1
|
Gaeta M, Galletta K, Cavallaro M, Mormina E, Cannizzaro MT, Lanzafame LRM, D'Angelo T, Blandino A, Vinci SL, Granata F. T1 relaxation: Chemo-physical fundamentals of magnetic resonance imaging and clinical applications. Insights Imaging 2024; 15:200. [PMID: 39120775 PMCID: PMC11315875 DOI: 10.1186/s13244-024-01744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024] Open
Abstract
A knowledge of the complex phenomena that regulate T1 signal on Magnetic Resonance Imaging is essential in clinical practice for a more effective characterization of pathological processes. The authors review the physical basis of T1 Relaxation Time and the fundamental aspects of physics and chemistry that can influence this parameter. The main substances (water, fat, macromolecules, methemoglobin, melanin, Gadolinium, calcium) that influence T1 and the different MRI acquisition techniques that can be applied to enhance their presence in diagnostic images are then evaluated. An extensive case illustration of the different phenomena and techniques in the areas of CNS, abdomino-pelvic, and osteoarticular pathology is also proposed. CRITICAL RELEVANCE STATEMENT: T1 relaxation time is strongly influenced by numerous factors related to tissue characteristics and the presence in the context of the lesions of some specific substances. An examination of these phenomena with extensive MRI exemplification is reported. KEY POINTS: The purpose of the paper is to illustrate the chemical-physical basis of T1 Relaxation Time. MRI methods in accordance with the various clinical indications are listed. Several examples of clinical application in abdominopelvic and CNS pathology are reported.
Collapse
Affiliation(s)
- Michele Gaeta
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Karol Galletta
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Marco Cavallaro
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | | | | | - Tommaso D'Angelo
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD, Rotterdam, The Netherlands.
| | - Alfredo Blandino
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| |
Collapse
|
2
|
Transvaginal Ultrasound vs. Magnetic Resonance Imaging (MRI) Value in Endometriosis Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12071767. [PMID: 35885670 PMCID: PMC9315729 DOI: 10.3390/diagnostics12071767] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Endometriosis is a widespread gynecological condition that causes chronic pelvic discomfort, dysmenorrhea, infertility, and impaired quality of life in women of reproductive age. Clinical examination, transvaginal ultrasonography (TVS), and magnetic resonance imaging (MRI) are significant preoperative non-invasive diagnosis procedures for the accurate assessment of endometriosis. Although TVS is used as the primary line for diagnosis, MRI is commonly utilized to achieve a better anatomical overview of the entire pelvic organs. The aim of this systematic review article is to thoroughly summarize the research on various endometriosis diagnosis methods that are less invasive. (2) Methods: To find relevant studies, we examined electronic databases, such as MEDLINE/PubMed, Cochrane, and Google Scholar, choosing 70 papers as references. (3) Results: The findings indicate that various approaches can contribute to diagnosis in different ways, depending on the type of endometriosis. For patients suspected of having deep pelvic endometriosis, transvaginal sonography should be the first line of diagnosis. Endometriosis cysts are better diagnosed with TVS, whereas torus, uterosacral ligaments, intestine, and bladder endometriosis lesions are best diagnosed using MRI. When it comes to detecting intestine or rectal nodules, as well as rectovaginal septum nodules, MRI should be the imaging tool of choice. (4) Conclusions: When diagnosing DE (deep infiltrative endometriosis), the examiner’s experience is the most important criterion to consider. In the diagnosis of endometriosis, expert-guided TVS is more accurate than routine pelvic ultrasound, especially in the deep infiltrative form. For optimal treatment and surgical planning, accurate preoperative deep infiltrative endometriosis diagnosis is essential, especially because it requires a multidisciplinary approach.
Collapse
|
3
|
Lorusso F, Scioscia M, Rubini D, Stabile Ianora AA, Scardigno D, Leuci C, De Ceglie M, Sardaro A, Lucarelli N, Scardapane A. Magnetic resonance imaging for deep infiltrating endometriosis: current concepts, imaging technique and key findings. Insights Imaging 2021; 12:105. [PMID: 34292422 PMCID: PMC8298718 DOI: 10.1186/s13244-021-01054-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is an estrogen-dependent chronic disease affecting about 10% of reproductive-age women with symptoms like pelvic pain and infertility. Pathologically, it is defined by the presence of endometrial tissue outside the uterine cavity responsible for a chronic inflammatory process. For decades the diagnosis of endometriosis was based on surgical exploration and biopsy of pelvic lesions. However, laparoscopy is not a risk-free procedure with possible false negative diagnosis due to an underestimate of retroperitoneal structures such as ureters and nerves. For these reasons nowadays, the diagnosis of endometriosis is based on a noninvasive approach where clinical history, response to therapy and imaging play a fundamental role. Trans-vaginal ultrasound and magnetic resonance imaging are suitable for recognizing most of endometriotic lesions; nevertheless, their accuracy is strictly determined by operators’ experience and imaging technique. This review paper aims to make radiologists aware of the diagnostic possibilities of pelvic MRI and familial with the MR acquisition protocols and image interpretation for women with endometriosis.
Collapse
Affiliation(s)
- Filomenamila Lorusso
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | | | - Dino Rubini
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Amato Antonio Stabile Ianora
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | | | - Carla Leuci
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Michele De Ceglie
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Angela Sardaro
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Radiation Therapy, Bari, Italy
| | - Nicola Lucarelli
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Arnaldo Scardapane
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| |
Collapse
|
4
|
Lupean RA, Ștefan PA, Lebovici A, Csutak C, Rusu GM, Mihu CM. Differentiation of Endometriomas from Hemorrhagic Cysts at Magnetic Resonance: The Role of Quantitative Signal Intensity Measurements. Curr Med Imaging 2021; 17:524-531. [PMID: 33115394 DOI: 10.2174/1573405616999201027211132] [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: 04/08/2020] [Revised: 07/26/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endometriomas and functional hemorrhagic cysts (FHCs) are a common gynecological encounter. OBJECTIVE This study aimed to assess the diagnostic efficiency of magnetic resonance imaging (MRI) using signal intensity measurements in differentiating endometriomas from FHCs. METHODS Forty-six patients who underwent pelvic MRI examinations (endometriomas, n=28; FHCs, n=18) were retrospectively included. The "T2 shading" sign was evaluated subjectively and quantitatively by measuring the T1-T2 signal intensity difference and calculating the percentage of signal decrease between T1 and T2-weighted sequences. The resulted values, along with the measurement of the Apparent Diffusion Coefficient (ADC) and the signal intensity on three diffusion- weighted sequences (DWI) (b50, b400, and b800), were compared between groups by using the Mann-Whitney U test. Also, the receiver operating characteristic analysis was performed for the statistically significant results (P<0.016), and the area under the curve (AUC) was also calculated. RESULTS The two quantitative assessment methods showed similar efficiency in detecting endometriomas (P<0.001; sensitivity, 100%; specificity, 81.82%; AUC>0.86), outperforming the classic subjective evaluation of the "T2 shading" sign (sensitivity, 92.86%; specificity, 66.67%). ADC (P=0.52) and DWI measurements (P=0.49, P=0.74, and P=0.78) failed to distinguish between the two entities. CONCLUSION The quantitative analysis and interpretation of the "T2 shading" sign can significantly improve the differential diagnosis between endometriomas and FHCs.
Collapse
Affiliation(s)
- Roxana-Adelina Lupean
- Histology, Morphological Sciences Department, "Iuliu Hațieganu" University of Medicine and Pharmacy; Louis Pasteur street, number 4, Cluj-Napoca, 400349, Cluj, Romania
| | - Paul-Andrei Ștefan
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Georgeta Mihaela Rusu
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Carmen Mihaela Mihu
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| |
Collapse
|
5
|
Bordonné C, Puntonet J, Maitrot-Mantelet L, Bourdon M, Marcellin L, Dion E, Plu-Bureau G, Santulli P, Chapron C. Imaging for evaluation of endometriosis and adenomyosis. Minerva Obstet Gynecol 2021; 73:290-303. [PMID: 34008384 DOI: 10.23736/s2724-606x.21.04710-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endometriosis and adenomyosis are two frequent diseases that impair women's quality of life by causing pain and infertility. Both endometriosis and adenomyosis are heterogeneous diseases that manifest as different forms. Adenomyosis may be described as diffuse adenomyosis, focal adenomyosis especially of the outer myometrium and cystic adenomyoma. Endometriosis has three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). These two diseases are closely linked, and it is now clear that adenomyosis can either arise on its own or coexist with endometriosis. There is a strong clinical relationship between endometriosis and adenomyosis according to their respective phenotypes. Various classifications are available to describe both diseases. Transvaginal ultrasonography (TVUS) and/or pelvic magnetic resonance imaging (MRI) are the first examination performed when endometriosis or adenomyosis are suspected. These two imaging techniques, used in a combination manner, allow accurate description of both endometriosis and adenomyosis, to assess the diagnosis and to improve clinical and surgical care. In this review, we described the different imaging aspects of endometriosis and adenomyosis to help the less experienced radiologist or gynecologist in the diagnosis and evaluation of those diseases.
Collapse
Affiliation(s)
- Corinne Bordonné
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France - .,Faculty of Medicine, University of Paris, Paris, France -
| | - Julien Puntonet
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Lorraine Maitrot-Mantelet
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Mathilde Bourdon
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Louis Marcellin
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Elisabeth Dion
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Geneviève Plu-Bureau
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Pietro Santulli
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Charles Chapron
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| |
Collapse
|
6
|
Chandramohan A, Bhat TA, John R, Simon B. Multimodality imaging review of complex pelvic lesions in female pelvis. Br J Radiol 2020; 93:20200489. [DOI: 10.1259/bjr.20200489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Complex pelvic lesions can originate from various anatomical structures in the pelvis and pose a diagnostic dilemma due to a wide range of possible diagnoses. Accurate characterisation of these lesions would often require an algorithmic approach, which incorporates clinical findings, sequential use of multiple imaging modalities and a multiparametric approach. This approach usually aims at identifying key imaging features, which aid in anatomical localisation, morphology and tissue characterisation. There have been various attempts to standardise the lexicon used for describing adnexal masses in female patients; stratify their risk of cancer and suggest appropriate next steps in the management pathway. Through this review, we extend this approach to complex pelvic masses in female pelvis in general and will focus on optimal use of different imaging modalities to arrive at definitive diagnosis or meaningful differential diagnosis. We will also discuss potential pitfalls of imaging diagnosis and common mimics.
Collapse
Affiliation(s)
| | | | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, India
| |
Collapse
|
7
|
Differentiation of Endometriomas from Ovarian Hemorrhagic Cysts at Magnetic Resonance: The Role of Texture Analysis. ACTA ACUST UNITED AC 2020; 56:medicina56100487. [PMID: 32977428 PMCID: PMC7598287 DOI: 10.3390/medicina56100487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To assess ovarian cysts with texture analysis (TA) in magnetic resonance (MRI) images for establishing a differentiation criterion for endometriomas and functional hemorrhagic cysts (HCs) that could potentially outperform their classic MRI diagnostic features. Materials and Methods: Forty-three patients with known ovarian cysts who underwent MRI were retrospectively included (endometriomas, n = 29; HCs, n = 14). TA was performed using dedicated software based on T2-weighted images, by incorporating the whole lesions in a three-dimensional region of interest. The most discriminative texture features were highlighted by three selection methods (Fisher, probability of classification error and average correlation coefficients, and mutual information). The absolute values of these parameters were compared through univariate, multivariate, and receiver operating characteristic analyses. The ability of the two classic diagnostic signs ("T2 shading" and "T2 dark spots") to diagnose endometriomas was assessed by quantifying their sensitivity (Se) and specificity (Sp), following their conventional assessment on T1-and T2-weighted images by two radiologists. Results: The diagnostic power of the one texture parameter that was an independent predictor of endometriomas (entropy, 75% Se and 100% Sp) and of the predictive model composed of all parameters that showed statistically significant results at the univariate analysis (100% Se, 100% Sp) outperformed the ones shown by the classic MRI endometrioma features ("T2 shading", 75.86% Se and 35.71% Sp; "T2 dark spots", 55.17% Se and 64.29% Sp). Conclusion: Whole-lesion MRI TA has the potential to offer a superior discrimination criterion between endometriomas and HCs compared to the classic evaluation of the two lesions' MRI signal behaviors.
Collapse
|
8
|
Diagnostic Efficacy of T2 Dark Spot, T2 Dark Rim Signs, and T2 Shading on Magnetic Resonance Imaging in Differentiating Endometriomas From Hemorrhagic Cysts. J Comput Assist Tomogr 2019; 43:619-622. [PMID: 31268877 DOI: 10.1097/rct.0000000000000892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic efficacy of T2 dark spot, T2 dark rim, and T2 shading signs on magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts. METHODS Seventy-two hemorrhagic lesions were included in this retrospective study. The presence of T2 dark spot, T2 dark rim, and T2 shading signs in the lesions and the presence of complete or incomplete rim in lesions exhibiting T2 dark rim signs were evaluated. RESULTS Of 72 lesions, 50 were diagnosed with endometrioma and 22 were diagnosed with hemorrhagic cyst. Twenty-six of 50 endometriomas and none of the hemorrhagic cysts showed T2 dark spot sign. T2 shading was observed in 90% of endometriomas and 18% of hemorrhagic cysts. Incomplete T2 dark rim was detected in 67% of endometriomas and 21% of hemorrhagic cysts. CONCLUSIONS T2 dark spot and T2 dark rim signs could be useful for distinguishing endometriomas from hemorrhagic cysts.
Collapse
|
9
|
Abstract
Developments in magnetic resonance imaging have expanded its role in the assessment of the female pelvis, including the diagnosis of ovarian lesions. In this setting, diffusion-weighted imaging has proven its diagnostic value, which is particularly important in differentiating between benign and malignant ovarian tumors. In general, the latter show restricted diffusion, whereas the former do not. Exceptions include teratomas, endometriomas, hemorrhagic cysts, ovarian abscesses, ovarian infarction, and some benign stromal tumors. The aim of this review is to draw attention to benign ovarian lesions with restricted diffusion, with a special focus on diffusion-weighted imaging pearls and pitfalls.
Collapse
Affiliation(s)
| | - Mariana Horta
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| | - João Cunha Salvador
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| |
Collapse
|
10
|
Kuwabara H, Yamamoto K, Terada T, Kawata R, Nagao T, Hirose Y. Hemorrhage of MRI and Immunohistochemical Panels Distinguish Secretory Carcinoma From Acinic Cell Carcinoma. Laryngoscope Investig Otolaryngol 2018; 3:268-274. [PMID: 30186957 PMCID: PMC6119803 DOI: 10.1002/lio2.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/08/2018] [Accepted: 04/26/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Secretory carcinoma (SC, mammary analogue secretory carcinoma) is a salivary gland tumor with ETV6-NTRK3 gene fusion, and its differential diagnosis includes acinic cell carcinoma (ACC). As hemorrhage is often seen in SC, we hypothesized that magnetic resonance imaging (MRI) and immunohistochemical analyses could distinguish SC from ACC. STUDY DESIGN Retrospective study. METHODS We used ETV6-NTRK3 gene fusion analyses to reclassify 19 parotid gland tumors that had previously been diagnosed as SC or ACC, and then investigated hemorrhage in both hematoxylin-eosin (H&E)-stained sections and MRIs, and immunohistochemical expression of S-100, mammaglobin, DOG1, and α-amylase. RESULTS The 19 tumors were genetically reclassified into 11 (58%) SC and 8 (42%) ACC. Combined S-100 and mammaglobin were specific for SC; whereas DOG1 was specific for ACC, and α-amylase was expressed only in 4 ACC cases (50%). H&E staining showed hemorrhage with hemosiderin deposition in all SC cases, and T2-weighted MRI showed hypointense areas in all investigated SC cases, but not in ACC. CONCLUSION Hemorrhage with hemosiderin deposition is frequently present in SC, and hemorrhage findings in MRI and an immunohistochemical panels for S-100, mammaglobin and DOG1 can distinguish SC from ACC. LEVEL OF EVIDENCE 3b.
Collapse
Affiliation(s)
| | | | - Tetsuya Terada
- Department of and OtorhinolaryngologyOsaka Medical CollegeOsakaJapan
| | - Ryo Kawata
- Department of and OtorhinolaryngologyOsaka Medical CollegeOsakaJapan
| | - Toshitaka Nagao
- Department of Anatomic PathologyTokyo Medical UniversityTokyoJapan
| | | |
Collapse
|
11
|
Abstract
Diffusion-weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. High signal intensity on DWI with simultaneous low signal intensity on apparent diffusion coefficient maps is usually associated with malignancy. However, that pattern can also be seen in many benign lesions, a fact that should be recognized by radiologists. Correlating DWI findings with those of conventional (T1- and T2-weighted) MRI sequences and those of contrast-enhanced MRI sequences is mandatory in order to avoid potential pitfalls. The aim of this review article is the description of the most relevant physiological and benign pathological conditions of the female pelvis that can show restricted diffusion on DWI.
Collapse
Affiliation(s)
- Ana Luisa Duarte
- Department of Radiology, Hospital do Espírito Santo E.P.E., Évora, Portugal
| | - João Lopes Dias
- Department of Radiology, Hospital de São José, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| |
Collapse
|
12
|
Bazot M, Bharwani N, Huchon C, Kinkel-Trugli K, Cunha TM, Guerra A, Manganaro L, Bunesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall A. Recommandations de la Société européenne d’imagerie génito-urinaire : IRM de l’endométriose pelvienne. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Gil R, Cunha TM, Rolim I. Mature cystic teratoma with high proportion of solid thyroid tissue: a controversial case with unusual imaging findings. J Radiol Case Rep 2017; 11:20-30. [PMID: 29299099 PMCID: PMC5743149 DOI: 10.3941/jrcr.v11i7.2853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We describe a case of a mature cystic teratoma of the ovary with high proportion of solid thyroid tissue (< 50% of the entire tumor) in a childbearing woman. The patient presented with non-specific abdominal bloating. Pelvic ultrasound and magnetic resonance imaging revealed a complex cystic-solid tumor confined to the left ovary with an anterior fat-containing locus compatible with mature cystic teratoma and a posterior predominantly solid component with low signal intensity on T2-weighted images that was histopatologically diagnosed as benign thyroid tissue. Thyroglobulin levels were in normal range. Although thyroid tissue is present in up to 20% of mature cystic teratomas, with exception of struma ovarii, it is not usually macroscopically nor radiologically identified. The differential diagnosis should include T2-hypointense adnexal lesions associated with mature cystic teratoma, malignant transformation of mature teratoma, and immature teratoma.
Collapse
Affiliation(s)
- Rui Gil
- Serviço de Radiologia, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Serviço de Radiologia, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ines Rolim
- Serviço de Anatomia Patológica, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| |
Collapse
|
15
|
The T2-dark spot sign. Abdom Radiol (NY) 2017; 42:1614-1615. [PMID: 28138730 DOI: 10.1007/s00261-017-1057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Masch WR, Daye D, Lee SI. MR Imaging for Incidental Adnexal Mass Characterization. Magn Reson Imaging Clin N Am 2017; 25:521-543. [PMID: 28668158 DOI: 10.1016/j.mric.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Incidentally detected adnexal masses are common, and the overwhelming majority of them are benign. As many of these adnexal masses are considered indeterminate at CT or US, a large number of benign oophorectomies occur. Of the malignant adnexal masses, high-grade primary ovarian neoplasms with fast doubling times and early dissemination are the most common. Due to their aggressive behavior, diagnosis of malignancy by interval growth on surveillance imaging represents an undesirable option. Immediate MR characterization allows for a decreased rate of benign oophorectomies and expedited triage of patients to definitive treatment when malignancy is suspected.
Collapse
Affiliation(s)
- William R Masch
- Department of Radiology, University of Michigan Health System, UH B2A205G, 1500 East Medical Center Drive, SPC 5030, Ann Arbor, MI 48109, USA.
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| |
Collapse
|
17
|
Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 2016; 27:2765-2775. [PMID: 27921160 PMCID: PMC5486785 DOI: 10.1007/s00330-016-4673-z] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/05/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
Abstract Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. Key Points • This report provides guidelines for MRI in endometriosis. • Minimal and optimal MRI acquisition protocols are provided. • Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4673-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Bazot
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France.
| | - N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, 3rd Floor Queen Elizabeth the Queen Mother Building, Praed Street, London, W2 1NY, UK
| | - C Huchon
- Department of Obtetrics and Gynaecology, CHI Poissy Saint-Germain en Laye,Versailles University France, 10 rue du champ Gaillard, 78300, Poissy, France
| | - K Kinkel
- Institut de radiologie, Clinique des Grangettes, 7, chemin des Grangettes, CH 1224, Chêne-Bougeries, Switzerland
| | - T M Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - A Guerra
- Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | - L Manganaro
- Department of Radiological Sciences, Sapienza University of Rome, Vle. Regina Elena 324, 00162, Rome, Italy
| | - L Buñesch
- Department of Radiology (Urogenital Section), Hospital Clínic Barcelona, Villarroel, 170, Barcelona, 08036, Spain
| | - A Kido
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - K Togashi
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France
| | - A G Rockall
- Department of Radiology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| |
Collapse
|
18
|
Affiliation(s)
- Pavani Thotakura
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
| | - Raymond B Dyer
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
| |
Collapse
|
19
|
Primary fallopian tube carcinoma: review of MR imaging findings. Insights Imaging 2015; 6:431-9. [PMID: 26150249 PMCID: PMC4519813 DOI: 10.1007/s13244-015-0416-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/20/2015] [Accepted: 06/15/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To review the epidemiological and clinical features of primary fallopian tube carcinoma (PFTC), and to illustrate the spectrum of MRI findings, with pathological confirmation. METHODS This article reviews the relevant literature on the epidemiological, clinical, and imaging features of primary fallopian tube carcinoma, with pathological confirmation, using illustrations from the authors' teaching files. RESULTS Primary fallopian tube carcinoma came under focus over the last few years due to its possible role on the pathogenesis of high-grade serous epithelial ovarian and peritoneal cancers. Typical symptoms, together with the presence of some of the most characteristic MRI signs, such as a "sausage-shaped" pelvic mass, hydrosalpinx, and hydrometra, may signal the presence of primary fallopian cancer, and allow the radiologist to report it as a differential diagnosis. CONCLUSIONS Primary fallopian tube carcinoma has a constellation of clinical symptoms and magnetic resonance imaging features, which may be diagnostic. Although these findings are not present together in the majority of cases, radiologists who are aware of them may include the diagnosis of primary fallopian tube cancer in their report more frequently and with more confidence. TEACHING POINTS • PFTC may be more frequent than previously thought • PFTC has specific clinical and MRI characteristics • Knowledge of typical PFTC signs enables its inclusion in the differential diagnosis • PFTC is currently staged under the 2013 FIGO system • PFTC is staged collectively with ovarian and peritoneal neoplasms.
Collapse
|