Pelvic lipomatosis: a nonsurgical diagnosis

Diagnostic accuracy of CT imaging parameters in pelvic lipomatosis

PURPOSE

To predict the diagnosis of pelvic lipomatosis (PL) by assessing CT imaging parameters.

METHODS

Fifty clinically proven PL patients and 50 controls were included. Two radiologists recorded the types of bladder shapes and measured the following CT imaging parameters: (1) pelvic fat volume (PFV); (2) a set of morphological indices of bladder and rectosigmoid, including the ratio of craniocaudal to anterior-posterior length of bladder (CC/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), right and left angles between bladder and seminal vesicle (RABS and LABS), distance from verumontanum to anterior wall of rectum (DVR) and rectosigmoid morphological index (RMI). Secondary complications were also noted.

RESULTS

The results were evaluated by an unpaired t test, ROC analysis and logistic regression. All CT imaging parameters except RMI (p = 1.000) indicated a statistical difference between PL and controls (p < 0.01). The AUCs of these parameters were between 0.724 (for rLPU) and 0.993 (for AAP). The sensitivity and specificity were 94% and 98% for AAP and 92% and 94% for the combined model, respectively. 23 patients were pathologically diagnosed with cystitis glandular. The incidence of hydronephrosis in the PL group was higher than that in the control group (p < 0.01).

CONCLUSION

CT imaging parameters can predict the diagnosis of PL. The combined model of objective parameters including PFV, rLPU and DVR showed the best diagnostic performance for PL.

Value of Multimode Sonography for Assessment of Pelvic Lipomatosis Compared With Computed Tomography

OBJECTIVES

To assess imaging features of pelvic lipomatosis with a multimode sonographic technique, including 2-dimensional (2D) grayscale sonography, 3-dimensional (3D) sonography, and transrectal sonography, and compare its diagnostic features with those of computed tomography (CT).

METHODS

In this study, 7 patients with different clinical manifestations were incidentally discovered by 2D sonography and followed by 3D and transrectal sonography before CT was performed for comparison. The urinary tract morphologic characteristics, bladder shape, and amount and distribution of perivesical or perirectal fatty tissue in all 7 patients were evaluated by both imaging modalities. Ten healthy participants were recruited and imaged as a control group.

RESULTS

The following sonographic features were shown in all 7 patients: (1) bilateral hydroureters and hydronephrosis on 2D sonography; (2) bladder shifting anteriorly and superiorly on 2D sonography; (3) nonvisualization of the prostate through the bladder window on transabdominal scanning and nonvisualization of the bladder when the prostate was scanned by transrectal sonography; (4) bladder elongation in the craniocaudal dimension, which appeared as a gourd or pear shape on 3D sonography; and (5) excessive fat accumulation between the prostate and rectum as well as in perivesical or perirectal regions on 2D and transrectal sonography. Computed tomography in these patients confirmed the sonographic findings, with evidence of hydronephrosis, bladder location shift and elongation, and excessive fitty tissue with extrinsic compression.

CONCLUSIONS

This preliminary study has shown that the application of a multimode sonographic technique (ie, 2D, 3D, and transrectal sonography) can provide unique evidence and imaging features of pelvic lipomatosis, which are comparable with CT for making a suggestive diagnosis of pelvic lipomatosis. Thus, multimode sonography may be the modality of choice for assessment of patients with a suspicion of lipomatosis.

Measuring diagnostic accuracy of imaging parameters in pelvic lipomatosis

OBJECTIVES

To study whether the individual radiological findings can help predict diagnosis of pelvic lipomatosis (PL) or, specifically appreciate its progression.

METHODS

Data from 32 clinically proven cases of PL and 25 controls were collected. Two reviewers were recruited for a blinded evaluation, image features were recorded in terms of: (1) bladder shape; (2) bladder-rectosigmoid morphological indexes including ratio of superior-inferior to anterior-posterior length of bladder (SI/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), angle between bladder and seminal vesicle (ABS) and rectosigmoid morphological index (RMI); (3) secondary complications. Results were evaluated by an unpaired t test and ROC analysis.

RESULTS

The sensitivity and specificity were 40.6% and 100% for pear and banana-shaped bladder, 62.5% and 100% for SI/AP, 40.6% and 100% for AAP, 62.5% and 100% for ABS, 78.1% and 72% for rLPU, 59.4% and 96% for RMI, respectively. These radiological findings partially correlated with the severity of disease weighted by hydronephrosis and treatment grade. Image analysis demonstrated high prevalence of glandular cystitis (100%) and hydronephrosis (73.4%).

CONCLUSION

We conclude that PL is a progressive disease involving multiple pelvic organs with high prevalence of intractable cystitis and hydronephrosis. The imaging characteristics can help predict diagnosis and, specifically appreciate progression.

[Pelvic lipomatosis: clinical review and report of 4 new cases]

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.