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Li Y, Jian J, Ge H, Gao X, Qiang J. Peritumoral MRI Radiomics Features Increase the Evaluation Efficiency for Response to Chemotherapy in Patients With Epithelial Ovarian Cancer. J Magn Reson Imaging 2024. [PMID: 38517321 DOI: 10.1002/jmri.29359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND It remains unclear whether extracting peritumoral volume (PTV) radiomics features are useful tools for evaluating response to chemotherapy of epithelial ovarian cancer (EOC). PURPOSE To evaluate MRI radiomics signatures (RS) capturing subtle changes of PTV and their added evaluation performance to whole tumor volume (WTV) for response to chemotherapy in patients with EOC. STUDY TYPE Retrospective. POPULATION 219 patients aged from 15 to 79 years were enrolled. FIELD STRENGTH/SEQUENCE 3.0 or 1.5T, axial fat-suppressed T2-weighted imaging (FS-T2WI), diffusion-weighted imaging (DWI), and contrast enhanced T1-weighted imaging (CE-T1WI). ASSESSMENT MRI features were extracted from the four axial sequences and six different volumes of interest (VOIs) (WTV and WTV + PTV (WPTV)) with different peritumor sizes (PS) ranging from 1 to 5 mm. Those features underwent preprocessing, and the most informative features were selected using minimum redundancy maximum relevance and least absolute shrinkage and selection operator to construct the RS. The optimal RS, with the highest area under the curve (AUC) of receiver operating characteristic was then integrated with independent clinical characteristics through multivariable logistic regression to construct the radiomics-clinical model (RCM). STATISTICAL TESTS Mann-Whitney U test, chi-squared test, DeLong test, log-rank test. P < 0.05 indicated a significant difference. RESULTS All the RSs constructed on WPTV exhibited higher AUCs (0.720-0.756) than WTV (0.671). Of which, RS with PS = 2 mm displayed a significantly better performance (AUC = 0.756). International Federation of Gynecology and Obstetrics (FIGO) stage was identified as the exclusive independent clinical evaluation characteristic, and the RCM demonstrated higher AUC (0.790) than the RS, but without statistical significance (P = 0.261). DATA CONCLUSION The radiomics features extracted from PTV could increase the efficiency of WTV radiomics for evaluating the chemotherapy response of EOC. The cut-off of 2 mm PTV was a reasonable value to obtain effective evaluation efficiency. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yong'ai Li
- Department of Radiology, Changzhi People's Hospital, Changzhi, Shanxi, China
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Junming Jian
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Huijie Ge
- Department of Radiology, Changzhi People's Hospital, Changzhi, Shanxi, China
| | - Xin Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- Jinan Guoke Medical Engineering and Technology Development Co., Ltd., Jinan, Shandong, China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Bairaktaris D, Tsoplaktsoglou S, Souka E, Kalmantis K, Iavazzo C. Paraovarian tumor of borderline malignancy: A case report. Folia Med (Plovdiv) 2024; 66:128-131. [PMID: 38426475 DOI: 10.3897/folmed.66.e116865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 03/02/2024] Open
Abstract
Paraovarian tumors of borderline malignancy (PTBM) are exceedingly rare, with only slightly over 60 cases reported worldwide. This report presents the case of a 22-year-old nulliparous patient who incidentally discovered a left paraovarian mass during a routine abdominal ultrasound. Subsequent MRI revealed a 2.5×2.1 cm cystic lesion located in close proximity to, but outside of, the left ovary, with no other pathological findings. A laparoscopic cystectomy was performed with meticulous care to prevent tumor spillage, and the patient experienced an uneventful recovery. Histopathological examination unveiled irregularly shaped tissue measuring 2.2×1.2×1 cm, characterized by fibrous tissue/wall with spindle cell stroma and an epithelium displaying features consistent with a serous borderline tumor. Our multidisciplinary team recommended diligent follow-up. This case contributes to the existing literature on PTBM and highlights the imperative for additional cases to enhance our comprehension of the optimal management of these exceedingly rare tumors.
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Akçay A, Peker AA, Oran Z, Toprak H, Toluk Ö, Balsak S, Badur BA, Gültekin MA. Role of magnetic resonance imaging to differentiate between borderline and malignant serous epithelial ovarian tumors. Abdom Radiol (NY) 2024; 49:229-236. [PMID: 37857912 DOI: 10.1007/s00261-023-04076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE We aimed to differentiate serous borderline ovarian tumors (SBOT) from serous epithelial ovarian carcinomas (SEOC) using morphological and functional MRI findings, to improve the patient management. METHOD We retrospectively investigated 24 ovarian lesions diagnosed with SBOT and 64 ovarian lesions diagnosed with SEOC. Additional to the demographic and morphological findings T2W signal intensity ratio, mean apparent diffusion coefficient (ADCmean) and total apparent diffusion coefficient (ADCtotal) values were analyzed and compared between two groups. RESULTS Bilaterality, pelvic free fluid presence, serum CA-125 level (U/mL), presence of pelvic peritoneal implant were in favor of SEOC. Lower maximum size of solid component and solid size to maximum size ratio, dominantly cystic and solid-cystic appearance, exophytic growth pattern, presence of papiller projection and papillary architecture and internal branching pattern, higher T2W signal intensity ratio, ADCmean and ADCtotal values were in favor of SBOT. CONCLUSION Our study revealed that morphological and functional imaging findings were valuable in differentiating BSOT from SEOC.
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Affiliation(s)
- Ahmet Akçay
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey.
| | - Abdusselim Adil Peker
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Zeynep Oran
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Hüseyin Toprak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Özlem Toluk
- Department of Biostatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Bahar Atasoy Badur
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
| | - Mehmet Ali Gültekin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, +34093, Istanbul, Turkey
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MR Imaging of Epithelial Ovarian Neoplasms Part I: Benign and Borderline. Magn Reson Imaging Clin N Am 2022; 31:43-52. [DOI: 10.1016/j.mric.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tsuboyama T, Sato K, Ota T, Fukui H, Onishi H, Nakamoto A, Tatsumi M, Tomiyama N. MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges. Radiographics 2022; 42:2095-2111. [PMID: 36083804 DOI: 10.1148/rg.220068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Borderline epithelial ovarian tumors are a distinct pathologic entity characterized by increased epithelial proliferation and nuclear atypia, but without frank stromal invasion. Borderline tumor (BT) is now considered to represent an intermediate phase in the stepwise progression from benign to malignant ovarian epithelial tumor. Since BTs commonly manifest at early stages in women of reproductive age and are associated with a good prognosis, making the correct diagnosis is important in determining whether a patient is a candidate for fertility-sparing surgery. There are six histologic BT subtypes (serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner), and each has different MRI features, reflecting their unique histologic architectures. Radiologists should be aware of the MRI features that can suggest BTs. These features include a hyperintense papillary architecture with hypointense internal branching, which can be observed with serous and seromucinous BTs on T2-weighted images; aggregates of microcysts that have hypointensity on T2-weighted images and reticular enhancement on contrast-enhanced T2-weighted images, which can be seen with mucinous BTs; and moderately high signal intensity on diffusion-weighted images along with relatively high apparent diffusion coefficient values, which can be observed regardless of the histologic subtype. Nevertheless, because the imaging features of BTs overlap with those of many benign lesions (eg, cystadenoma and cystadenofibroma, decidualized endometriosis, and polypoid endometriosis) and malignant tumors (ovarian cancers and metastases), histologic confirmation is required for the final diagnosis. Special emphasis is placed on the MRI features of BTs, pathologic correlation, and the challenges related to diagnosis. ©RSNA, 2022.
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Affiliation(s)
- Takahiro Tsuboyama
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuaki Sato
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Ota
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideyuki Fukui
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hiromitsu Onishi
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Atsushi Nakamoto
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mitsuaki Tatsumi
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Noriyuki Tomiyama
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Role of MRI in characterizing serous borderline ovarian tumor and its subtypes: Correlation of MRI features with clinicopathological characteristics. Eur J Radiol 2021; 147:110112. [PMID: 34972058 DOI: 10.1016/j.ejrad.2021.110112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE This study aimed to investigate the diagnostic value of MRI in serous borderline ovarian tumor (SBOT), and to determine the MRI features of SBOT and their correlations with clinicopathological characteristics. MATERIALS AND METHODS A total of 121 patients suspected of SBOT by preoperative MRI and then underwent surgery at our hospital were retrospectively reviewed. The accuracy of MRI in diagnosing SBOT was assessed. MRI features of the SBOT subtypes were compared and their correlations with clinicopathological characteristics were evaluated. RESULTS SBOT was confirmed by postoperative pathology in 95 patients, including 77 patients with conventional SBOT (SBOT-C) and 18 patients with micropapillary SBOT (SBOT-MP). The accuracy of MRI in diagnosing SBOT was 87.6%. Three MRI morphological patterns of SBOT were identified: (i) mainly solid, (ii) mainly cystic, and (iii) mixed. Branching papillary architecture and internal branching (PA&IB) structures corresponding to multiple branching papillary projections and internal fibrous stalks in tumors were observed in 69.7% of SBOTs on T2-weighted images. MRI findings were consistent with postoperative pathology. Compared with SBOT-C, patients with SBOT-MP were more likely to display elevated cancer antigen 125, bilateral tumors, peritoneal implantation, lymph node metastasis, and advanced tumor staging. No significant differences were observed in MRI features between SBOT-C and SBOT-MP groups. CONCLUSION MRI has good performance in diagnosing SBOT. MRI findings of SBOT are consistent with clinicopathological characteristics. The PA&IB structure is the characteristic MRI finding of SBOT. Compared to SBOT-C, SBOT-MP tends to display more aggressive clinical behavior, but their MRI features are similar.
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Jian J, Li Y, Xia W, He Z, Zhang R, Li H, Zhao X, Zhao S, Zhang J, Cai S, Wu X, Gao X, Qiang J. MRI-Based Multiple Instance Convolutional Neural Network for Increased Accuracy in the Differentiation of Borderline and Malignant Epithelial Ovarian Tumors. J Magn Reson Imaging 2021; 56:173-181. [PMID: 34842320 DOI: 10.1002/jmri.28008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Preoperative differentiation of borderline from malignant epithelial ovarian tumors (BEOT vs. MEOT) is challenging and can significantly impact surgical management. PURPOSE To develop a multiple instance convolutional neural network (MICNN) that can differentiate BEOT from MEOT, and to compare its diagnostic performance with that of radiologists. STUDY TYPE Retrospective study of eight clinical centers. SUBJECTS Between January 2010 and June 2018, a total of 501 women (mean age, 48.93 ± 14.05 years) with histopathologically confirmed BEOT (N = 165) or MEOT (N = 336) were divided into the training (N = 342) and validation cohorts (N = 159). FIELD STRENGTH/SEQUENCE Three axial sequences from 1.5 or 3 T scanner were used: fast spin echo T2-weighted imaging with fat saturation (T2WI FS), echo planar diffusion-weighted imaging, and 2D volumetric interpolated breath-hold examination of contrast-enhanced T1-weighted imaging (CE-T1WI) with FS. ASSESSMENT Three monoparametric MICNN models were built based on T2WI FS, apparent diffusion coefficient map, and CE-T1WI. Based on these monoparametric models, we constructed an early multiparametric (EMP) model and a late multiparametric (LMP) model using early and late information fusion methods, respectively. The diagnostic performance of the models was evaluated using the receiver operating characteristic (ROC) curve and compared to the performance of six radiologists with varying levels of experience. STATISTICAL TESTS We used DeLong test, chi-square test, Mann-Whitney U-test, and t-test, with significance level of 0.05. RESULTS Both EMP and LMP models differentiated BEOT from MEOT, with an area under the ROC curve (AUC) of 0.855 (95% CI, 0.795-0.915) and 0.884 (95% CI, 0.831-0.938), respectively. The AUC of the LMP model was significantly higher than the radiologists' pooled AUC (0.884 vs. 0.797). DATA CONCLUSION The developed MICNN models can effectively differentiate BEOT from MEOT and the diagnostic performances (AUCs) were more superior than that of the radiologists' assessments. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Junming Jian
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.,Jinan Guoke Medical Engineering and Technology Development Co., Ltd., Jinan, China
| | - Yong'ai Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Wei Xia
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Zhang He
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Rui Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Haiming Li
- Department of Radiology, Cancer Hospital, Fudan University, Shanghai, China
| | - Xingyu Zhao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Shuhui Zhao
- Department of Radiology, Xinhua Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China
| | - Jiayi Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Songqi Cai
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Wu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Xin Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.,Jinan Guoke Medical Engineering and Technology Development Co., Ltd., Jinan, China.,Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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MRI characteristics for differentiating mucinous borderline ovarian tumours from mucinous ovarian cancers. Clin Radiol 2021; 77:142-147. [PMID: 34848025 DOI: 10.1016/j.crad.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022]
Abstract
AIM To investigate the magnetic resonance imaging (MRI) characteristics that could differentiate mucinous borderline ovarian tumours (MBOTs) from mucinous ovarian cancers (MOCs). MATERIALS AND METHODS MRI data from 75 patients with MBOTs and 38 patients with MOCs were reviewed retrospectively. The clinicopathological and MRI features, including age, bilaterality, maximum diameter (MD), shape, margin, configuration, cystic-solid interface, papillae, MD of the cyst walls and septa, MD of the solid components, number of cysts, honeycomb loculi, signal of the cystic and solid components, apparent diffusion coefficient (ADC) value and enhancement ratio of the solid components, peritoneal implants and ascites, were compared using univariable analysis and multivariable logistic regression analysis. RESULTS There were 76 MBOTs and 39 MOCs, and median patient age was 41 years (range 16-77 years) and 51 years (range 15-90 years), respectively (p=0.004). There were significant differences between MBOTs and MOCs regarding the presence of papillae (p=0.013), MD of the solid components (p=0.001), enhancement ratio of the solid components (p=0.003), ADC value (p<0.001), and ascites (p<0.001). The optimal cut-off ADC value was 1.16 × 10-3 mm2/s, with a sensitivity of 87.1%, a specificity of 83.3%, and an area under the curve (AUC) of 0.917. CONCLUSION Compared with MOCs, MBOTs had fewer papillae or solid components, lower enhancement ratio, higher ADC values, and were less likely to have moderate or massive ascites.
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Clues to the diagnosis of borderline ovarian tumours: An imaging guide. Eur J Radiol 2021; 143:109904. [PMID: 34412008 DOI: 10.1016/j.ejrad.2021.109904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/12/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
Borderline Ovarian Tumours (BOTs) are an interesting subset of epithelial neoplasms defined histologically by atypical epithelial proliferation without stromal invasion. These tumours typically affect young women in the reproductive age group and have a good prognosis. Although ultrasonography is the primary screening imaging technique in the evaluation of any suspected adnexal mass, grey-scale and colour Doppler have limited value in characterizing BOTs. Thus, a pelvic magnetic resonance imaging (MRI) is recommended for further characterization on account of its multiplanar capabilities, excellent soft-tissue contrast and high spatial resolution. BOTs histological subtypes display specific features on MRI that are useful in differential diagnosis. However, the final diagnosis and staging of BOTs require pathologic evaluation after surgical excision. Therefore, the purpose of this review is to describe, illustrate and compare the imaging characteristics of the different subtypes of BOTs - serous, mucinous and seromucinous - focusing on MRI, as well as to correlate with pathology findings considering the recent 2020 World Health Organization (WHO) classification, in order to improve the accuracy of preoperative diagnosis and facilitate optimal patient management.
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Sahin H, Akdogan AI, Smith J, Zawaideh JP, Addley H. Serous borderline ovarian tumours: an extensive review on MR imaging features. Br J Radiol 2021; 94:20210116. [PMID: 34111956 DOI: 10.1259/bjr.20210116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Serous borderline ovarian tumours (SBOTs) are an intermediate group of neoplasms, which have features between benign and malignant ovarian tumours and for which, fertility-sparing surgery can be offered. MRI in imaging of SBOTs is, therefore, crucial in raising the possibility of the diagnosis, in order to present the patient with the most appropriate treatment options. There are characteristic MRI features that SBOTs demonstrate. In addition, recent advanced techniques, and further classification into subtypes within the borderline group have been developed. The aim of this article is to review the MRI features of SBOT and provide the reporter with an awareness of the imaging tips and tricks in the differential diagnosis of SBOT.
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Affiliation(s)
- Hilal Sahin
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Asli Irmak Akdogan
- Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jeries Paolo Zawaideh
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Addley
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Are CT and MRI useful tools to distinguish between micropapillary type and typical type of ovarian serous borderline tumors? Abdom Radiol (NY) 2021; 46:3354-3364. [PMID: 33660041 DOI: 10.1007/s00261-021-03000-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of ovarian serous borderline tumors (SBTs), and evaluate whether CT and MRI can be used to distinguish micropapillary from typical subtypes. MATERIALS AND METHODS We retrospectively reviewed the clinical features and CT and MR imaging findings of 47 patients with SBTs encountered at our institute from September 2013 to December 2019. 30 patients with 58 histologically proven typical SBT and 17 patients with 26 micropapillary SBT were reviewed. Preoperative CT and MR images were evaluated, by two observers in consensus for the laterality, maximum diameter (MD), morphology patterns, internal architecture, attenuation or signal intensity, ADC value, enhancement patterns of solid portions (SP), and extra-ovarian imaging features. RESULTS The median age were similar between typical SBT and SBT-MP (32.5 years, 36 years, respectively, P>0.05). Morphology patterns between two subtypes were significantly different on CT and MR images (P < 0.001). Irregular solid tumor (21/37, 56.76%) was the major morphology pattern of typical SBT tumor, while unilocular cyst with mural nodules (14/20, 70%) was the major morphology pattern of SBT-MP on CT images. Similarly, papillary architecture with internal branching (PA&IB) (17/21, 80.95%) was the major morphology pattern of typical SBT tumor, while unilocular cyst with mural nodules (4/6, 66.67%) was the major pattern of SBT-MP on MR images. PA&IB all showed slightly hyperintense papillary architecture with hypointense internal branching on T2-weighted MRI. More calcifications were found in typical SBT (24/37, 64.86%) than SBT-MP mass lesion (6/20, 30%) (P < 0.05). Hemorrhage was less frequently visible in (20/37, 54.05%) typical SBT lessons than SBT-MP mass lesion (18/20, 90%) (P < 0.05). The ovarian preservation is more seen in typical SBT (38/58, 65.52%) than SBT-MP (12/28, 42.86%) in our series (P < 0.05). Mean ADC value of solid portions (papillary architecture and mural nodules) was 1.68 (range from 1.44 to 1.85) × 10-3 mm2/s for typical SBT and 1.62 (range from 1.45 to 1.7) × 10-3 mm2/s for that of SBT-MP. The solid components of the two SBT subtypes showed wash-in appearance enhancements after contrast injection both in CT and MR images except 2 of SBT-MP with no enhancement as complete focal hemorrhage on MR images. CONCLUSION Morphology and internal architecture are two major imaging features that can help to distinguish between SBT-MP and typical SBT.
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Abdel Wahab C, Rousset P, Milon A, Bazot M, Thomassin-Naggara I. Recommandations pour l’imagerie des tumeurs frontières de l’ovaire. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yang XY, Li Y, Cai SQ, Wang L, Qiang JW. Optimization of 7,12-dimethylbenz(a)anthracene-induced rat epithelial ovarian tumors. Oncol Lett 2021; 21:206. [PMID: 33574945 PMCID: PMC7816358 DOI: 10.3892/ol.2021.12467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/13/2020] [Indexed: 01/26/2023] Open
Abstract
Ovarian carcinoma is the second most common malignant tumor of the female reproductive system and an notable cause of cancer death. The detection and diagnosis of early ovarian carcinomas are still clinical challenges, which calls for imaging studies using early ovarian carcinoma animal models. The present study aimed to optimize the 7,12-dimethylbenz(a)anthracene (DMBA)-induced model of rat ovarian tumors by investigating the delivery methods, induction dose and time of DMBA exposure, and explored the morphological features of tumors using MRI. Three schemes were performed. In scheme one the ovary was covered with absorbable hemostatic gauze loaded with a high concentration of liquid DMBA. For this scheme, 150 Sprague-Dawley rats were divided into three groups depending on the DMBA dose (1.0, 2.0 and 3.0 mg). In scheme two DMBA solution was injected under the ovarian capsule. For this scheme, 159 rats were divided into 0.5, 1.0 and 1.5 mg DMBA groups. In scheme three the ovary was covered with absorbable gauze loaded with a high concentration of solid DMBA. For this scheme 161 rats were divided into 1.0, 2.0 and 3.0 mg DMBA groups. Each group of the three schemes was further subdivided into 60-, 90-, 120-, 150- and 180-day groups. In scheme two, the tumor formation rate was 75.6% (99/131), which was the highest in the 1.5 mg group (86.4%, 38/44) and reached 100% (10/10) on day 120. The induced tumors were serous in 93.9% (93/99) of tumors. Borderline ovarian tumors accounted for 19.2% (19/99) of all tumors, and ovarian cancer accounted for 46.5% (46/99). The mean maximum diameter (MMD) of borderline ovarian tumors was 10.29±3.41 mm, and that of ovarian cancer was 15.19±7.10 mm. MMD of the solid components increased with increasing malignancy. Cystic, cystic-solid and solid tumors were observed. The ovarian subcapsular injection of 1.5 mg DMBA was the best scheme for the rat ovarian tumor model. The present model is ideal for investigating the occurrence, development and imaging of ovarian tumors.
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Affiliation(s)
- Xiu Ying Yang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, P.R. China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, P.R. China
| | - Song Qi Cai
- Departments of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Li Wang
- Department of Pathology, Jinshan Hospital, Fudan University, Shanghai 201508, P.R. China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, P.R. China
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MR imaging findings of low-grade serous carcinoma of the ovary: comparison with serous borderline tumor. Jpn J Radiol 2020; 38:782-789. [PMID: 32246351 DOI: 10.1007/s11604-020-00960-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess MR imaging findings of low-grade serous carcinoma (LGSC) of the ovary compared with those of serous borderline tumor (SBT). METHODS Twenty-four patients with histopathologically proven 7 LGSCs and 25 SBTs who underwent preoperative MR imaging were included. We retrospectively reviewed MR images and compared MR findings between the two pathologies. RESULTS The predominantly solid lesions were marginally more frequent in LGSCs than in SBTs (43% vs. 8%, p = 0.057). All predominantly cystic LGSCs were multilocular cystic lesions with mural nodules. Predominantly solid LGSCs exhibited pure solid masses in 2 of 3 and solid masses with intratumoral cysts in 1 of 3. Papillary growth pattern with internal branching was observed only in 18 of 25 SBTs. Signal intensity ratio on T2-weighted images (4.48 ± 1.55 vs. 8.40 ± 3.53, p < 0.01) and apparent diffusion coefficient (ADC) values (1.12 ± 0.21 vs. 1.73 ± 0.27 × 10-3 mm2/s, p < 0.01) of solid components was significantly lower in LGSCs than in SBTs. CONCLUSION Compared with SBTs, lower signal intensity on T2-weighted images and lower ADC values were characteristic features of solid components in LGSCs. Papillary growth pattern with internal branching was not observed in LGSCs.
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Abdel Wahab C, Rousset P, Bolze PA, Thomassin-Naggara I. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Imaging]. ACTA ACUST UNITED AC 2020; 48:260-276. [PMID: 32004779 DOI: 10.1016/j.gofs.2020.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the place of imaging and the performance of different imaging techniques (transvaginal ultrasound with or without Doppler, scoring, CT, MRI) to differentiate benign tumour, borderline ovarian tumour (BOT) and malignant ovarian tumor. Differentiate the histological subtypes of BOT (serous, sero-mucinous, mucinous) and prediction in imaging of the possibility of conservative treatment. METHODS The research was carried out over the last 16 years using the terms "MeSH" based on the query of the Medline® database and supplemented by the review of references contained in the meta-analyzes, systematic reviews and original articles included. RESULTS Endo-vaginal and suprapubic ultrasonography is recommended for analysis of an ovarian mass (grade A). In the case of ultrasound by a referent, subjective analysis is the recommended technique (grade A). In case of echography by a non-referent, the use of "Simple Rules" is recommended (grade A) and should be best combined with subjective analysis to rejoin the performance of a sonographer refer (grade A). In cases of undetermined ovarian lesions in endovaginal ultrasound and suprapubic ultrasound, it is recommended to perform a pelvic MRI (grade A). The MRI protocol should include T2, T1, T1 sequences with fat saturation, diffusion, injected dynamics, and after gadolinium injection (grade B). To characterize an MRI-adnexal image, it is recommended to include a risk score for malignancy (ADNEX-MR/O-RADS) (grade C) in the report and to formulate an anatomopathological hypothesis (Grade C). The predictive signs of benignity in front of a cyst with endocystic vegetations are the low number, the small size, the presence of calcifications and the absence of Doppler flow in case of size greater than 10mm in echography (LP 4) and a curve of type 1 MRI (LP4). MRI is recommended for suspicious lesions of BOT in ultrasound (grade B) or indeterminate lesions in ultrasound (grade A). There is no data to support the usefulness of CT or PET-CT for BOT. Morphological criteria in ultrasound and MRI exist to differentiate BOT from invasive tumors regardless of grade (NP 2). Pelvic MRI is recommended to characterize a tumor suggestive of ultrasound BOT (grade C). No recommendations can be made about the use of combined ultrasound, biological, and menopausal status scores for the diagnosis of BOT. The diagnostic performance of imaging to detect peritoneal implants of BOT is not known. The assessment of the invasiveness of peritoneal implants of imaging BOT has not been evaluated. The association of macroscopic signs in MRI makes it possible to differentiate the different subtypes - serous, sero-mucinous and mucinous (intestinal type) - of BOT, despite the overlap of certain presentations (LP3). The analysis of macroscopic MRI signs must be performed to differentiate the different subtypes of TFO (grade C). No recommendation can be made on imaging prediction of the possibility of conservative BOT treatment.
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Affiliation(s)
- C Abdel Wahab
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; ISCD, équipe médecine, Sorbonne université, université Paris 06, IUC, 75005 Paris, France
| | - P Rousset
- HCL, EMR 3738, service de radiologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon 1, 43, boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - P-A Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France
| | - I Thomassin-Naggara
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; ISCD, équipe médecine, Sorbonne université, université Paris 06, IUC, 75005 Paris, France.
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Ibrahim RSM, El Fattah MSA, Metwally ZM, Eldin LAS. Value of magnetic resonance spectroscopy in assessment of adnexal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this study is to investigate the role of proton MR spectroscopy (1H-MRS) in the characterization and diagnosis of ovarian lesions.
Results
From October 2015 to October 2017, a total of 57 female patients (65 adnexal lesions; 8 cases were bilateral) were included. The examined lesions were classified according to their histopathological findings, (37 (57%) benign lesions, 4 (6%) borderline lesions, and 24 (37%) malignant lesions). The mean choline/creatinine (CHO/Cr) ratio was 1.29 ± 0.98 SD for malignant lesions, while the mean value in borderline lesions was 0.63 ± 0.15 SD, and the mean value for the benign lesions was 0.65 ± 0.34. Therefore, the mean CHO/Cr ratio was much higher in malignant than in benign lesions, which was statistically significant (P ≤ 0.001) as well as between the borderline and invasive lesions (P = 0.05), but not between the benign and borderline lesions. The diagnostic performance of conventional MRI in diagnosing adnexal lesions was 100%, specificity was 76%, and accuracy was 86%. However, MRS individual diagnostic performances are the following: sensitivity 89%, specificity, and 100% with an accuracy of 95%.
Conclusion
MRS proved to be an accurate and efficient method for the analysis of adnexal lesions and in differentiation between benign and malignant tumors.
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Lu JJ, Pi S, Ma FH, Zhang GF, Wei Qiang J. Apparent diffusion coefficients measured using different regions of interest in differentiating borderline from malignant ovarian tumors. Acta Radiol 2019; 60:1020-1027. [PMID: 30335478 DOI: 10.1177/0284185118805272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Apparent diffusion coefficients (ADCs) measured using different regions of interest (ROIs) are widely used in differentiating ovarian tumors. Purpose To evaluate the diagnostic performance of ADCs with different ROIs in differentiating borderline ovarian tumors (BOTs) from malignant ovarian tumors (MOTs). Material and Methods Thirty-five BOTs and 54 MOTs who underwent diffusion-weighted magnetic resonance imaging (MRI) were evaluated retrospectively. ADC values were independently measured using five ROI methods: round; rectangle; hot-spot; edge drawing; and five sample ROIs. The inter- and intraclass correlation coefficients (ICCs), one-way analysis of variance, receiver operating characteristic curve analysis, and unpaired t-tests were used to perform the statistical analyses. Results The measurement reproducibility of the minimum ADC and mean ADC values were good or excellent for BOTs and MOTs (ICC = 0.70–0.95). The minimum and mean ADC value by the edge drawing ROI were significantly higher than those of the other ROI methods (both P < 0.05). The area under the curve (AUC) of the minimum ADC value was less than that of the mean ADC value from the five ROI methods, whereas the AUCs of the mean ADC values from the round ROI and five sample ROIs were significantly larger than those of the other ROI methods ( P < 0.05). The minimum and mean ADC values from the five ROI methods showed significant differences between BOTs and MOTs (all P < 0.05). Conclusion The ROI shape influences the diagnostic performance of ADC value for differentiating BOTs from MOTs. The mean ADC values from the round ROI and five sample ROIs have better diagnostic efficiency.
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Affiliation(s)
- Jing Jing Lu
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China
| | - Shan Pi
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China
| | - Feng Hua Ma
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Guo Fu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, PR China
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Value of normalized apparent diffusion coefficients in differentiating between borderline and malignant epithelial ovarian tumors. Eur J Radiol 2019; 118:44-50. [PMID: 31439257 DOI: 10.1016/j.ejrad.2019.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the diagnostic performance of normalized apparent diffusion coefficients (nADCs) of different references with that of ADCs at differentb factors in differentiating borderline epithelial ovarian tumors (BEOTs) from malignant epithelial ovarian tumors (MEOTs). METHOD This retrospective study included 53 BEOTs and 148 MEOTs. Conventional magnetic resonance and diffusion-weighted imaging withb factors of 800 and 1000s/mm2 were performed. ADC was measured three times at solid components of tumors, gluteus maximus muscle (GMM), iliopsoas muscle (IM) and urine and then averaged. ADCtumor, nADCs were then obtained. Differences and the diagnostic performance of ADCtumor and nADCs between BEOTs and MEOTs with different b factors were compared. RESULTS ADCtumor, nADCs regardless of b factors were significantly higher in BEOTs than MEOTs. The diagnostic performance of nADCurine regardless of b factors was significantly larger than that of nADCGMM and nADCIM. There was no significant difference in the diagnostic performance between ADCtumor and nADCurine regardless of b factors. A significantly lower ADCtumor and a larger diagnostic performance for ADCtumor was found with a b factor of 1000s/mm2 than 800 s/mm2. There were no significant differences in nADCurine of BEOTs or MEOTs or in the diagnostic performance of nADCurine with b factors between 800 and 1000s/mm2. CONCLUSIONS ADCtumor and nADCs were both capable of differentiating BEOTs from MEOTs. nADCurine was the best of all nADCs and was superior to ADCtumor because of its stable performance in differentiating BEOTs from MEOTs, regardless of b factors.
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Analysis of MRI Values and Hemoglobin and Total Protein Concentrations of Cystic Ovarian Tumors. J Magn Reson Imaging 2018; 49:1133-1140. [DOI: 10.1002/jmri.26299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022] Open
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Park SB, Kim MJ, Lee KH, Ko Y. Ovarian serous surface papillary borderline tumor: characteristic imaging features with clinicopathological correlation. Br J Radiol 2018; 91:20170689. [PMID: 29888983 DOI: 10.1259/bjr.20170689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the clinical, pathological, and imaging features of ovarian serous surface papillary borderline tumors (SSPBTs). METHODS Imaging features were analyzed, including the tumor size, laterality, tumor spread and the presence of ascites. Morphological nature (encased normal ovary, characteristics on MRI) and contrast enhancement (increased flow on Doppler ultrasound) were also evaluated. Clinical and pathological features, such as tumor markers (CA 125), treatment methods, outcomes on follow-up, and surgical staging, were analyzed. RESULTS 10 tumors in 5 patients were evaluated. Mean largest tumor diameter was 45 mm. All patients had bilateral involvement and ascites. 40% of all patients showed peritoneal implants. 20% of patients evaluated had lymph node metastasis. These patients showed grossly normal ovaries that were encased in or surrounded by irregular solid tumors. They had a mostly hyperintense papillary architecture with hypointense internal branching on T2 weighted MR images (90%). Contrast enhancement and serum levels of CA 125 were elevated in all cases evaluated. All patients underwent radical surgery, and 80% of patients evaluated were of low stage. No recurrence occurred, during follow-up. CONCLUSION SSPBT of the ovary, which has a good prognosis, should be considered as a diagnosis for patients who have bilateral enhancing irregular solid masses with papillary architecture and internal branching, and encasing normal-appearing ovaries. Advances in knowledge: Serous surface papillary borderline tumor of the ovary is unique and has characteristic features. Knowledge of this specific ovarian tumor and radiological suspicion can have important implications for the patient to facilitate management including fertility-preserving surgery.
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Affiliation(s)
- Sung Bin Park
- 1 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul , Korea
| | - Min-Jeong Kim
- 2 Department of Radiology, Hallym University Sacred Heart Hospital , Gyeonggi-do , Korea
| | - Kyoung Ho Lee
- 3 Department of Radiology, Seoul National University Bundang Hospital , Gyeonggi-do , Korea.,4 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University , Seoul , Korea
| | - Yousun Ko
- 3 Department of Radiology, Seoul National University Bundang Hospital , Gyeonggi-do , Korea
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CT Features of Ovarian Tumors: Defining Key Differences Between Serous Borderline Tumors and Low-Grade Serous Carcinomas. AJR Am J Roentgenol 2018; 210:918-926. [PMID: 29489407 DOI: 10.2214/ajr.17.18254] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of our study was to investigate whether the CT features of serous borderline tumors (SBTs) differ from those of low-grade serous carcinomas (LGSCs) and to evaluate if mutation status is associated with distinct CT phenotypes. MATERIALS AND METHODS This retrospective study included 59 women, 37 with SBT and 22 with LGSC, who underwent CT before primary surgical resection. Thirty of 59 patients were genetically profiled. Two radiologists (readers 1 and 2) independently and retrospectively reviewed CT examinations for qualitative features and quantified total tumor volumes (TTVs), solid tumor volumes (STVs), and solid proportion of ovarian masses. Univariate and multivariate associations of the CT features with histopathologic diagnoses and mutations were evaluated, and interreader agreement was determined. RESULTS At multivariate analysis, the presence of bilateral ovarian masses (p = 0.03), the presence of peritoneal disease (PD) (p = 0.002), and higher STV of ovarian masses (p = 0.002) were associated with LGSC. The presence of nodular PD pattern (p < 0.001 each reader) and the presence of PD calcifications (reader 1, p = 0.02; reader 2, p = 0.003) were associated with invasive peritoneal lesions (i.e., LGSC). The presence of bilateral ovarian masses (p = 0.04 each reader), PD (reader 1, p = 0.01; reader 2, p = 0.004), and higher STV (p = 0.03 for each reader) were associated with the absence of BRAF mutation (i.e., wild type [wt]-BRAF). CONCLUSION The CT features of LGSCs were distinct from those of SBTs. The CT manifestations of LGSC and the wt-BRAF phenotype were similar.
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Nakai G, Yamada T, Yamamoto K, Hirose Y, Ohmichi M, Narumi Y. MRI appearance of ovarian serous borderline tumors of the micropapillary type compared to that of typical ovarian serous borderline tumors: radiologic-pathologic correlation. J Ovarian Res 2018; 11:7. [PMID: 29321056 PMCID: PMC5764013 DOI: 10.1186/s13048-018-0379-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022] Open
Abstract
Background Serous borderline tumor (SBT) of the micropapillary type (SBT-MP) became one of the major pathological SBT diagnoses in addition to typical SBT, and was also defined as “non-invasive” low-gradeserous carcinoma according to the World Health Organization (WHO) classification in 2014. In this study, we investigated the MRI appearance of SBT-MP compared to that of typical SBT in order to identify specific imaging features of SBT-MP that correspond to pathological findings. Methods MR images of 6 histologically proven ovarian SBT-MP in four patients and 14 typical SBT in ten patients were reviewed retrospectively. Images were evaluated for laterality, size and morphology of the lesion and the solid component (SC) and signal intensity (SI) of the SC. MRI findings were correlated with pathological findings. Results The patients with SBT-MP (mean 26.3 years) were younger than those with typical SBT (mean 44.5 years). Postoperative staging in patients with SBT-MP was II in two and III in two cases, while staging for typical SBT was I in seven, II in one and III in two cases. The morphologic patterns of SBT-MP were a unilateral cystic mass with intracystic mural nodules (CwMN) (n = 2), bilateral solid papillary masses (SM), and bilateral SM with CwMN. The pattern of typical SBT was CwMN (n = 13) in all but one lesion (SM with CwMN). All SCs showed inhomogeneous slight hyperintensity on T2 weighted images (WI) and high SI on diffusion-WI (DWI) except for in one typical SBT. Although diffuse proliferation of the tumor cells in micropapillary projections with little stroma seemed to correspond to inhomogeneous slightly hyperintense foci in SC on T2WI and high SI on DWI, similar MR findings were observed in typical SBT in all lesions on T2WI and 11 of 12 lesions on DWI. In typical SBT, inhomogeneous slightly hyperintense foci in SC on T2WI and high SI on DWI corresponded to highly cellular foci with densely branched papillae. Conclusion Pathological findings and clinical behavior of SBT-MP differed from those of typical SBT, but morphology and SI of SC on MRI were similar, with papillary projections demonstrating inhomogeneous slight hyperintensity on T2WI and high SI on DWI.
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Affiliation(s)
- Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan.
| | - Takashi Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
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MRI features and score for differentiating borderline from malignant epithelial ovarian tumors. Eur J Radiol 2017; 98:136-142. [PMID: 29279152 DOI: 10.1016/j.ejrad.2017.11.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/04/2017] [Accepted: 11/19/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify the MRI features of borderline epithelial ovarian tumors (BEOTs) and to differentiate BEOTs from malignant epithelial ovarian tumors (MEOTs). MATERIALS AND METHODS The clinical and MRI data of 89 patients with a BEOT and 109 patients with a MEOT proven by surgery and histopathology were retrospectively reviewed. MRI features, including bilaterality, size, shape, margin, cystic-solid interface, configuration, papillae or nodules, signal intensity, enhancement, presence of an ipsilateral ovary, peritoneal implants and ascites were analyzed and compared. Based on the odds ratio (OR) values, the significant risk features for BEOTs were scored as 3 (OR≈∞), 2 (5≤OR<∞) or 1 (OR<5). RESULTS There were 89 BEOT patients with 113 tumors [mean size of (13±6.7)cm], with bilateral ovary involvement in 24 cases. There were 109 MEOT patients with 142 tumors [(9.3±4.2)cm] with bilateral ovary involvement in 33 cases. There were eight significant risk factors for BEOTs, including round or oval shape (OR=2.714), well-defined margins (OR=3.318), clear cystic-solid interfaces (OR=5.593), purely cystic (OR=15.206), predominantly cystic with papillae or nodules (OR=2.579), exophytic papillae or nodules (OR=5.351), branching papilla (OR≈∞) and the presence of an ipsilateral ovary (OR≈∞). Based on the scoring of the eight risk factors, a cut-off score of 3.5 yielded a differential sensitivity, specificity, and accuracy of 82%, 85% and 84%, respectively. CONCLUSION In contrast to MEOTs, BEOTs frequently had the following features on MRI: round or oval, with well-defined margins and clear cystic-solid interfaces, purely cystic or predominantly cystic with papillae or nodules, branching or exophytic papillae, with the presence of an ipsilateral ovary. MRI can reveal the distinct morphological features of BEOTs and MEOTs and facilitate their discrimination.
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Kurata Y, Kido A, Moribata Y, Kameyama K, Minamiguchi S, Konishi I, Togashi K. Differentiation of Seromucinous Borderline Tumor from Serous Borderline Tumor on MR Imaging. Magn Reson Med Sci 2017; 17:211-217. [PMID: 28993546 PMCID: PMC6039779 DOI: 10.2463/mrms.mp.2017-0055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Seromucinous borderline tumor (SMBT) is a newly categorized ovarian tumor in the 2014 revised World Health Organization (WHO) classification. SMBT is similar to serous borderline tumor (SBT) on MRI reflecting their pathological findings. This study was conducted to demonstrate the usefulness of MRI findings and quantitative values for differentiating SMBT from SBT. METHODS This retrospective study examined 23 lesions (20 patients) from SMBT and 26 lesions (22 patients) from SBT. The following quantitative values were evaluated using receiver-operating characteristics analysis: overall and solid portion sizes, intracystic fluid signal intensity (SI) ratio compared with skeletal muscle on T1weighted image (T1WI) and T2weighted image (T2WI), contrast enhancement (CE) ratio, and mean and minimum apparent diffusion coefficient values of the solid portion. Two radiologists evaluated the prevalence of MRI finding characteristics of SMBT and SBT. The SI of the intracystic fluid on T1WI and T2WI and the association with endometriosis were evaluated visually. RESULTS The CE ratio was significantly higher in SBT (P = 0.007). It achieved the highest area under the curve (AUC) (0.739). The fluid SI ratio on T1WI was higher in SMBT (P = 0.036, AUC = 0.676). Exophytic growth of the solid portion was observed only in SBT (P = 0.011). Intracystic fluid SI of SMBT was higher on T1WI and lower on T2WI in visual evaluation (P = 0.008 and 0.007, respectively). Findings suggesting endometriosis were observed more frequently in SMBT patients (P = 0.019). CONCLUSION Higher CE ratio of the solid portion and exophytic growth were findings suggesting SBT. Higher intracystic fluid SI on T1WI and lower SI on T2WI suggested SMBT. MRI findings suggesting endometriosis favored the diagnosis of SMBT.
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Affiliation(s)
- Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Kyoko Kameyama
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine
| | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine.,National Hospital Organization Kyoto Medical Center
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kajiyama A, Edo H, Takeya C, Kubushiro K, Oharaseki T, Gomi T. Spontaneously Ruptured Paraovarian Tumor of Borderline Malignancy with Extremely Elevated Serum Carbohydrate Antigen 125 (CA125) Levels: A Comparison of the Imaging and Pathological Features. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:919-925. [PMID: 28835604 PMCID: PMC5580534 DOI: 10.12659/ajcr.904462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Female, 22 Final Diagnosis: Paraovarian tumor of borderline malignancy Symptoms: Hypochondriac pain Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- Akiko Kajiyama
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiromi Edo
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Chiaki Takeya
- Department of Gynecology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kaneyuki Kubushiro
- Department of Gynecology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiaki Oharaseki
- Department of Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tatsuya Gomi
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan
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Multiparametric MRI for differentiation of borderline ovarian tumors from stage I malignant epithelial ovarian tumors using multivariate logistic regression analysis. Eur J Radiol 2017. [PMID: 28629557 DOI: 10.1016/j.ejrad.2017.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the value of contrast-enhanced MRI, apparent diffusion coefficient (ADC) measurement, and CA-125 measurement for differentiating borderline ovarian tumors (BOTs) from stage I malignant epithelial ovarian tumors (MEOTs). MATERIAL AND METHODS This retrospective study included 43 patients with BOTs and 43 patients with stage I MEOTs who underwent contrast-enhanced MRI with DWI and CA-125 analysis. Two radiologists evaluated the MRI findings in consensus. Univariate and multivariate analyses were performed to detect the best predictor variables for MEOTs. RESULTS Mixed cystic/solid and predominantly solid appearances, as well as thickened irregular septa, were more frequent in MEOTs. A papillary architecture and internal branching (PA&IB) pattern was more frequent in BOTs. MEOTs had thicker walls and septa, larger solid components, and higher CA-125 values. The mean ADC value of solid components (ADCmean) and minimum ADC value of whole lesions (ADCmin) were lower in MEOTs. Multivariate analysis revealed that ADCmin and maximum diameter of the solid components were independent indicators of MEOTs with an AUC, sensitivity, and specificity of 0.86, 81%, and 84%, respectively. CONCLUSION ADCmin and maximum diameter of solid components were useful for differentiating BOTs from MEOTs.
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Xu Y, Yang J, Zhang Z, Zhang G. MRI for discriminating metastatic ovarian tumors from primary epithelial ovarian cancers. J Ovarian Res 2015; 8:61. [PMID: 26310488 PMCID: PMC4551762 DOI: 10.1186/s13048-015-0188-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/25/2015] [Indexed: 01/30/2023] Open
Abstract
AIMS To find specific magnetic resonance imaging (MRI) features to differentiate metastatic ovarian tumors from primary epithelial ovarian cancers. METHODS Eleven cases with metastatic ovarian tumors and 26 cases with primary malignant epithelial ovarian cancers were retrospectively studied. All features such as patient characteristics, MRI findings and biomarkers were evaluated. The differences including laterality, configuration, uniformity of locules, diffusion weighted imaging (DWI) signal of solid components and enhancement of solid portions between metastatic ovarian tumors and primary epithelial ovarian cancers were compared by Fisher's exact test. Median age of patients, the maximum diameter of lesions and biomarkers were compared by the Mann-Whitney test. RESULTS Patients with metastatic ovarian tumors were younger than patients with primary epithelial ovarian cancers in the median age (P = 0.015). Patients with bilateral tumors in metastatic ovarian tumors were more than those of primary epithelial ovarian cancers (P = 0.032). The maximum diameter of lesions in metastatic ovarian tumors was smaller than that of primary epithelial ovarian cancers (P = 0.005). The locules in metastatic ovarian tumors were more uniform than those of primary epithelial ovarian cancers (P = 0.024). The enhancement of solid portions in metastatic ovarian tumors showed more moderate than that of primary epithelial ovarian cancers (P = 0.037). There was no statistically significant difference between the two groups in configuration, DWI signal of solid components and ascites. Biomarkers such as CA125 and human epididymis protein 4 (HE4) in metastatic ovarian tumors showed less elevated than that of primary epithelial ovarian cancers. CONCLUSIONS Significant differences between metastatic ovarian tumors and primary epithelial ovarian cancers were found in the median age of patients, laterality, the maximum diameter of lesions, uniformity of locules, enhancement patterns of solid portions and biomarkers. Metastatic ovarian tumors usually presented in the younger patients, smaller-sized, more bilateral lesions, more uniform of locules, more moderate enhancement of solid portions, and less elevated levels of CA125 and HE4 than those of primary epithelial ovarian cancers.
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Affiliation(s)
- Yanhong Xu
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Jia Yang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Zaixian Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Guixiang Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China.
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Primary ovarian endometrioid adenocarcinoma: magnetic resonance imaging findings including a preliminary observation on diffusion-weighted imaging. J Comput Assist Tomogr 2015; 39:401-5. [PMID: 25978592 DOI: 10.1097/rct.0000000000000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to investigate the magnetic resonance imaging (MRI) features of ovarian endometrioid adenocarcinoma (OEC) and to evaluate conventional MRI and diffusion-weighted imaging (DWI) for diagnosing OEC. MATERIALS AND METHODS Twenty patients with OEC proven by surgery and pathology underwent MRI. The MRI features of the tumors evaluated included laterality, shape, size, configuration, mural nodules, signal intensity, apparent diffusion coefficient (ADC) values, enhancement, peritoneal implants, ascites, and synchronous primary cancer (SPC) of the ovary and endometrium. RESULTS Unilateral ovarian masses were observed in 18 (90%) of the 20 patients with 22 OEC lesions, whereas the remaining 2 (10%) patients had bilateral masses. Oval, lobulated, and irregular shapes were observed in 13 (59%), 6 (27%), and 3 (14%) tumors, respectively. The maximum diameter of the tumors ranged from 3.7 to 22.5 cm, with a mean of 11.2 ± 5.1 cm. Fifteen (68%) masses were mainly cystic with mural nodules, 5 (23%) were mixed cystic-solid, and 2 (9%) were solid. The solid components of tumors showed isointensity (100%) on T1-weighted imaging (T1WI), heterogeneous hyperintensity on T2-weighted imaging (T2WI) (86%), and hyperintensity on DWI (82%), with a mean ADC value of (0.96 ± 0.20) × 10 mm/s. The cystic components showed isointensity or hyperintensity (85%) on T1WI, hyperintensity on T2WI (100%), and hypointensity on DWI (63%), with a mean ADC value of (2.27 ± 0.27) × 10 mm/s. Ten (50%) of the patients were SPC. The mean ADC values of the solid components were (0.85 ± 0.19) × 10 mm/s and (1.08 ± 0.15) × 10 mm/s in only-OEC and SPC, respectively, with a statistically significant difference (P = 0.012). CONCLUSIONS Ovarian endometrioid adenocarcinoma usually appears as a large, oval, or lobulated cystic mass with mural nodules. Cystic components show isointensity or hyperintensity on T1WI, solid components and hyperintensity on T2WI and DWI. Synchronous primary cancer of the ovary endometrium is another characteristic feature of OEC.
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Naqvi J, Nagaraju E, Ahmad S. MRI appearances of pure epithelial papillary serous borderline ovarian tumours. Clin Radiol 2014; 70:424-32. [PMID: 25515794 DOI: 10.1016/j.crad.2014.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
Borderline epithelial ovarian tumours (BOT) represent 15-20% of all non-benign ovarian epithelial neoplasms. Compared to malignant ovarian tumours, they usually present at a younger age and carry a far superior prognosis. Fertility-conserving surgery is an important treatment option for patients with BOT. Ultrasound and CT are both widely available and play roles in the initial investigation and staging of BOT, respectively. However, lack of soft-tissue contrast limits their ability to characterize BOT. MRI can facilitate recognition of pure epithelial serous BOT (SBOT), including the cystic papillary and surface papillary subtypes. An abundance of hyperintense papillary projections with low signal internal branching and ovarian stroma preservation with a hypointense ovarian capsular margin on T2-weighted imaging are features strongly suggestive of SBOT. In this review we will discuss the general morphological features of SBOT, the benefits and drawbacks of ultrasound and CT in the initial work-up, and the principal MRI features enabling recognition of surface papillary and cystic papillary SBOT.
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Affiliation(s)
- J Naqvi
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK.
| | - E Nagaraju
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
| | - S Ahmad
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
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