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Mekni K, Baba M, Haddad I, Aaraar M, Mejri O, ElFekih C. [Applicability of the Adnex score in predicting the malignancy of ovarian cysts]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:398-402. [PMID: 38065408 DOI: 10.1016/j.gofs.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/10/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Ovarian cancer screening is a difficult problem due to the anatomy of the ovaries. Only histology allows a definite diagnosis. Our objective was to study the contribution of the Adnex score in the histological characterization of adnexal images for adequate management. METHODS It was a retrospective, mono-center, descriptive and analytical. Sixty-five patients were included, those operated for an ovarian cyst and meeting the Adnex criteria: clinical, ultrasound and laboratory. RESULTS The mean age of the patients was 38.6 years. They were nulliparous in 43 % of cases, and only four had a history of operation on ovarian cyst. Abdominal pelvic pain was the most frequent reason for consultation in 48 % of cases. An abdominopelvic mass was found on abdominal examination in 11 % of cases. Pelvic ultrasound made it possible to objectify the presence of an ovarian mass in all cases, with an average size of 79.66mm and a reassuring appearance in 66 % of cases. The calculation of the Adnex score was done in all patients preoperatively, for a 10 % cut-off, the model showed an 86 % chance of benignity for tumors proven to be histologically benign. The main route of entry was laparoscopy, in 61 % of cases. The treatment was in most cases conservative consisting essentially of a cystectomy. CONCLUSION The Adnex score discriminated well between benign and malignant masses, allowing for a better diagnosis preoperatively. It thus deserves its applicability in the clinical setting.
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Affiliation(s)
- Karima Mekni
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie; Faculté of Médicine, Université Tunis El Manar, Tunis, Tunisia; Laboratoire de recherche LR18SP05, Tunis, Tunisia.
| | - Meriam Baba
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie
| | - Ines Haddad
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie
| | - Monia Aaraar
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie
| | - Oumayma Mejri
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie; Faculté of Médicine, Université Tunis El Manar, Tunis, Tunisia
| | - Chiraz ElFekih
- Service de gynéco-obstétrique, hôpital Mahmoud El Matri, 2080 Ariana, Tunisie; Faculté of Médicine, Université Tunis El Manar, Tunis, Tunisia
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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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3
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Braungart S, Williams C, Arul SG, Bambang K, Craigie RJ, Cross KM, Dick A, Hammond P, Okoye B, Rogers T, Losty PD, Glaser A, Powis M. Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement. Pediatr Blood Cancer 2022; 69:e29589. [PMID: 35118808 DOI: 10.1002/pbc.29589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/19/2022]
Abstract
AIM No widely agreed consensus protocols exist for the management of benign ovarian tumors (BOT) in children. This presents a substantial risk for suboptimal management. We aimed to generate multispecialty consensus guidance to standardize surgical management and provide a clear follow-up protocol for children with BOTs. METHODS Prospective two-round confidential e-Delphi consensus survey distributed among multispecialty expert panel; concluded by two semistructured videoconferences. MAIN RESULTS Consensus was generated on these core outcome sets: preoperative/intraoperative management; follow-up; adolescent gynecology referral. (1) Children with BOTs should receive the same management as other patients with potentially neoplastic lesions: Preoperative discussion at a pediatric oncology multidisciplinary meeting to risk stratify tumors, and management by health professionals with expertise in ovarian-sparing surgery and laparoscopy. (2) Ovarian-sparing surgery for BOTs should be performed wherever possible to maximize fertility preservation. (3) Ovarian masses detected during emergency laparoscopy/laparotomy should be left in situ wherever feasible and investigated appropriately (imaging/tumor markers) before resection. (4) Follow-up should be undertaken for all patients after BOT resection. Patients should be offered referral to adolescent gynecology to discuss fertility implications. CONCLUSION This best practice Delphi consensus statement emphasizes the importance of managing children with BOTs through a well-defined oncological MDT strategy, in order to optimize risk stratification and allow fertility preservation by ovarian-sparing surgery wherever possible.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.,Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Cara Williams
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - Suren G Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Katerina Bambang
- Department of Reproductive Medicine, Liverpool Women's Hospital, Liverpool, UK
| | - Ross James Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Kate Mary Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alistair Dick
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Philip Hammond
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Bruce Okoye
- Department of Paediatric Surgery, St George's Hospital London, London, UK
| | - Timothy Rogers
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Paul Damian Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Adam Glaser
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Zhang X, Meng X, Dou T, Sun H. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses: A meta-analysis. Exp Ther Med 2020; 20:265. [PMID: 33199990 PMCID: PMC7664593 DOI: 10.3892/etm.2020.9395] [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: 02/24/2020] [Accepted: 09/18/2020] [Indexed: 01/01/2023] Open
Abstract
Transvaginal ultrasound (TVUS) is a standard imaging modality for differentiating patients with benign or malignant suspected adnexal mass. To date, numerous studies have assessed the diagnostic accuracy of TVUS in various settings but with variable results. Therefore, the purpose of the present study was to perform a meta-analysis to evaluate the diagnostic accuracy of TVUS for the differentiation of adnexal masses. An electronic search in the Medline, Scopus, Cochrane and Embase databases from inception till November 2019 was carried out. Meta-analysis was performed to obtain pooled sensitivity and specificity of TVUS to distinguish malignant from benign adnexal masses. The quality assessment of diagnostic accuracy studies-2 tool was used to assess the quality of trials. A total of 41 studies with 18,391 patients were included. The pooled sensitivity and specificity of TVUS was 92% (95% CI: 90-94%) and 89% (95% CI: 85-92%), respectively. The area under the receiver operating characteristic curve was 0.96 (95% CI: 0.84-1.00). There was considerable heterogeneity with a statistically significant chi-square test (P<0.001) and I2 of 99%. Meta-regression results indicated that index test standards, patient selection bias and study design were potential sources of heterogeneity (P<0.05). The funnel plot was symmetrical and low publication bias was confirmed by an insignificant Deek's test (P=0.90). The present systematic review and meta-analysis indicated that TVUS is useful in differentiating between benign and malignant tumours among patients with suspected adnexal mass with high sensitivity and specificity.
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Affiliation(s)
- Xiya Zhang
- Department of Special Inspection, Shandong Qingdao Hospital of Integrated Traditional and Western Medicine, Qingdao, Shandong 266002, P.R. China
| | - Xuan Meng
- Department of Ultrasound, Qingdao Fuwai Cardiovascular Hospital, Qingdao, Shandong 266021, P.R. China
| | - Ting Dou
- Department of Ultrasound Medicine, The Third People's Hospital of Qingdao, Qingdao, Shandong 266041, P.R. China
| | - Hui Sun
- Department of Special Inspection, Qingdao Women and Children's Hospital, Qingdao, Shandong 266000, P.R. China
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Abstract
This article provides an overview of the imaging evaluation of benign ovarian and adnexal masses in premenopausal and postmenopausal women and lesions discovered during pregnancy. Current imaging techniques are discussed, including pitfalls and differential diagnosis when necessary, as well as management. It also reviews the now well-established American College of Radiology (ACR)/Society of Radiologists in Ultrasound consensus guidelines and covers the more recently introduced Ovarian-Adnexal Reporting and Data System by the ACR and the recently published ADNEx Scoring System.
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Affiliation(s)
- Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
| | - Tammy Kim
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
| | - Joanna Riess
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
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Patel MD, Ascher SM, Horrow MM, Pickhardt PJ, Poder L, Goldman M, Berland LL, Pandharipande PV, Maturen KE. Management of Incidental Adnexal Findings on CT and MRI: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2020; 17:248-254. [DOI: 10.1016/j.jacr.2019.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/24/2022]
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7
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Zhang G, Yao W, Sun T, Liu X, Zhang P, Jin J, Bai Y, Hua K, Zhang H. Magnetic resonance imaging in categorization of ovarian epithelial cancer and survival analysis with focus on apparent diffusion coefficient value: correlation with Ki-67 expression and serum cancer antigen-125 level. J Ovarian Res 2019; 12:59. [PMID: 31242916 PMCID: PMC6595619 DOI: 10.1186/s13048-019-0534-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/21/2019] [Indexed: 01/25/2023] Open
Abstract
Background To determine whether magnetic resonance (MR) imaging features combined with apparent diffusion coefficient (ADC) values could be used as a tool for categorizing ovarian epithelial cancer (OEC) and predicting survival, as well as correlating with laboratory tests (serum cancer antigen 125, serum CA-125) and tumor proliferative index (Ki-67 expression). Methods and materials MRI examination was undertaken before invasive procedures. MRI features were interpreted and recorded on the picture archive communication system (PACS). ADC measurements were manually performed on post-process workstation. Clinical characteristics were individually retrieved and recorded through the hospital information system (HIS). Cox hazard model was used to estimate the effects of both clinical and MRI features on overall survival. Results Both clinical and MRI features differed significantly between Type I and Type II cancer groups (p < 0.05). The mean ADC value was inversely correlated with Ki-67 expression in Type I cancer (ρ = − 0.14, p < 0.05). A higher mean ADC value was more likely to suggest Type I ovarian cancer (Odds Ratio (OR) = 16.80, p < 0.01). Old age and an advanced International Federation of Gynecology and Obstetrics (FIGO) stage were significantly related to Type II ovarian cancer (OR = 0.22/0.02, p < 0.05). An advanced FIGO stage, solid components, and old age were significantly associated with poor survival (Hazard Ratio (HR) = 23.54/3.69/2.46, p < 0.05). Clear cell cancer type had a poorer survival than any other pathological subtypes of ovarian cancer (HR = 13.6, p < 0.01). Conclusions MR imaging features combined with ADC value are helpful in categorizing OEC. ADC values can reflect tumor proliferative ability. A solid mass may predict poor prognosis for OEC patients. Electronic supplementary material The online version of this article (10.1186/s13048-019-0534-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guofu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Weigen Yao
- Department of Radiology, Yuyao People's Hospital, Ningbo, Zhejiang province, People's Republic of China
| | - Taotao Sun
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xuefen Liu
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Peng Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jun Jin
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yu Bai
- Center for Child and Family Policy, Duke University, Durham, USA
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China.
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Cappabianca S, Iaselli F, Reginelli A, D'Andrea A, Urraro F, Grassi R, Rotondo A. Value of Diffusion-Weighted Magnetic Resonance Imaging in the Characterization of Complex Adnexal Masses. TUMORI JOURNAL 2018; 99:210-7. [DOI: 10.1177/030089161309900215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aims and background The aim of the study was to define the role of diffusion-weighted imaging in the characterization of adnexal complex masses, with particular regard to the distinction between benign and malignant lesions. Conflicting results on this topic have emerged from studies in the last decade, with a consequent substantial limitation to the use of this relatively novel technique in clinical practice. Methods and study design Magnetic resonance imaging examinations performed on 91 patients with ovarian masses (56 benign, 35 malignant) were retrospectively evaluated by two observers unaware of the final histopathological diagnosis. Diffusion-weighted sequences with b values of 0, 500 and 1000 were performed in all cases, and apparent diffusion coefficient maps were automatically generated. The signals of both the cystic and solid components of the ovarian masses were evaluated on T2-weighted and diffusion-weighted images acquired with a b value of 1000. Apparent diffusion coefficient values were measured in all cases. Results With regard to the solid components, hypointensity on both the T2-weighted and diffusion-weighted images has proved to be a reliable indicator of benignancy. In contrast, hyperintensity on both sequences was suggestive of malignancy. Signal intensity of the cystic components and apparent diffusion coefficient values of both components have not proven useful in characterization of the masses. Conclusions Only the definition of the signal intensities on diffusion-weighted images obtained with the use of high b values on the solid component of a complex adnexal mass is useful to characterize an ovarian mass as benign or malignant.
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Affiliation(s)
- Salvatore Cappabianca
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Francesco Iaselli
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Alfonso Reginelli
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Alfredo D'Andrea
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Fabrizio Urraro
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Roberto Grassi
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Antonio Rotondo
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
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Taïeb S, Ben Haj Amor M, Mailliez A, Adenis C, Leblanc É. Dépistage des cancers de l’ovaire : chez qui, comment et pour quelle efficacité ? IMAGERIE DE LA FEMME 2016. [DOI: 10.1016/j.femme.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Suggested spontaneous resolution of possible paediatric hydrosalpinx: a case report with discussion. GYNECOLOGICAL SURGERY 2016; 13:43-48. [PMID: 26918003 PMCID: PMC4753245 DOI: 10.1007/s10397-015-0925-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/17/2015] [Indexed: 10/25/2022]
Abstract
Hydrosalpinx is a rare cause of abdominal pain in paediatric patients, though cases are documented in the literature. Its aetiology differs considerably from traditional hydrosalpinx due to ascending sexually transmitted infection. Hydrosalpinx can resent mimicking an acute abdomen or can be asymptomatic. Management of paediatric hydrosalpinx varies but often involves surgical removal of the affected tube. A 12-year-old girl presented with left-sided acute abdominal pain setting within 24 h. Initial ultrasound scan suggested presence of hydrosalpinx. Post-discharge follow-up appointment with a consultant paediatric gynaecologist demonstrated no symptomology, but repeated scan by another sonographer showed continued presence of possible hydrosalpinx, which had since grown. Later, MRI was performed to confirm site of the lesion. However, MRI revealed no tubal masses, suggesting spontaneously resolved hydrosalpinx. Consultant-administered ultrasound scan confirm no tubal abnormalities. Our case suggests spontaneous resolution in possible paediatric hydrosalpinx. Our recommendation is for conservative management of asymptomatic paediatric and adolescent hydrosalpinges, with emergency surgery offered if symptoms indicative of tubal or adnexal torsion.
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Chabrol A, Rousset P, Charlot M, Chateau F, Cotton F, Golfier F, Rety F. Lesions of the ovary with T1-hypersignal. Clin Radiol 2014; 69:e404-13. [PMID: 25017450 DOI: 10.1016/j.crad.2014.05.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/08/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
Abstract
Pelvic magnetic resonance imaging (MRI) has been used successfully to diagnose ovarian masses that cannot be adequately evaluated using pelvic ultrasound. T1 hyperintensity is a common finding in an ovarian mass and has important diagnostic implications. The aims of this review are to list the substances that may produce high signal intensity on T1-weighted MRI, to explain the physical basis for causes of the high T1 signal intensity, and to describe common and uncommon T1 hyperintense ovarian lesions. The morphological findings, the imaging features of the additional sequences, and clinical variables can help in the differential diagnosis, and in some cases, enable a specific diagnosis, leading to appropriate management of the patient.
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Affiliation(s)
- A Chabrol
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France.
| | - P Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - M Charlot
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Chateau
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Cotton
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Golfier
- Department of Gynaecological and Oncological Surgery-Obstetrics, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
| | - F Rety
- Department of Radiology, Centre Hospitalier Lyon Sud, chemin du grand revoyet, 69310 Pierre Bénite, France
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Coccia ME, Rizzello F, Romanelli C, Capezzuoli T. Adnexal masses: what is the role of ultrasonographic imaging? Arch Gynecol Obstet 2014; 290:843-54. [DOI: 10.1007/s00404-014-3327-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
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Zhang H, Li J, Sun W, Hu Y, Zhang G, Shen M, Shi X. Hyaluronic acid-modified magnetic iron oxide nanoparticles for MR imaging of surgically induced endometriosis model in rats. PLoS One 2014; 9:e94718. [PMID: 24722347 PMCID: PMC3983238 DOI: 10.1371/journal.pone.0094718] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/18/2014] [Indexed: 01/09/2023] Open
Abstract
Endometriosis is defined as the presence of endometrial tissue outside the uterine, which may affect nearly 60% of women in reproductive age. Deep infiltrating endometriosis (DIE) defined as an endometriotic lesion penetrating into the retroperitoneal space or the wall of the pelvic organs to a depth of at least 5 mm represents the most diagnostic challenge. Herein, we reported the use of hyaluronic acid (HA)-modified magnetic iron oxide nanoparticles (HA-Fe3O4 NPs) for magnetic resonance (MR) imaging of endometriotic lesions in the rodent model. Sixteen endometriotic lesions were surgically induced in eight rats by autologous transplantation. Four weeks after lesion induction, three rats were scanned via MR imaging after tail vein injection of the HA-Fe3O4 NPs. Accordingly, the remaining five mice were sacrificed in the corresponding time points. The ectopic uterine tissues (EUTs) were confirmed by histological analysis. Quantification of Fe in the EUT was also performed by inductively coupled plasma-optical emission spectroscopy. Our results showed that by using the HA-Fe3O4 NPs, the EUTs were able to be visualized via T2-weighted MR imaging at 2 hours post injection, corroborating the Prussian blue staining results. The developed HA-Fe3O4 NPs could be used as negative contrast agents for sensitively detecting endometriosis in a mouse model and may be applied for future hyperthermia treatment of endometriosis.
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Affiliation(s)
- He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Jingchao Li
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, PR China
| | - Wenjie Sun
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, PR China
| | - Yong Hu
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, PR China
| | - Guofu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
- * E-mail: (GZ); (MS); (XS)
| | - Mingwu Shen
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, PR China
- * E-mail: (GZ); (MS); (XS)
| | - Xiangyang Shi
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, PR China
- * E-mail: (GZ); (MS); (XS)
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Laculle-Massin C, Collinet P, Faye N. Stratégies diagnostiques des tumeurs ovariennes présumées bénignes. ACTA ACUST UNITED AC 2013; 42:760-73. [DOI: 10.1016/j.jgyn.2013.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Zhang H, Zhang GF, He ZY, Li ZY, Zhang GX. Prospective evaluation of 3T MRI findings for primary adnexal lesions and comparison with the final histological diagnosis. Arch Gynecol Obstet 2013; 289:357-64. [PMID: 23934242 DOI: 10.1007/s00404-013-2990-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 07/31/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE We prospectively investigated the diagnostic accuracy of magnetic resonance imaging (MRI) at 3.0 Tesla (3T) for the detection of suspected primary adnexal masses in a large cohort of patients. METHODS This prospective clinical study included 223 patients with suspected gynaecological disease who were referred for 3T MRI assessments before laparoscopy or laparotomy. Fifty-nine patients were excluded. All detected adnexal pathologies on MRI were categorized into the four groups (endometric cysts, teratomas, benign tumours and malignant tumours). Histological findings were used as the comparative reference standard. As measures to detect or rule out primary adnexal masses, accuracy, sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were determined by lesion-based evaluations. RESULTS The reference standard method detected 141 primary adnexal lesions in 125 patients. The areas under the receiver operating characteristic curve of the lesion-based evaluations for endometric cysts, teratomas, benign lesions and malignant lesions were 92.8, 93.6, 95.1 and 94.4 %. Lesion-based evaluation yielded an accuracy of 90.3 %, sensitivity of 92.7 %, specificity of 89.3 %, PPV of 77.6 % and NPV of 96.8 % in differentiating malignancies from non-malignant lesions. The diagnostic value of 3T MRI for detecting malignancies was superior to that for benign tumours. CONCLUSIONS 3T MRI well categorize the characteristics of primary adnexal lesions and may be a reliable modality for distinguishing malignancies from benign tumours.
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Affiliation(s)
- He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, No. 419 Fang Xie Road, Shanghai, 200011, China
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Zhang H, Zhang GF, He ZY, Li ZY, Zhu M, Zhang GX. Evaluation of primary adnexal masses by 3T MRI: categorization with conventional MR imaging and diffusion-weighted imaging. J Ovarian Res 2012; 5:33. [PMID: 23148860 PMCID: PMC3576319 DOI: 10.1186/1757-2215-5-33] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/29/2012] [Indexed: 12/15/2022] Open
Abstract
Background To investigate the 3.0-Tesla (3 T) magnetic resonance imaging (MRI) characteristics of primary adnexal lesions for discriminating benign from malignant lesions. Methods One hundred thirty-nine patients with pathologically proven primary adnexal masses referred for 3 T MRI assessment preoperatively were included. Baseline characteristics, components, and conventional MRI and diffusion-weighted imaging (DWI-MRI) signals were recorded and compared. Results There were 22 ovarian cysts, 33 endometriomas, 43 benign tumors and 42 malignant tumors. When ovarian cyst and endometrioma were excluded, there were no significant differences in patients’ age between benign and malignant tumor (P = 0.235). There were no significant differences (P = 0.606) in the conventional MRI signals and significant difference (P = 0.008) in DWI-MRI signal between the non-malignant and malignant lesions. There was a significant difference (P = 0.000) in the apparent diffusion coefficient values (ADCs) between the non-malignant and malignant lesions. Conclusions 3 T MRI categorized the characteristics of primary adnexal lesions. Conventional MRI signals were not useful for characterizing between benign and malignant lesions. DWI-MRI and ADCs were helpful for distinguishing malignant from benign ovarian lesions.
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Affiliation(s)
- He Zhang
- Department of Radiology, Shanghai First People's Hospital, Medical College, Shanghai Jiaotong University, No, 100, Hai Ning Road, Shanghai, 200080, China.
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Haoula Z, Deshpande R, Jayaprakasan K, Raine-Fenning N. Doppler imaging in the diagnosis of ovarian disease. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2012; 6:59-73. [PMID: 23480621 DOI: 10.1517/17530059.2012.642366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Pelvic ultrasonography remains the non-invasive imaging modality of choice for detecting and characterising adnexal masses. The use of Doppler ultrasound has improved the differential diagnosis of ovarian disease and helped to widen the understanding of the aetiology and possible pathophysiology of the various underlying conditions with an aim of improved diagnosis and management. AREAS COVERED This review describes the basis of different Doppler techniques and their application in ovarian disease. The present evidence is critically analysed in an attempt to define the current role of Doppler ultrasound of the ovaries. The technique holds promise in certain ovarian diseases but remains controversial in others. EXPERT OPINION Doppler ultrasound has a role in both the clinical and research settings. Clinically, it can be used to differentiate benign and malignant disease and help confirm diagnoses suggested on grey-scale imaging giving the user more confidence. Its use here, however, is generally restricted to a subjective impression of colour flow rather than a quantitative analysis of vascularity or blood flow velocity. These measures are more relevant in the research setting where quantitative Doppler is being used to clarify the possible underlying aetiology of various ovarian diseases such as polycystic ovarian syndrome and benign cysts. Doppler ultrasound has also been used in various models to evaluate the response to ovarian stimulation and the effect of surgery on the ovary.
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Affiliation(s)
- Zeina Haoula
- University of Nottingham, School of Clinical Sciences, Division of Obstetrics & Gynaecology , Nottingham , UK +44 0 115 823 1000 ; +44 0 115 823 0704 ;
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Eskander RN, Bristow RE. Adnexal Masses in Pediatric and Adolescent Females: A Review of the Literature. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2011. [DOI: 10.1007/s13669-011-0001-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Taïeb S, Vennin P. Dépistage du cancer de l’ovaire : le point en 2011. IMAGERIE DE LA FEMME 2011. [DOI: 10.1016/j.femme.2011.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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