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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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Computer Tomography in the Diagnosis of Ovarian Cysts: The Role of Fluid Attenuation Values. Healthcare (Basel) 2020; 8:healthcare8040398. [PMID: 33066370 PMCID: PMC7711840 DOI: 10.3390/healthcare8040398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022] Open
Abstract
Pathological analysis of ovarian cysts shows specific fluid characteristics that cannot be standardly evaluated on computer tomography (CT) examinations. This study aimed to assess the ovarian cysts’ fluid attenuation values on the native (Np), arterial (Ap), and venous (Vp) contrast phases of seventy patients with ovarian cysts who underwent CT examinations and were retrospectively included in this study. Patients were divided according to their final diagnosis into the benign group (n = 32) and malignant group (n = 38; of which 27 were primary and 11 were secondary lesions). Two radiologists measured the fluid attenuation values on each contrast phase, and the average values were used to discriminate between benign and malignant groups and primary tumors and metastases via univariate, multivariate, multiple regression, and receiver operating characteristics analyses. The Ap densities (p = 0.0002) were independently associated with malignant cysts. Based on the densities measured on all three phases, neoplastic lesions could be diagnosed with 89.47% sensitivity and 62.5% specificity. The Np densities (p = 0.0005) were able to identify metastases with 90.91% sensitivity and 70.37% specificity, while the combined densities of all three phases diagnosed secondary lesions with 72.73% sensitivity and 92.59% specificity. The ovarian cysts’ fluid densities could function as an adjuvant criterion to the classic CT evaluation of ovarian cysts.
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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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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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Laurent PE, Thomassin-Piana J, Jalaguier-Coudray A. Mucin-producing tumors of the ovary: MR imaging appearance. Diagn Interv Imaging 2015; 96:1125-32. [DOI: 10.1016/j.diii.2014.11.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 11/29/2022]
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Dogheim OY, Abdel Hamid AEDM, Barakat MS, Eid M, El-Sayed SM. Role of novel magnetic resonance imaging sequences in characterization of ovarian masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Une masse annexielle complexe. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Peyron N, Coulon A. Struma ovarii, pseudo-Meigs' syndrome and raised CA125, a rare association. Answer to May e-quid. Diagn Interv Imaging 2012; 93:643-7. [PMID: 22818078 DOI: 10.1016/j.diii.2012.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N Peyron
- Service d'imagerie médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, Lyon, France.
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Imaging appearance of petrous apex dermoid cysts containing little or no fat. Jpn J Radiol 2012; 31:133-7. [DOI: 10.1007/s11604-012-0150-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Tang YZ, Liyanage S, Narayanan P, Sahdev A, Sohaib A, Singh N, Rockall A. The MRI features of histologically proven ovarian cystadenofibromas-an assessment of the morphological and enhancement patterns. Eur Radiol 2012; 23:48-56. [PMID: 22814827 DOI: 10.1007/s00330-012-2568-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/30/2012] [Accepted: 05/31/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the morphological and enhancement features of histologically proven cystadenofibromas (CAFs) on magnetic resonance imaging (MRI). METHODS Forty-seven histologically proven CAFs (42 benign, five borderline) were retrospectively reviewed. One benign CAF had a synchronous adenocarcinoma in the same ovary. The morphological, signal and enhancement characteristics on MRI were recorded. RESULTS The mean long axis diameter of the CAFs was 80 mm. The contralateral ovary was abnormal in 45 % of cases. A solid component was seen in 85 %, which returned low T2-weighted signal in 75 % of CAFs. Septa were seen in 74 % and one CAF was purely cystic. The majority of solid components and septa demonstrated enhancement that was less than the myometrium. Wash-in rates (WIR) of the solid tissue were available for measurement in nine patients with an average WIR of 3.2 l/s. CONCLUSION This is the largest series describing MRI appearances of histologically proven CAFs. They are typically complex adnexal lesions containing septa, cystic components and solid tissue. The majority of solid components demonstrate low T2 signal and minimal enhancement. Almost half of the cases have an abnormal contralateral ovary.
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Affiliation(s)
- Yen Zhi Tang
- Imaging Department, Barts and the London NHS Trust, London, UK.
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Benign and Suspicious Ovarian Masses-MR Imaging Criteria for Characterization: Pictorial Review. JOURNAL OF ONCOLOGY 2012; 2012:481806. [PMID: 22536238 PMCID: PMC3321462 DOI: 10.1155/2012/481806] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/15/2012] [Indexed: 01/13/2023]
Abstract
Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are currently used to evaluate ovarian tumors. US is the first-line imaging investigation for suspected adnexal masses. Color Doppler US helps the diagnosis identifying vascularized components within the mass. CT is commonly performed in preoperative evaluation of a suspected ovarian malignancy, but it exposes patients to radiation. When US findings are nondiagnostic or equivocal, MRI can be a valuable problem solving tool, useful to give also surgical planning information. MRI is well known to provide accurate information about hemorrhage, fat, and collagen. It is able to identify different types of tissue contained in pelvic masses, distinguishing benign from malignant ovarian tumors. The knowledge of clinical syndromes and MRI features of these conditions is crucial in establishing an accurate diagnosis and determining appropriate treatment. The purpose of this paper is to illustrate MRI findings in neoplastic and non-neoplastic ovarian masses, which were assessed into three groups: cystic, solid, and solid/cystic lesions. MRI criteria for the correct diagnosis and characteristics for differentiating benign from malignant conditions are shown in this paper.
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Fiaschetti V, Calabria F, Crusco S, Meschini A, Nucera F, Schillaci O, Simonetti G. MR-PET fusion imaging in evaluating adnexal lesions: a preliminary study. Radiol Med 2011; 116:1288-302. [PMID: 21892714 DOI: 10.1007/s11547-011-0720-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 12/28/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE The objective of this preliminary study was to examine the effects of combined magnetic resonance/positron emission tomography (MR-PET) evaluation in the morphofunctional characterisation of ovarian lesions. MATERIALS AND METHODS From June 2008 to September 2010, we evaluated 24 patients (mean age 44±10 years; range 24-74) with ovarian lesions incidentally detected on ultrasonography (US) and/or multislice computed tomography (CT). All patients underwent MR imaging of the pelvis and total-body CT-PET. PET and MR images were subsequently fused at postprocessing using specific anatomical criteria. Results were compared with the histological examination. RESULTS Of the 24 examined lesions, 19 were malignant and five were benign on histological examination. MR, CT-PET and MR-PET sensitivity was 84%, 74% and 94%, respectively and specificity 60%, 80% and 100%, respectively. Positive (PPV) and negative predictive (NPV) values were 93% and 44% for CT-PET, 89% and 50% for MR and 100% and 83% for MR-PET, respectively. CONCLUSIONS Pelvic MR-PET fusion imaging provides advantages in terms of sensitivity and especially specificity compared with MR imaging or CT-PET alone. The added value of this fusion imaging modality lies in combining the benefits of the morphological evaluation provided by MR imaging and the metabolic assessment provided by PET.
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Affiliation(s)
- V Fiaschetti
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Policlinico Universitario Tor Vergata, Viale Oxford 81, 00133, Roma, Italy
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Tératomes parasitiques péritonéaux et péritonites chimiques dermoïdes. ACTA ACUST UNITED AC 2011; 92:382-92. [DOI: 10.1016/j.jradio.2011.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 05/31/2010] [Accepted: 03/07/2011] [Indexed: 11/17/2022]
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Froehlich JM, Metens T, Chilla B, Hauser N, Hohl MK, Kubik-Huch RA. MRI of the female pelvis: a possible pitfall in the differentiation of haemorrhagic vs. fatty lesions using fat saturated sequences with inversion recovery. Eur J Radiol 2011; 81:598-602. [PMID: 21306852 DOI: 10.1016/j.ejrad.2011.01.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 01/03/2011] [Indexed: 11/17/2022]
Abstract
The use of fat-saturated techniques should be an integral part of the work-up of any T1-hyperintense structure in the female pelvis for tissue characterization and for differentiation of a fat-containing ovarian mature teratoma from a haemorrhagic lesion. Two cases with haematocolpos and haematometra are presented, respectively. The haemorrhagic content showed high signal both on T1- and T2-weighted images, whereas an unexpected signal decrease in the fat-saturated T2-weighted inversion-recovery sequence was encountered. This unspecific suppression of signal in tissues with similar T1 relaxation times as fat can lead to a diagnostic pitfall both in T1- and T2-weighted STIR pulse sequences. Furthermore, a loss of signal on T2-weighting may also be due to the phenomenon of "T2-shading" in T1-bright ovarian endometrioma. Therefore, the fat-specific spectral fat-saturation of T1-weighted images is strongly recommended for tissue characterization in gynaecological disease.
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[Multiple ovarian fibromas in a patient with Gorlin syndrome: US and MR imaging features with pathological correlation]. ACTA ACUST UNITED AC 2010; 91:917-20. [PMID: 20814383 DOI: 10.1016/s0221-0363(10)70137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of multiple ovarian fibromas in a 23 year old woman with Gorlin syndrome. We describe the US and MR imaging features with pathological correlation. The fibrous component of the tumors were hypoechoic and attenuating on US with corresponding T2W hypointensity whereas myxoid components were hypoechoic with increased through transmission on US with corresponding T2W hyperintensity.
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Damarey B, Farine M, Vinatier D, Collinet P, Lucot J, Kerdraon O, Poncelet E. Tératomes ovariens matures et immatures : caractéristiques en échographie, TDM et IRM. ACTA ACUST UNITED AC 2010; 91:27-36. [DOI: 10.1016/s0221-0363(10)70003-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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