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Leng Y, Kan A, Wang X, Li X, Xiao X, Wang Y, Liu L, Gong L. Contrast-enhanced CT radiomics for preoperative prediction of stage in epithelial ovarian cancer: a multicenter study. BMC Cancer 2024; 24:307. [PMID: 38448945 PMCID: PMC10916071 DOI: 10.1186/s12885-024-12037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Preoperative prediction of International Federation of Gynecology and Obstetrics (FIGO) stage in patients with epithelial ovarian cancer (EOC) is crucial for determining appropriate treatment strategy. This study aimed to explore the value of contrast-enhanced CT (CECT) radiomics in predicting preoperative FIGO staging of EOC, and to validate the stability of the model through an independent external dataset. METHODS A total of 201 EOC patients from three centers, divided into a training cohort (n = 106), internal (n = 46) and external (n = 49) validation cohorts. The least absolute shrinkage and selection operator (LASSO) regression algorithm was used for screening radiomics features. Five machine learning algorithms, namely logistic regression, support vector machine, random forest, light gradient boosting machine (LightGBM), and decision tree, were utilized in developing the radiomics model. The optimal performing algorithm was selected to establish the radiomics model, clinical model, and the combined model. The diagnostic performances of the models were evaluated through receiver operating characteristic analysis, and the comparison of the area under curves (AUCs) were conducted using the Delong test or F-test. RESULTS Seven optimal radiomics features were retained by the LASSO algorithm. The five radiomics models demonstrate that the LightGBM model exhibits notable prediction efficiency and robustness, as evidenced by AUCs of 0.83 in the training cohort, 0.80 in the internal validation cohort, and 0.68 in the external validation cohort. The multivariate logistic regression analysis indicated that carcinoma antigen 125 and tumor location were identified as independent predictors for the FIGO staging of EOC. The combined model exhibited best diagnostic efficiency, with AUCs of 0.95 in the training cohort, 0.83 in the internal validation cohort, and 0.79 in the external validation cohort. The F-test indicated that the combined model exhibited a significantly superior AUC value compared to the radiomics model in the training cohort (P < 0.001). CONCLUSIONS The combined model integrating clinical characteristics and radiomics features shows potential as a non-invasive adjunctive diagnostic modality for preoperative evaluation of the FIGO staging status of EOC, thereby facilitating clinical decision-making and enhancing patient outcomes.
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Affiliation(s)
- Yinping Leng
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Ao Kan
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Xiwen Wang
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Xiaofen Li
- Department of Radiology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Xuan Xiao
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Lan Liu
- Department of Radiology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China.
| | - Lianggeng Gong
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China.
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Leng Y, Li S, Zhu J, Wang X, Luo F, Wang Y, Gong L. Application of medical imaging in ovarian cancer: a bibliometric analysis from 2000 to 2022. Front Oncol 2023; 13:1326297. [PMID: 38111527 PMCID: PMC10725957 DOI: 10.3389/fonc.2023.1326297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Background Ovarian cancer (OC) is the most lethal tumor within the female reproductive system. Medical imaging plays a significant role in diagnosis and monitoring OC. This study aims to use bibliometric analysis to explore the current research hotspots and collaborative networks in the application of medical imaging in OC from 2000 to 2022. Methods A systematica search for medical imaging in OC was conducted on the Web of Science Core Collection on August 9, 2023. All reviews and articles published from January 2000 to December 2022 were downloaded, and an analysis of countries, institutions, journals, keywords, and collaborative networks was perfomed using CiteSpace and VOSviewer. Results A total of 5,958 publications were obtained, demonstrating a clear upward trend in annual publications over the study peroid. The USA led in productivity with 1,373 publications, and Harvard University emerged as the most prominent institution with 202 publications. Timmerman D was the most prolific contributor with 100 publications, and Gynecological Oncology led in the number of publications with 296. The top three keywords were "ovarian cancer" (1,256), "ultrasound" (725), and "diagnosis" (712). In addition, "pelvic masses" had the highest burst strength (25.5), followed by "magnetic resonance imaging (MRI)" (21.47). Recent emergent keywords such as "apoptosis", "nanoparticles", "features", "accuracy", and "human epididymal protein 4 (HE 4)" reflect research trends in this field and may become research hotspots in the future. Conclusion This study provides a comprehensive summary of the key contributions of OC imaging to field's development over the past 23 years. Presently, primary areas of OC imaging research include MRI, targeted therapy of OC, novel biomarker (HE 4), and artificial intelligence. These areas are expected to influence future research endeavors in this field.
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Affiliation(s)
- Yinping Leng
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuhao Li
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianghua Zhu
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiwen Wang
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fengyuan Luo
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Lianggeng Gong
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
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Liu R, Li R, Fang J, Deng K, Chen C, Li J, Wu Z, Zeng X. Apparent diffusion coefficient histogram analysis for differentiating solid ovarian tumors. Front Oncol 2022; 12:904323. [PMID: 35978817 PMCID: PMC9376384 DOI: 10.3389/fonc.2022.904323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/06/2022] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the utility of apparent diffusion coefficient (ADC) histogram analysis to differentiate between three types of solid ovarian tumors: granulosa cell tumors (GCTs) of the ovary, ovarian fibromas, and high-grade serous ovarian carcinomas (HGSOCs). Methods The medical records of 11 patients with GCTs of the ovary (regions of interest [ROI-cs], 137), 61 patients with ovarian fibromas (ROI-cs, 161), and 14 patients with HGSOCs (ROI-cs, 113) confirmed at surgery and histology who underwent diffusion-weighted imaging were retrospectively reviewed. Histogram parameters of ADC maps (ADCmean, ADCmax, ADCmin) were estimated and compared using the Kruskal-WallisH test and Mann-Whitney U test. The area under the curve of receiver operating characteristic curves was used to assess the diagnostic performance of ADC parameters for solid ovarian tumors. Results There were significant differences in ADCmean, ADCmax and ADCmin values between GCTs of the ovary, ovarian fibromas, and HGSOCs. The cutoff ADCmean value for differentiating a GCT of the ovary from an ovarian fibroma was 0.95×10-3 mm2/s, for differentiating a GCT of the ovary from an HGSOC was 0.69×10-3 mm2/s, and for differentiating an ovarian fibroma from an HGSOC was 1.24×10-3 mm2/s. Conclusion ADCmean derived from ADC histogram analysis provided quantitative information that allowed accurate differentiation of GCTs of the ovary, ovarian fibromas, and HGSOCs before surgery.
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Affiliation(s)
- Renwei Liu
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Ruifeng Li
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Jinzhi Fang
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Kan Deng
- C&TS Clinical Science, Philips Healthcare, Guangzhou, China
| | - Cuimei Chen
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Jianhua Li
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Zhiqing Wu
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Xiaoxu Zeng
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
- *Correspondence: Xiaoxu Zeng,
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Hanna DH, R. Saad G. Induction of mitochondria mediated apoptosis in human ovarian cancer cells by folic acid coated tin oxide nanoparticles. PLoS One 2021; 16:e0258115. [PMID: 34597348 PMCID: PMC8486119 DOI: 10.1371/journal.pone.0258115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aims to prepare folic acid coated tin oxide nanoparticles (FA-SnO2 NPs) for specifically targeting human ovarian cancer cells with minimum side effects against normal cells. METHODS The prepared FA-SnO2 NPs were characterized by FT-IR, UV-vis spectroscopy, XRD, SEM and TEM. The inhibition effects of FA-SnO2 NPs against SKOV3 cancer cell were tested by MTT and LDH assay. Apoptosis induction in FA-SnO2 NPs treated SKOV3 cells were investigated using Annexin V/PI, AO/EB and Comet assays and the possible mechanisms of the cytotoxic action were studied by Flow cytometry, qRT-PCR, Immunohistochemistry, and Western blotting analyses. The effects of FA-SnO2 NPs on reactive oxygen species generation in SKOV3 cells were also examined. Additionally, the safety of utilization FA-SnO2 NPs were studied in vivo using Wister rats. RESULTS The obtained FA-SnO2 NPs displayed amorphous spherical morphology with an average diameter of 157 nm and a zeta potential value of -24 mV. Comparing to uncoated SnO2 NPs, FA-SnO2 NPs had a superior inhibition effect towards SKOV3 cell growth that was suggested to be mediated through higher reactive oxygen species generation. It was showed that FA-SnO2 NPs increased significantly the % of apoptotic cells in the sub- G1 and G2/M phases with a higher intensity comet nucleus in SKOV3 treated cells. Furthermore, FA-SnO2 NPs was significantly increased the expression levels of P53, Bax, and cleaved Caspase-3 and accompanied with a significant decrease of Bcl-2 in the treated SKOV3 cells. CONCLUSION Overall, the results suggested that an increase in cellular FA-SnO2 NPs internalization resulted in a significant induced cytotoxicity in SKOV3 cancer cells in dose-dependent mode through ROS-mediated cell apoptosis that may have occurred through mitochondrial pathway. Additionally, the results confirmed the safety of utilization FA-SnO2 NPs against living systems. So, FA-SnO2 NPs with a specific targeting moiety may be a promising therapeutic candidate for human ovarian cancer.
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Affiliation(s)
- Demiana H. Hanna
- Faculty of Science, Department of Chemistry, Cairo University, Giza, Egypt
| | - Gamal R. Saad
- Faculty of Science, Department of Chemistry, Cairo University, Giza, Egypt
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Amante S, Santos F, Cunha TM. Low-grade serous epithelial ovarian cancer: a comprehensive review and update for radiologists. Insights Imaging 2021; 12:60. [PMID: 33974157 PMCID: PMC8113429 DOI: 10.1186/s13244-021-01004-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022] Open
Abstract
Low-grade serous carcinoma (LGSC) is an infrequent subtype of ovarian cancer, corresponding to 5% of epithelial neoplasms. This subtype of ovarian carcinoma characteristically has molecular features, pathogenesis, clinical behaviour, sensitivity to chemotherapy, and prognosis distinct to high-grade serous carcinoma (HGSC). Knowing the difference between LGSC and other ovarian serous tumours is vital to guide clinical management, which currently is only possible histologically. However, imaging can provide several clues that allow differentiating LGSC from other tumours and enable precise staging and follow-up of ovarian cancer treatment. Characteristically, LGSC appears as mixed lesions with variable papillary projections and solid components, usually in different proportions from those detected in serous borderline tumour and HGSC. Calcified extracellular bodies, known as psammoma bodies, are also a common feature of LGSC, frequently detectable within lymphadenopathies and metastases associated with this type of tumour. In addition, the characterisation of magnetic resonance imaging enhancement also plays an essential role in calculating the probability of malignancy of these lesions. As such, in this review, we discuss and update the distinct radiological modalities features and the clinicopathologic characteristics of LGSC to allow radiologists to be familiarised with them and to narrow the differential diagnosis when facing this type of tumour.
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Affiliation(s)
- Sofia Amante
- Department of Radiology, Hospital do Divino Espírito Santo de Ponta Delgada, Avenida D. Manuel I, 9500-370, Ponta Delgada, Azores, Portugal.
| | - Filipa Santos
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Delaney LJ, Machado P, Torkzaban M, Lyshchik A, Wessner CE, Kim C, Rosenblum N, Richard S, Wallace K, Forsberg F. Characterization of Adnexal Masses Using Contrast-Enhanced Subharmonic Imaging: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:977-985. [PMID: 31769529 PMCID: PMC7174081 DOI: 10.1002/jum.15183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 10/31/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVES This pilot study evaluated whether contrast-enhanced subharmonic imaging (SHI) could be used to characterize adnexal masses before surgical intervention. METHODS Ten women (with 12 lesions) scheduled for surgery of an ovarian mass underwent an SHI examination of their adnexal region using a modified LOGIQ E9 scanner (GE Healthcare, Waukesha, WI) with an endocavitary transducer, in which digital clips were acquired by pulse destruction-replenishment SHI across the lesions. Time-intensity curves were created offline to quantitatively evaluate SHI parameters (fractional tumor perfusion, peak contrast intensity, time to peak contrast enhancement, and area under the time-intensity curve), which were compared to pathologic characterizations of the lesions. RESULTS Of the 12 masses, 8 were benign, and 4 were malignant. A qualitative analysis of the SHI images by an experienced radiologist resulted in diagnostic accuracy of 70%, compared to 56% without contrast, whereas an inexperienced radiologist improved from 50% to 58% accuracy, demonstrating the benefit of SHI. A quantitative analysis of SHI parameters produced diagnostic accuracy as high as 81%. Peak contrast intensity was significantly greater in malignant than benign masses (mean ± SD, 0.109 ± 0.088 versus 0.046 ± 0.030 arbitrary units; P = .046). Malignant masses also showed significantly greater perfusion than benign masses (24.79% ± 25.34% versus 7.62% ± 6.50%; P = .045). When the radiologist reads were combined with the most predictive quantitative SHI parameter (percent perfusion), diagnostic accuracy improved to 84% for the experienced radiologist and 96% for the novice radiologist. CONCLUSIONS Results indicate that SHI for presurgical characterization of adnexal masses may improve the determination of malignancy and diagnostic accuracy, albeit based on a small sample size.
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Affiliation(s)
- Lauren J Delaney
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christine Kim
- Division of Gynecologic Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Norman Rosenblum
- Division of Gynecologic Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott Richard
- Division of Gynecologic Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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De Blasis I, Moruzzi MC, Moro F, Mascilini F, Cianci S, Gueli Alletti S, Turco LC, Garganese G, Scambia G, Testa AC. Role of ultrasound in advanced peritoneal malignancies. Minerva Med 2019; 110:292-300. [DOI: 10.23736/s0026-4806.19.06103-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Elsherif S, Javadi S, Viswanathan C, Faria S, Bhosale P. Low-grade epithelial ovarian cancer: what a radiologist should know. Br J Radiol 2019; 92:20180571. [PMID: 30604635 DOI: 10.1259/bjr.20180571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ovarian cancer accounts for the death of over 100,000 females every year and is the most lethal gynecological malignancy. Low-grade serous ovarian carcinoma (LGSOC) and high-grade serous ovarian carcinoma (HGSOC) have been found to represent two distinct entities based on their molecular differences, clinical course, and response to chemotherapy. Currently, all ovarian cancers are staged according to the revised staging system of the International Federation of Gynecology and Obstetrics (FIGO). Imaging plays an integral role in the diagnosis, staging, and follow-up of ovarian cancers. This review will be based on the two-tier grading system of epithelial ovarian cancers, with the main emphasis on serous ovarian cancer, and the role of imaging to characterize low-grade vs high-grade tumors and monitor disease recurrence during follow-up.
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Affiliation(s)
- Sherif Elsherif
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Sanaz Javadi
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Chitra Viswanathan
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Silvana Faria
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Priya Bhosale
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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Alcázar JL, Caparros M, Arraiza M, Mínguez JÁ, Guerriero S, Chiva L, Jurado M. Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography. Int J Gynecol Cancer 2019; 29:227-233. [DOI: 10.1136/ijgc-2018-000066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 01/13/2023] Open
Abstract
ObjectiveTo compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer.MethodsAn observational cohort study of 93 patients (mean age 57.6 years) with an ultrasound diagnosis of adnexal mass suspected of malignancy and confirmed histologically as epithelial ovarian cancer was undertaken. In all cases, transvaginal and transabdominal ultrasound as well as CT scans were performed to assess the extent of the disease within the pelvis and abdomen prior to surgery. The exploration was systematic, analyzing 12 anatomical areas. All patients underwent surgical staging and/or cytoreductive surgery with an initial laparoscopy for assessing resectability. The surgical and pathological findings were considered as the 'reference standard'. Sensitivity and specificity of ultrasound and CT scanning were calculated for the different anatomical areas and compared using the McNemar test. Agreement between ultrasound and CT staging and the surgical stage was estimated using the weighted kappa index.ResultsThe tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1 cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1 cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT.ConclusionDetailed ultrasound examination renders a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread in women with epithelial ovarian cancer.
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Gao Y, Hernandez C, Yuan HX, Lilly J, Kota P, Zhou H, Wu H, Exner AA. Ultrasound molecular imaging of ovarian cancer with CA-125 targeted nanobubble contrast agents. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:2159-2168. [PMID: 28603079 DOI: 10.1016/j.nano.2017.06.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/09/2017] [Accepted: 06/01/2017] [Indexed: 02/03/2023]
Abstract
Ultrasound is frequently utilized in diagnosis of gynecologic malignancies such as ovarian cancer. Because epithelial ovarian cancer (EOC) is often characterized by overexpression of cancer antigen 125 (CA-125), ultrasound contrast agents able to target this molecular signature could be a promising complementary strategy. In this work, we demonstrate application of CA-125-targeted echogenic lipid and surfactant-stabilized nanobubbles imaged with standard clinical contrast harmonic ultrasound for imaging of CA-125 positive OVCAR-3 tumors in mice. Surface functionalization of the nanobubbles with a CA-125 antibody achieved rapid significantly (P < 0.05) enhanced tumor accumulation, higher peak ultrasound signal intensity and slower wash out rates in OVCAR-3 tumors compared to CA-125 negative SKOV-3 tumors. Targeted nanobubbles also exhibited increased tumor retention and prolonged echogenicity compared to untargeted nanobubbles. Data suggest that ultrasound molecular imaging using CA-125 antibody-conjugated nanobubbles may contribute to improved diagnosis of EOC.
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Affiliation(s)
- Yong Gao
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
| | - Christopher Hernandez
- Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
| | - Hai-Xia Yuan
- Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
| | - Jacob Lilly
- Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
| | - Pavan Kota
- Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
| | - Haoyan Zhou
- Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
| | - Hanping Wu
- Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
| | - Agata A Exner
- Department of Radiology, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, USA.
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Zhang H, Li J, Hu Y, Shen M, Shi X, Zhang G. Folic acid-targeted iron oxide nanoparticles as contrast agents for magnetic resonance imaging of human ovarian cancer. J Ovarian Res 2016; 9:19. [PMID: 27025582 PMCID: PMC4812633 DOI: 10.1186/s13048-016-0230-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Improved methods for the early and specific detection of ovarian cancer are needed. METHODS In this experimental study, we used folic acid (FA)-targeted iron oxide (Fe3O4) nanoparticles (NPs) as a T2-negative contrast agent for magnetic resonance (MR) imaging to accurately detect ovarian cancer tissues in an intraperitoneal xenograft tumor model. Human serous ovarian cell line (Skov-3), with overexpressed FA receptors, was chosen as the targeted tumor cell mode. For in vivo experiments, the cells were injected intraperitoneally into nude mice to produce intraabdominal ovarian cancers. FA-targeted and non-targeted Fe3O4 NPs were prepared. RESULTS FA-targeted Fe3O4 NPs with a mean size of 9.2 ± 1.7 nm have a negligible cytotoxicity to human serous ovarian cell line (Skov-3). Importantly, the results of cellular uptake suggested that FA-targeted Fe3O4 NPs have a targeting specificity to Skov-3 cells overexpressing FA receptors. FA-targeted Fe3O4 NPs could be specifically localized by magnetic resonance (MR) imaging to the intraperitoneal human ovarian carcinoma tissues, as documented by a statistically significant difference (p = 0.002, n = 3) in T2 signal intensities of xenograft tumor tissues when injected with FA-targeted and non-targeted Fe3O4 NPs at 4 h post-injection. CONCLUSION FA-targeted Fe3O4 NPs appear to be promising agents for the detection of human ovarian carcinoma by MR imaging, and possibly also for the hyperthermal treatment of the tumors.
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Affiliation(s)
- He Zhang
- />Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, No.419 Fangxie Road, Shanghai, 200011 P. R. China
| | - Jingchao Li
- />College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620 P. R. China
| | - Yong Hu
- />College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620 P. R. China
| | - Mingwu Shen
- />College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620 P. R. China
| | - Xiangyang Shi
- />College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620 P. R. China
| | - Guofu Zhang
- />Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, No.419 Fangxie Road, Shanghai, 200011 P. R. China
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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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