprehend the role of MR, to include protocol and interpretation pearls and pitfalls, for potential UAE candidates. 3) To interpret MR images...

Uterine fibroid embolization (UFE) has become established as an accepted minimally invasive treatment for uterine fibroids and should be considered a treatment option for patients with symptomatic uterine fibroids. It is important for diagnostic radiologists to understand the procedure, since imaging is a key component in the evaluation and care of...

LEARNING OBJECTIVES 1) To analyze published studies on uterine artery embolization (UAE) for women with symptomatic fibroids to include symptomatic relief, durability, fertility and cost effectiveness. 2) To comprehend the role of MR, to include protocol and interpretation pearls and pitfalls, for potential UAE candidates. 3) To interpret MR images...

LEARNING OBJECTIVES 1) Be familiar with the potential advantages of 3D T2-W SPACE for gynecologic imaging. 2) To protocol a 3D T2 SPACE exam recognizing tradeoffs in imaging parameters. 3) The potential challenges of 3D T2-W SPACE for gynecologic imaging.

PURPOSE To compare uterine peristalsis between fibroid patients and normal subjects to determine effect of fibroids on uterine contractility at high field MRI. METHOD AND MATERIALS 20 symptomatic fibroid patients (ages: 39–53) and 20 normal subjects (ages; 19-46.) were included in the study. MR images were obtained at the peri-ovulatory phase with...

Magnetic resonance (MR) imaging is a well-established modality for the evaluation of the female pelvis. Accepted clinical applications at 1.5T include staging of gynecologic malignancies, evaluation of congenital uterine anomalies, evaluation pre and post uterine artery embolization, evaluation of adnexal masses, and problem-solving difficult cases...

The purpose of this article is to compare uterine peristalsis before and after uterine artery embolization (UAE) on a 3-T MRI system. MRI scans were prospectively performed for 20 women with symptomatic uterine fibroids (age range, 39-53 years) before and after UAE in the periovulatory phase with a 3-T scanner. Sagittal T2 turbo spin-echo sequences...

LEARNING OBJECTIVES 1) Be familiar with the potential advantages of 3D T2-W SPACE for gynecologic imaging. 2) To protocol a 3D T2 SPACE exam recognizing tradeoffs in imaging parameters. 3) The potential challenges of 3D T2-W SPACE for gynecologic imaging.

LEARNING OBJECTIVES 1) The anatomy of the pelvis to determine the origin of a cystic pelvic mass. 2) Classify and diagnose common nongynecologic cystic pelvic masses that may mimic ovarian pathology. ABSTRACT http://radiology.georgetown.edu/ URL's http://radiology.georgetown.edu/

Advances in cross-sectional imaging have led to an increasingly important role for radiology in the management of malignant gynecological conditions. A number of imaging modalities can be used to evaluate malignant diseases of the female pelvis, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emis...

LEARNING OBJECTIVES 1) To understand the anatomy of the pelvis to determine the origin of a cystic pelvic mass. 2) To classify and diagnose common non-gynecologic cystic pelvic masses that may mimic ovarian pathology. URL's http://radiology.georgetown.edu/research/

PURPOSE The purpose of this study was to determine if there are MR imaging characteristics that could reliably distinguish uterine sarcoma from leiomyoma. METHOD AND MATERIALS MR images from pathology proven cases of uterine sarcoma were identified at Georgetown University Hospital (GUH), Addenbrookes Hospital Cambridge, and multiple hospitals in...

LEARNING OBJECTIVES Review latest in patient safety issues in US, in CT and in MR. ABSTRACT URL's http://gumc.georgetown.edu/departments/radiology/

Tamoxifen is a selective estrogen receptor modulator (SERM) that is widely used in the treatment of patients with breast cancer and for chemoprophylaxis in high risk women. Tamoxifen results in a spectrum of abnormalities involving the genital tract, the most significant being an increased incidence of endometrial cancer and uterine sarcoma. This a...

To prospectively determine cancer yield, callback and biopsy rates, and positive predictive value (PPV) of mammography, magnetic resonance (MR) imaging, and ultrasonography (US) in women at high risk for breast cancer. The study was approved by the institutional review board and was HIPAA compliant, and informed consent was obtained. We conducted a...

Magnetic resonance imaging is commonly used for the identification and characterization of many pelvic abnormalities. Magnetic resonance provides the most comprehensive and detailed view of the uterus of any imaging modality. This article focuses on the magnetic resonance imaging features used to recognize and describe congenital uterine anomalies...

A multidisciplinary UAE RCP was convened to develop a prioritized research agenda for uterine embolization and related topics. The panel recommended the development of a protocol tentatively entitled "Impact of Uterine Embolization and Myomectomy on Ovarian and Endometrial Function." Accordingly, this prioritized research project will be the subjec...

Develop a fully automated, objective method for evaluating morphology on breast magnetic resonance (MR) images and evaluate effectiveness of the new morphologic method for detecting breast cancers. We present a new automated method (morphologic blooming) for identifying and classifying breast lesions on MR that measures margin sharpness, a characte...

Our objective was to describe the MRI features of patients with pure or dominant adenomyosis treated with uterine artery embolization (UAE) and to correlate imaging features with symptoms. Nineteen patients with symptomatic pure or dominant adenomyosis on MRI were referred for UAE. All 19 patients had repeat MRI 4 months after UAE. The MR images ob...

Transvaginal Sonography (TVS) is often the initial imaging exam used when evaluating the female genital tract. However, if the TVS is suboptimal or non-diagnostic, or if additional information is needed, magnetic resonance imaging (MRI) should be considered. MRI is advantageous because of its multiplanar capability, high spatial and contrast resolu...

LEARNING OBJECTIVES ABSTRACT

Uterine artery embolization (UAE) is an increasingly performed, minimally invasive alternative to hysterectomy or myomectomy for women with symptomatic uterine fibroids. A growing body of literature documents symptomatic improvement in the majority of women who undergo UAE. Although UAE is usually safe and effective, there are a number of known com...

PURPOSE To assess the ability of MRA in detecting the presence of ovarian collateral arteries as compared to conventional angiography in patients prior to uterine artery embolization (UAE) for uterine leiomyomata. METHOD AND MATERIALS Ovarian collateral arteries were detected by conventional angiography in nineteen patients (mean age: 44 y) during...

LEARNING OBJECTIVES By the conclusion of the presentation, the attendee should: 1) be familiar with the MR indications for evaluation of known or suspected benign uterine conditions; 2) be able to set up protocols for benign uterine conditions; and 3) be able to diagnose common benign uterine conditions and recognize potential pitfalls and limitati...

LEARNING OBJECTIVES URL's

LEARNING OBJECTIVES 1) Describe the advantages and disadvantages of current imaging methods used to evaluate women believed to have debilitating fibroids. 2) Recognize the appearance of fibroids on MRI. 3) Recognize the MRI appearance of comorbid or other conditions that can mimic the symptoms of fibroids. 4) Describe the potential of MRI to predic...

9626 Background: Several single institution trials suggest MRI and US may be beneficial in detecting clinically and mammographically occult cancer in women at high risk for breast cancer. However, few prior studies include both US and MRI in patient evaluation, and the range of added cancer yield of both modalities varies widely from 10%. This is t...

Ovarian Brenner tumor is an uncommon epithelial tumor that accounts for 1.5% to 2.5% of all ovarian neoplasms. These tumors are usually benign. Whereas the magnetic resonance imaging features of benign Brenner tumors have been described, reports of malignant findings are limited. We report a case of borderline malignant Brenner tumor that imaged as...

To assess and report the long-term magnetic resonance (MR) imaging outcomes of fibroid tumors treated with uterine artery embolization (UAE). Contrast material-enhanced pelvic MR imaging was performed in 20 patients before UAE, at 3 months after UAE, and then yearly for up to 3 years. Two readers compared the uterine fibroid, dominant (ie, largest)...

PURPOSE: To assess and report the long-term magnetic resonance (MR) imaging outcomes of fibroid tumors treated with uterine artery embolization (UAE). MATERIALS AND METHODS: Contrast material-enhanced pelvic MR imaging was performed in 20 patients before UAE, at 3 months after UAE, and then yearly for up to 3 years. Two readers compared the uterine...

The purpose of this study was to determine the MRI features seen after uterine artery embolization and to evaluate the clinical response in patients with adenomyosis. Thirty women with adenomyosis underwent uterine artery embolization and follow-up MRI for 1 year. Of the 30, 27 patients were diagnosed with uterine fibroids and adenomyosis on the ba...

Leiomyomas and adenomyosis are common benign myometrial conditions. Although their symptoms overlap, traditional treatment of these two entities differs; thus, making the correct diagnosis is critical. Specifically, uterine-conserving therapy is well established for many women with symptomatic leiomyomas, whereas hysterectomy is the treatment for d...

The Image Interpretation Session is an exciting, traditional event presented in the Sunday afternoon program at the annual meeting of the Radiological Society of North America. Since its establishment in 1939, this valuable teaching session brings together a distinguished panel of experts who stimulate and captivate the audience with 10 distinctive...

To determine the imaging outcome after uterine artery embolization (UAE) with use of tris-acryl gelatin microspheres (Embospheres). A retrospective analysis of magnetic resonance (MR) images was performed comparing studies completed 3-4 months after UAE to those performed before UAE. Twenty-three patients with 61 leiomyomata (as many as three fibro...

The purpose of our study was to evaluate the effectiveness of gadolinium-enhanced MR imaging in imaging arterial, venous, and ureteric anatomy in a group of potential laparoscopic renal donors and to compare our findings with those established at surgery. Sixty-four consecutive patients underwent successful laparoscopic donor nephrectomy. Imaging o...

Transvaginal US is often the initial imaging examination for women with dysfunctional (postmenopausal or intermenstrual) uterine bleeding. However, once the diagnosis of endometrial cancer has been made, contrast-enhanced MRI should be performed in patients who require multifactorial assessment (eg, depth of myometrial invasion, cervical involvemen...

To evaluate uterine changes on MRI before and after GnRH analog (GnRHa) treatment in diffuse adenomyosis. Thirty-one patients with MRI features suggestive of diffuse adenomyosis received GnRHa for 6 months. Diffuse adenomyosis was sub-classified as: symmetric (symmetric/ entire widening of the junctional zone [JZ]) and asymmetric (asymmetric/ parti...

In three healthy gravidas at 38 and 39 weeks gestation, fetal MR spectroscopy was performed with a breath-hold technique by using the following pulse sequences: single voxel point-resolved spectroscopy, or PRESS, for liver and heart studies and stimulated-echo acquisition mode, or STEAM, for brain studies. Signal peaks of lipid from heart and liver...

Magnetic resonance imaging (MRI) is gaining momentum for staging gynecologic malignancies. MRI staging is an adjunct to clinical and surgical staging in women with cervical or endometrial cancer, respectively. For women with possible adnexal pathology, MRI is useful for lesion characterization. In patients with ovarian cancer, MRI determination of...

To determine the magnetic resonance (MR) imaging features of uterine fibroleiomyomata after uterine arterial embolization (UAE) and identify pretreatment MR imaging features that may be predictive of successful UAE. T1- and T2-weighted and dynamic gadolinium-enhanced T1-weighted images were obtained before and 3 months after UAE in 31 patients. Up...

Chronic pelvic pain (CPP) presents a diagnostic as well as a therapeutic challenge to many clinicians. This chapter briefly describes the most frequent identifiable causes for CPP amenable to imaging; explains the most widely-used and widely available radiological tests for CPP; and compares/contrasts each test's utility and accuracy for a given ca...

Proton magnetic resonance spectroscopy is a noninvasive technique that detects molecules within a specified region in vivo. Lecithin, the major component of surfactant, has a characteristic magnetic resonance signal, but to our knowledge, it has never been reported in fetal lung or amniotic fluid (AF). The objective of this study was to characteriz...

Tamoxifen citrate is an orally administered, nonsteroidal antiestrogen agent that is widely used for the treatment of breast cancer and that has recently been found to prevent breast cancer in some high-risk populations. Tamoxifen may, however, cause adverse effects at the uterine level. In this article, the authors review (a) the histopathologic u...

To develop and refine a pulse sequence and protocol for testing the feasibility of magnetic resonance (MR) hysterosalpingography in a phantom model. A phantom simulating the uterus, fallopian tubes, and surrounding pelvic cavity was constructed. T2-weighted acquisition strategies-breath-hold fast spin-echo, rapid acquisition with relaxation enhance...

Purpose: To evaluate the safety and short-term efficacy of uterine fibroid embolization (UFE) in patients with symptomatic uterine fibroids. Materials and methods: Bilateral UFE was performed in 61 patients with symptomatic uterine leiomyomata during a 16-month period. Imaging was performed before the procedure and at 3 months and 1 year after t...

This study compared one routine T2-weighted fast spin echo (T2FSE) sequence with a breath-hold T2FSE (BH T2FSE) sequence of the female pelvis for image quality, uterine anatomy, lesion detection, and signal intensity measurements. Thirty-two consecutive women (mean age 41.7 years) were imaged at 1.5 T with one high-resolution routine T2FSE sequence...

We retrospectively reviewed the MR studies on all patients with liver-related fluid collections compatible with acute or early subacute hemorrhage, who underwent MR imaging at our center between June 1994 and January 1998. All patients had a clinical history of an underlying liver lesion or injury with a duration of symptomatology of less than 5 da...

Magnetic resonance imaging (MRI) of the breast has been proposed as a noninvasive diagnostic test for evaluation of suspicious ("index") lesions noted on mammography and/or clinical breast examination (CBE). However, women may have incidental ("serendipitous") lesions detected by MRI that are not found on mammography or CBE. To understand better wh...

The purpose of this study is to describe the appearance of bowel-related abscesses on magnetic resonance (MR) images. Sixteen consecutive patients who had bowel-related abscesses underwent MR examination at 1.5T. MR sequences included T1-weighted fat-suppressed imaging pre- and post-intravenous gadolinium chelate administration (all patients) and b...

Many reports describe an increased frequency and unusual features of endometrial polyps and carcinomas in women treated with tamoxifen (TMX) for breast cancer. Postmenopausal women with endometrial polyps were identified by computer search of pathology files from 1990 to 1996. Medical records were reviewed, and patients were divided into three grou...

This study describes the sequential use of ferumoxide (superparamagnetic iron oxide) particles and nonspecific extracellular gadolinium chelate (Gd) for evaluation of focal liver lesions on MRI to evaluate order of contrast administration and imaging effect of the first contrast agent on sequences acquired after the second contrast agent. Thirteen...

The purpose of this study was to define the common appearances of hepatocellular carcinoma (HCC) in patients in North America by analyzing T1-weighted, T2-weighted, and serial gadolinium-enhanced gradient-echo images interpreted by radiologists at multiple institutions in North America. One hundred thirteen consecutive patients with HCC from eight...

We describe our 6-year experience in the prospective examination of patients with suspected hepatosplenic fungal disease to show the diagnostic accuracy of MR imaging and the spectrum of appearances on MR images. All patients who underwent MR examination for suspected hepatosplenic fungal disease from January 1990 to January 1997 in three universit...

This multi-institutional study examines appearances of pelvic fistulas on magnetic resonance (MR) images. MR images of 46 patients with documented fistulas from five teaching hospitals were retrospectively reviewed. All patients underwent T1-weighted (T1WI), T2-weighted (T2WI), and intravenous gadolinium chelate-enhanced T1-weighted (Gd-T1WI) image...

To determine the accuracy of magnetic resonance (MR) imaging in the evaluation of patients with a history of primary amenorrhea. Twenty-nine patients with primary amenorrhea underwent T2-weighted MR imaging in the axial and sagittal planes. Contrast material-enhanced and unenhanced T1-weighted MR imaging was performed in selected cases. MR imaging...

This study demonstrates the appearance of focal hepatic lymphoma using current magnetic resonance techniques including gadolinium enhancement. Fifteen patients with hepatic lymphoma were imaged at 1.5T. T1-weighted, T2-weighted, immediate, and 5-10-min delayed T1-weighted spoiled gradient echo images were acquired in all patients. Determination was...

The purpose of this study was to evaluate the ability of in-phase spoiled gradient echo combined with chemically selective fat suppression or out-of-phase spoiled gradient echo MR images to characterize small renal masses as angiomyolipomas. Eleven patients with a total of 35 small (< 1.5 cm) angiomyolipomas underwent MR examination at 1.5T. Eight...

To determine the magnetic resonance (MR) imaging features of splenic hemangiomas and hamartomas, including their pattern of dynamic contrast material enhancement. The appearance of 28 lesions in 18 patients was retrospectively reviewed on T2-weighted images (16 patients), unenhanced T1-weighted images (18 patients), and dynamic contrast-enhanced T1...

The objective of this study was to demonstrate the appearance of ampullary carcinoma using current MR techniques, including fat suppression, gadolinium enhancement, and MR cholangiography. Nine patients with ampullary carcinoma were examined by MRI at 1.5 T. MR examinations included T1-weighted spoiled gradient echo, T1-weighted fat-suppressed, and...

To describe the spin-echo and dynamic gadolinium-enhanced magnetic resonance (MR) imaging appearance of the uterus in women receiving tamoxifen. Thirty-five postmenopausal women with breast carcinoma receiving tamoxifen therapy underwent pelvic MR imaging. T1-weighted, T2-weighted, and dynamic gradient-echo T1-weighted sequences were used. Twenty-s...

This study demonstrates the appearance of small bowel tumors on MR images. Sixteen patients with tumors involving small bowel were studied by MRI. All tumors were proven with histopathology. Eleven patients had primary tumors of the small bowel, which included the following: four carcinoid tumors, three adenocarcinomas, two lymphomas, one leiomyosa...

Helical scanning offers many advantages for the evaluation of benign and malignant pancreatobiliary disease. This article presents these advantages, recommended screening protocols, and guidelines for the use of three-dimensional rendering of the peripancreatic vessels and bile ducts.

To survey the nonsurgical diagnostic techniques for distinguishing adenomyosis, and to determine whether one technique offers diagnostic advantages. We conducted a thorough search of the MEDLINE data base and identified English-language papers on adenomyosis published during the last 28 years. Reference lists of retrieved articles were also examine...

Bile duct anatomy depicted with a three-dimensional (3D) model developed with helical computed tomography (CT) data was compared with cholangiographic depiction. The ductal system was completely displayed from all angles in four of six patients, as well as the stricture and length of bile duct between strictures and the bifurcation in five of six c...

Dramatic refinements in CT technology are resulting in improved evaluation of the liver, pancreas, and gastrointestinal tract. Further clinical trials are necessary to compare the relative merits of CT versus MR imaging and endoscopic ultrasonography in a wide variety of gastrointestinal diseases.

Dramatic refinements in CT technology are resulting in improved evaluation of the liver, pancreas, and gastrointestinal tract. Further clinical trials are necessary to compare the relative merits of CT versus MR imaging and endoscopic ultrasonography in a wide variety of gastrointestinal diseases.

Suspected pelvic endometrlosis was prospectively evaluated in 31 women with T1- and T2-weighted conventional spin-echo (CSE) magnetic resonance imaging alone and in combination with Tl-weighted fat-suppressed (TIPS) and gadolinium-enhanced TIPS (Gd-TlFS) spin-echo techniques. Images were grouped for interpretation and comparison as follows: (a) CSE...

A case of preoperative spontaneous internal jugular/subclavian vein thrombosis documented with magnetic resonance imaging associated with a synchronous stage II ovarian/stage I endometrial malignancy is presented. This unusual deep venous thrombosis site is classically associated with trauma, infection, head and neck malignancies, or central venous...