The occurrence of nodules in patients with adrenal enzymatic defects is reported in the literature, but its frequency and etiology are not clear. We studied 14 patients (10F, 4M) with congenital adrenal hyperplasia due to 21-hydroxylase deficiency with mean age 13,3y (2,4-36y). Two patients had the salt-losing form, 7 simple virilizing and 5 symptomatic non classic form. Image studies were carried out before treatment in 2 patients and after 1,4 to 14 y of therapy in 12 (mean 5,7y). Two had computed tomography and the other 12 magnetic resonance imaging. Treatment was classified according to 4 quarterly testosterone and adrostenedione measurements during the year before imaging in: (E) Excellent -all levels normal (1 case); (G) Good -one high value (4); (R) Regular -two high values (6); (P) Poor-three or more abnormal values(1). Both patients evaluated before therapy had enlarged adrenals one with 0.9 cm nodule that disappeared after one year of therapy; of the 12 patients studied during therapy 6 (50%) had an enlarged left adrenal and one patient with P control both adrenal enlarged and a 0,9 cm nodule in the L. adrenal. The patient with E control had normal adrenals and the patients with G and R controls had normal or enlarged adrenals. We conclude that adrenal enlargement and nodules are related to control suggesting an effect mediated by ACTH.

Diagnostic accuracy of magnetic resonance imaging (MRI) interpretation was assessed prospectively in patients with ambiguous genitalia or intersex problems. MRI depiction of the uterus was possible in 93%, the vagina in 95%, the penis in 100%, the testis in 88%, and the ovary in 74% of patients. The strength of MRI lies in the multiplanar capability and tissue characterization by means of T1- and T2-weighted sequences. MRI contributes to accurate morphologic evaluation of müllerian duct structures, the gonads, and the development of the phallus, all of which are essential for appropriate gender assignment and planning of surgical reconstruction.

The potential of magnetic resonance (MR) imaging in the evaluation of the female urethra was studied in 64 patients. Spin-echo T1- and T2-weighted images were obtained in all 64 patients, and contrast-enhanced T1-weighted images were also obtained in 27 patients. Urethral pathologic conditions, established with urethroscopy or histologic examination, or both, included urethral diverticula, inflammatory granuloma, and primary and metastatic neoplasms. On T2-weighted images, all normal urethras demonstrated a characteristic targetlike appearance with differentiation among the outer ring of low signal intensity, the middle zone of higher signal intensity, and the center of low signal intensity. After injection of gadopentetate dimeglumine, the targetlike appearance of the normal urethra was seen on the T1-weighted images. Urethral diverticula were detected with MR imaging in all nine patients with that diagnosis, and in each, MR imaging demonstrated urethral expansion, distortion of the zonal anatomy, and presence of fluid in the middle zone. Primary or metastatic urethral neoplasms were also detected with MR imaging in every patient with the diagnosis, but differentiation between benign and malignant disease was not possible. Local staging of primary or metastatic malignant disease was correct in eight of the 11 patients. In three patients, the inflammatory changes could not be differentiated from tumor invasion, resulting in overestimation of tumor extent.

This prospective study assessed the role of gadopentetate dimeglumine-enhanced magnetic resonance imaging in the detection and staging of carcinomas of the endometrium and cervix. Surgical-pathologic findings were used as the standard of reference. In the evaluation of endometrial carcinoma, contrast-enhanced imaging improved tumor detection and differentiation between viable tumor and retained debris. Use of contrast material significantly improved the staging accuracy. The ability to assess the depth of myometrial invasion was also improved. In the evaluation of cervical carcinoma, assessment of tumor location and size did not improve following contrast enhancement. Use of gadopentetate dimeglumine resulted in overestimation of stromal, parametrial, vaginal, and/or bladder wall invasion in eight patients. However, evaluation of intratumoral architecture and large lesions was easier with contrast-enhanced imaging. When only stage II and higher disease was analyzed, use of contrast material improved the evaluation of disease extent. The authors conclude that gadolinium enhancement adds to the accuracy of evaluation of endometrial carcinoma but is useful in only advanced cases of cervical carcinoma.

MR imaging (0.35 and 1.50 T) was used to assess the appearance of the seminal vesicles. The size and signal intensity of normal seminal vesicles vary with the age of the subject. In general, on T2-weighted images, the signal intensity of normal seminal vesicles is lower than that of fat in prepubertal children, similar to or higher than that of fat in adults, and similar to or lower than that of fat in patients older than 70 years of age. Endocrine and radiation therapy will influence the size and signal intensity of the seminal vesicles. The purpose of the essay is to illustrate the spectrum of seminal vesicle disease, including congenital anomalies, inflammation, and neoplastic disease. Although MR imaging is helpful in depicting seminal vesicle abnormalities, it does not allow differentiation of benign from malignant disease, distinction of hemorrhage due to tumor invasion from postbiopsy changes, or distinguishing between glandular obstruction due to tumor infiltration and mechanical compression.

Twenty-nine patients underwent magnetic resonance (MR) imaging for investigation of müllerian duct anomalies (MDAs). The anomalies evaluated were uterine agenesis (n = 2), uterine hypoplasia (n = 5), unicornuate uterus (n = 5), uterus didelphys (n = 5), bicornuate uterus (n = 10), and septate uterus (n = 2). The MR imaging interpretation was correlated with results of laparotomy (n = 18), hysterosalpingography (HSG) (n = 5), laparoscopy (n = 2), hysteroscopy (n = 1), HSG and laparotomy (n = 2), and HSG and laparoscopy (n = 1). MR imaging enabled correct classification of the anomaly in each patient and identification of coincidental gynecologic disease in 10 patients (34%). MR imaging results influenced clinical treatment in six (24%) of 25 patients referred prospectively. Of particular value was the ability to characterize septal tissue (myometrium versus fibrous tissue), identify the patients in whom the septum of bicornuate uteri had both fibrous and myometrial components, and establish that suspected adnexal lesions were actually components of obstructed MDAs.