Revision of the MRI and CT of August 2022 (Dr. Zeltser)
Dr. Johan Seltzer
Specialist in Diagnostic and Interventional Radiology
License No. 130889
Specialist License No. 33492
MRI of the pelvis
Name: Anastasia Zherlitsyna
ID No.: ME9239960
Date of birth: April 25th, 1976
The study was conducted on August 24, 2022, and the transcript was made on May 31, 2023.
Indications for research:
Examination as part of a gastrointestinal stromal tumor, in order to exclude sarcoma.
Description of observations:
Comparison with the previous CT scan, dated August 23, 2022, is done.
Belly:
The signal from the liver is within normal limits. There is dysmorphia and hypertrophy of the left lobe of the liver.
Pathological foci in the liver are observed:
- A formation extending into segments 5 and 6, about 16.5 by 10.8 cm in size, exerting pressure on the structures of the hilum of the liver.
- A formation with a diameter of 10 by 21 mm in segment 8 (located anteriorly and upwards in comparison with the above described lesion).
- A formation with a diameter of 57 to 82 mm in 7 and 8 segments.
- A formation with a diameter of 45 to 66 in the left lobe, leading to a moderate expansion of the intrahepatic biliary tract from above.
From all the above-described foci comes a heterogeneous signal with a necrotic and hemorrhagic component and gradual contrast enhancement. No signs of calcification on CT.
It should be noted side cystic formation with a diameter of 6 mm, behind the main process in the right lobe, in the 6th segment behind.
The amplitude of the liver is measured at 20.7 cm along the midclavicular line.
A small amount of fluid around the liver and spleen.
The portal vein and hepatic veins are open, without thrombosis.
In the lesser curvature of the stomach, in the wall, there is a volumetric process about 48 by 55 mm in size, with the same characteristics as the formations in the liver.
The gallbladder is compressed and shifted down and to the left, without pronounced stones.
No signs of pathological expansion of the extrahepatic bile ducts.
Wirsung's duct is not dilated, there are no pathological changes in the pancreas.
No signs of pathological changes in the spleen or kidneys.
There is a moderate diffuse thickening of the left adrenal gland without a node. The right adrenal gland is normal.
The amplitude of the spleen is 8.7 cm.
No signs of enlarged retroperitoneal or mesenteric lymph nodes in the scanned area.
Pelvis area:
The uterus is anterior, without deviation.
Dimensions: length 79 mm, width 50 mm, thickness 45 mm.
Endometrial thickness: 1 mm, within normal limits.
No signs of thickening of the transition zone and microcystic changes.
In the myometrium, there is a fibroid in the right walls (FIGO 5) with a diameter of about 28 mm. There is a volumetric process pedunculated at the bottom of the uterus, about 6 x 9 cm in size.
The mass shows an elevated T2 signal with high degree diffusion, with no limitation in abnormal diffusion, consistent with pedunculated hypercellular leiomyoma (FIGO 7). Calcifications were observed inside the leiomyoma on CT.
Cystic process with a diameter of 65 to 57 mm in the cyst on the right, with "shading", due to endometrioma. The left ovary is normal, without cysts and endometriosis.
Thickening of tissues in the uterine fold, apparently, there are adhesions with the upper rectum.
Thickening of the tissues inside the utero-sacral ligaments is observed. Thickening in the proximal round ligaments, more pronounced on the right. The vesico-vaginal and rectovaginal septa appear normal. There are no signs of hydrosalpinx or hematosalpinx.
Douglas pouch with no signs of fluid or pathological changes. There is a small amount of preperitoneal fluid in front and to the left of the bladder.
Without signs of lymphadenopathy in the small pelvis.
No signs of pathological changes in the bladder (when full) or in the abdominal wall.
Conclusion:
1. The image primarily corresponds to a gastrointestinal stromal tumor of the stomach wall with secondary lesions in two lobes of the liver (lesions of a necrotic nature, with hemorrhagic changes without calcification and no signs of lymphadenopathy).
2. Pedunculated fibroid corresponds to fundal hypercellular leiomyoma of the bottom of the uterus: in the absence of restriction by abnormal diffusion, the diagnosis of sarcoma is unlikely.
3. Endometrioma of the right ovary with deep foci of endometriosis (in the roller and, possibly, in the round ligaments).
4. Peritoneal fluid in a small amount in the abdominal cavity and pelvis without obvious signs of secondary peritoneal spread.
Dr. Selzer Johann