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Nakazono T, Yoshinaga Y, Yamaguchi K, Yokoyama M, Kai K, Fukui S, Egashira R, Ichinohe K, Nagaoka S, Irie H. MRI features of ovarian teratomas with somatic-type malignancy and mature cystic teratomas. Abdom Radiol (NY) 2024:10.1007/s00261-024-04287-8. [PMID: 38856767 DOI: 10.1007/s00261-024-04287-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE We evaluated the magnetic resonance imaging (MRI) features of ovarian teratomas with somatic-type malignancy (TSMs) and benign ovarian mature cystic teratomas (MCTs) to determine the diagnostic contribution of the MRI findings for differentiating these two teratomas. METHODS We compared the MRI findings between ovarian TSMs (n = 10) and MCTs (n = 193), and we conducted a receiver operating characteristic (ROC) analysis to determine the MRI findings' contribution to the differentiation of TSMs from MCTs. RESULTS The maximum diameters of whole lesion and the largest solid component in the TSMs were larger than those of the MCTs (p = 0.0001 and p < 0.0001, respectively). Fat tissue in solid components was seen in 73/116 (62.9%) MCTs but in none of the TSMs (p = 0.0001). Ring-like enhancement in solid components was seen in 60/116 (51.7%) MCTs and none of the TSMs (p = 0.0031). On dynamic contrast-enhanced MRI (DCE MRI), all of the solid components in the TSMs showed a high- or intermediate-risk time intensity curve (TIC), and those in 113 of the 116 (97.4%) MCTs showed a low-risk TIC (p < 0.0001). The area under the curve of the ROC analysis using the high-/intermediate-risk TIC on DCE MRI was the highest (0.99) for differentiating TSMs from MCTs: sensitivity 100%, specificity 97.4%, positive predictive value 75.0%, negative predictive value 100%, and accuracy, 97.6%. CONCLUSION Compared to ovarian MCTs, ovarian TSMs are larger and have larger solid components with high- or intermediate-risk TICs on DCE MRI. Ovarian MCTs frequently show small solid components with fat tissue, ring-like enhancement, and a low-risk TIC on DCE MRI.
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Affiliation(s)
- Takahiko Nakazono
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan.
| | - Yutaka Yoshinaga
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Keita Kai
- Department of Pathology, Saga University Hospital, Saga, Japan
| | - Shuichi Fukui
- Department of Radiology, Takagi Hospital, Fukuoka, Japan
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Kanto Ichinohe
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Shigeru Nagaoka
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
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Fukuzawa T, Ohya A, Tanaka M, Shimizu M, Kobayashi K, Matsushita T, Watanabe T, Kobara H, Fujinaga Y. MR diagnosis of SCC arising within ovarian cystic teratomas: analysis of mural nodule characteristics. Abdom Radiol (NY) 2024; 49:1264-1274. [PMID: 38393356 PMCID: PMC10955018 DOI: 10.1007/s00261-024-04186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE This study aims to evaluate and identify magnetic resonance (MR) findings of mural nodules to detect squamous cell carcinoma arising from ovarian mature cystic teratoma (SCC-MCT). METHODS This retrospective study examined 135 patients (SCC-MCTs, n = 12; and benign MCTs, n = 123) with confirmed diagnoses across five different institutions between January 2010 and June 2022. Preoperative MR images for each patient were independently assessed by two experienced radiologists and analyzed following previously reported findings (PRFs): age, tumor size, presence of mural nodules, size of mural nodule, and the angle between mural nodule and cyst wall (acute or obtuse). Furthermore, this study evaluated four mural nodule features-diffusion restriction, fat intensity, Palm tree appearance, and calcification-and the presence of transmural extension. RESULTS There were significant differences between the SCC-MCT and benign MCT groups in terms of all PRFs and all mural nodule findings (p < 0.01). Among the PRFs, "tumor size" demonstrated the highest diagnostic performance, with a sensitivity of 83.3% and a specificity of 88.6%. A combination of the aforementioned four mural nodule findings showed a sensitivity and specificity of 83.3% and 97.6%, respectively, for the diagnosis of SCC-MCT. Regarding diagnosis based on a combination of four mural nodule findings, the specificity was significantly higher than the diagnosis based on tumor size (p = 0.021). Based on these mural nodule findings, three SCC-MCT patients without transmural invasion could be diagnosed. CONCLUSION Mural nodule MR findings had a higher diagnostic performance than PRFs for SCC-MCT and can potentially allow early detection of SCC-MCTs.
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Affiliation(s)
- Takuya Fukuzawa
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Ayumi Ohya
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Mika Tanaka
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Marika Shimizu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kentaro Kobayashi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tomohito Matsushita
- Department of Radiology, Fujimi Kogen Hospital, 11100 Ochiai, Fujimi-Cho, Suwa-Gun, 399-0214, Japan
| | - Tomofumi Watanabe
- Department of Radiology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502, Japan
| | - Hisanori Kobara
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Hirano M, Muto Y, Kuroda M, Fujiwara Y, Sasaki T, Kuroda K, Kamizaki R, Imajoh S, Tanabe Y, Al-Hammad WE, Nakamitsu Y, Shimizu Y, Sugimoto K, Oita M, Sugianto I, Bamgbose BO. Quantitative evaluation of the reduction of distortion and metallic artifacts in magnetic resonance images using the multiacquisition variable‑resonance image combination selective sequence. Exp Ther Med 2023; 25:109. [PMID: 36793326 PMCID: PMC9922940 DOI: 10.3892/etm.2023.11808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Magnetic resonance imaging (MRI) is superior to computed tomography (CT) in determining changes in tissue structure, such as those observed following inflammation and infection. However, when metal implants or other metal objects are present, MRI exhibits more distortion and artifacts compared with CT, which hinders the accurate measurement of the implants. A limited number of reports have examined whether the novel MRI sequence, multiacquisition variable-resonance image combination selective (MAVRIC SL), can accurately measure metal implants without distortion. Therefore, the present study aimed to demonstrate whether MAVRIC SL could accurately measure metal implants without distortion and whether the area around the metal implants could be well delineated without artifacts. An agar phantom containing a titanium alloy lumbar implant was used for the present study and was imaged using a 3.0 T MRI machine. A total of three imaging sequences, namely MAVRIC SL, CUBE and magnetic image compilation (MAGiC), were applied and the results were compared. Distortion was evaluated by measuring the screw diameter and distance between the screws multiple times in the phase and frequency directions by two different investigators. The artifact region around the implant was examined using a quantitative method following standardization of the phantom signal values. It was revealed that MAVRIC SL was a superior sequence compared with CUBE and MAGiC, as there was significantly less distortion, a lack of bias between the two different investigators and significantly reduced artifact regions. These results suggested the possibility of utilizing MAVRIC SL for follow-up to observe metal implant insertions.
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Affiliation(s)
- Masaki Hirano
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Radiology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Yuki Muto
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Radiology, Oomoto Hospital, Okayama 700-0924, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Correspondence to: Professor Masahiro Kuroda, Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yuta Fujiwara
- Division of Clinical Radiology Service, Okayama Central Hospital, Okayama 700-0017, Japan
| | - Tomoaki Sasaki
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Kazuhiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Health and Welfare Science, Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama 719-1197, Japan
| | - Ryo Kamizaki
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Satoshi Imajoh
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yoshinori Tanabe
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Wlla E. Al-Hammad
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-0017, Japan
| | - Yuki Nakamitsu
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yudai Shimizu
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-0017, Japan
| | - Kohei Sugimoto
- Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University, Okayama, 770-8558, Japan
| | - Masataka Oita
- Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University, Okayama, 770-8558, Japan
| | - Irfan Sugianto
- Department of Oral Radiology, Faculty of Dentistry, Hasanuddin University, Makassar, Sulawesi 90245, Indonesia
| | - Babatunde O. Bamgbose
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, Bayero University, Kano 00234, Nigeria
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Assouline V, Dabi Y, Jalaguier-Coudray A, Stojanovic S, Millet I, Reinhold C, Bazot M, Thomassin-Naggara I. How to improve O-RADS MRI score for rating adnexal masses with cystic component? Eur Radiol 2022; 32:5943-5953. [PMID: 35332409 DOI: 10.1007/s00330-022-08644-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/02/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To test the performance of the Ovarian-Adnexal Reporting Data System (O-RADS) MRI in characterizing adnexal masses with cystic components and to test new specific MRI features related to cystic components to improve the ability of the O-RADS MRI score to stratify lesions according to their risk of malignancy. METHODS The EURopean ADnexal study (EURAD) database was retrospectively queried to identify adnexal masses with a cystic component. One junior and 13 radiologists independently reviewed cases blinded to the pathological diagnosis. For each lesion, the size of the whole lesion, morphological appearance, number of loculi, presence of a thickened wall, thickened septae, signal intensity of the cystic components on T1-weighted/T2-weighted/diffusion weighted, mean value of the apparent diffusion coefficient, and O-RADS MRI score were reported. Univariate and multivariate logistic regression analysis was performed to determine significant features to predict malignancy. RESULTS The final cohort consisted of 585 patients with 779 pelvic masses who underwent pelvic MRI to characterize an adnexal mass(es). Histology served as the standard of reference. The diagnostic performance of the O-RADS MRI score was 0.944, 95%CI [0.922-0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADCmean of cystic component > 1.69, number of loculi > 3, lesion size > 75 mm, the presence of a thick wall, and a low T1-weighted, a high T2-weighted, and a low diffusion-weighted signal intensity of the cystic component. Multivariate analysis demonstrated that an O-RADS MRI score ≥ combined with an ADC mean of the cystic component > 1.69, size > 75 mm, and low diffusion-weighted signal of the cystic component significantly improved the diagnostic performance up to 0.958, 95%CI [0.938-0.973]. CONCLUSION Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses. KEY POINTS • O-RADS MRI score combined with specific cystic features (area under the receiving operating curve, AUROC = 0.958) improves the diagnostic performance of the O-RADS MRI score (AUROC = 0.944) for predicting malignancy in this cohort. • Cystic features that improve the prediction of malignancy are ADC mean > 1.69 (OR = 7); number of loculi ≥ 3 (OR = 5.16); lesion size > 75 mm (OR = 4.40); the presence of a thick wall (OR = 3.59); a high T2-weighted signal intensity score 4 or 5 (OR = 3.30); a low T1-weighted signal intensity score 1, 2, or 3 (OR = 3.45); and a low diffusion-weighted signal intensity (OR = 2.12). • An adnexal lesion with a cystic component rated O-RADS MRI score 4 and an ADC value of the cystic component < 1.69 associated with a low diffusion-weighted signal, has virtually a 0% risk of malignancy.
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Affiliation(s)
- Victoria Assouline
- Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France.
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France.
| | - Yohann Dabi
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France
- Service de gynécologie et obstétrique, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France
| | | | - Sanja Stojanovic
- Centre for Radiology, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Ingrid Millet
- Department of Radiology, Lapeyronie Hospital, Montpellier, France
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM - Univ. Montpellier, Montpellier, France
| | - Caroline Reinhold
- Department of Medical Imaging, McGill University Health Centre, Montreal, Canada
| | - Marc Bazot
- Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France
| | - Isabelle Thomassin-Naggara
- Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France
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Saleh M, Bhosale P, Menias CO, Ramalingam P, Jensen C, Iyer R, Ganeshan D. Ovarian teratomas: clinical features, imaging findings and management. Abdom Radiol (NY) 2021; 46:2293-2307. [PMID: 33394097 DOI: 10.1007/s00261-020-02873-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022]
Abstract
Ovarian teratomas are the most common type of germ cell tumors. There are three major subtypes of ovarian teratomas including mature, immature, and monodermal teratomas. Ultrasound, computed tomography and magnetic resonance imaging can demonstrate specific imaging findings for mature teratoma. Imaging features of immature and monodermal teratomas are less specific, but a combination of clinical features and imaging findings can help in the diagnosis. Imaging is also very helpful in guiding management. In this article, we review the epidemiology, histopathology, clinical presentation, imaging features and management of ovarian teratomas.
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Affiliation(s)
- Mohammed Saleh
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Corey Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Revathy Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Dhakshinamoorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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AlGhamdi M, AlMutairi B, AlOsaimi A, Felemban A, AlYahya M. Mature cystic ovarian teratoma without intracystic fat: Case report with the "fat within the wall" sign. Radiol Case Rep 2020; 15:367-370. [PMID: 32055261 PMCID: PMC7005499 DOI: 10.1016/j.radcr.2020.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/01/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022] Open
Abstract
Mature cystic teratoma is the most common ovarian neoplasm among young females. Diagnosed through radiological imaging as it exhibits typical radiological features; typically, fat. However, complete cystic teratoma without visible fat is a very rare and challenging diagnosis. It is difficult to distinguish it from malignant neoplasm, due to the presence of enhancing components, for example, Rokitansky nodule and the presence of diffusion restriction from keratinized products. We present a case of an incidental mature cystic teratoma without visible intracystic fat, where the correct diagnosis based on imaging was failed. Mature cystic teratoma was then confirmed upon histologic examination.
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Affiliation(s)
- Maram AlGhamdi
- Department of Medical Imaging, Prince Sultan Military Medical City, P. Box. 7897, Riyadh, Saudi Arabia
- Corresponding author.
| | - Badr AlMutairi
- Department of Diagnostic Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz AlOsaimi
- Department of Diagnostic Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Afaf Felemban
- Department of Obstetrics and Gynaecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mauth AlYahya
- Department of Histopathology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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7
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Chung AD. Extrahepatic Fat-Containing Lesions of the Abdomen and Pelvis: An Organ-Based Approach to Differential Diagnoses. Can Assoc Radiol J 2020; 71:19-29. [PMID: 32063003 DOI: 10.1177/0846537119887871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The presence of intralesional fat provides an invaluable tool for narrowing the differential diagnosis for both benign and malignant neoplasms of the abdomen and pelvis. The ability to characterize intralesional fat is further expanded by the ability of magnetic resonance imaging to detect small quantities (intravoxel) of fat. While the presence of intralesional fat can help to provide a relatively narrow set of diagnostic possibilities, depending on the type of fat (macroscopic vs intravoxel) that is present and the organ of origin, radiologists must be aware of uncommon mimickers of pathology, both benign and malignant.
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Affiliation(s)
- Andrew D Chung
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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8
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Analysis of MRI Values and Hemoglobin and Total Protein Concentrations of Cystic Ovarian Tumors. J Magn Reson Imaging 2018; 49:1133-1140. [DOI: 10.1002/jmri.26299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022] Open
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Lam CZ, Chavhan GB. Magnetic resonance imaging of pediatric adnexal masses and mimics. Pediatr Radiol 2018; 48:1291-1306. [PMID: 30078037 DOI: 10.1007/s00247-018-4073-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/07/2017] [Accepted: 01/03/2018] [Indexed: 01/09/2023]
Abstract
Evaluation of adnexal masses in children and adolescents relies on imaging for appropriate diagnosis and management. Pelvic MRI is indicated and adds value for all adnexal masses when surgery is considered or when ultrasound findings are indeterminate. Specifically, features on MR imaging can help distinguish between benign and malignant lesions, which not only influences the decision between surgery and conservative treatment, but also the type of surgery to be performed, including potential use of fertility-sparing approaches with minimally invasive techniques. Larger size, younger age, presentation with precocious puberty or virilization, restricted diffusion in a solid mass, and rapid and strong enhancement of solid components are all features concerning for malignancy. In addition, distinctive MR imaging features of adnexal masses, combined with clinical and laboratory biomarkers, might suggest a specific histological diagnosis.
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Affiliation(s)
- Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
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Mukuda N, Fujii S, Inoue C, Fukunaga T, Oishi T, Harada T, Ogawa T. Bilateral Ovarian Tumors on MRI: How Should We Differentiate the Lesions? Yonago Acta Med 2018. [PMID: 29946217 DOI: 10.33160/yam.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background We investigated the distinguishing pathological features of bilateral ovarian tumors using magnetic resonance (MR) imaging. Methods Eighty-six patients with bilateral ovarian tumors on MR imaging were evaluated. The pathological diagnosis was investigated, and the results were subjected to statistical analysis using Mann-Whitney U test, Fisher's exact test, Chi-squared test and receiver operating characteristic (ROC) curve to determine the features useful for the differentiation of distinct types of lesions. Results The diagnosis of bilateral ovarian tumors was confirmed in eighty-one patients and the majority of the lesions were further classified into serous carcinoma (n = 36), mature teratoma (n = 20) and metastasis (n = 12). We assessed the existence of factors useful for the MR imaging differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors. Cancer antigen (CA) 125 serum level and maximum tumor diameter were significantly different between metastasis and serous carcinoma and similarly, between metastasis and primary malignant ovarian tumors. MR imaging morphology, ascites and peritoneal implants did not show any significant difference between the different types of lesions. Conclusion Within our patient cohort, most bilateral ovarian tumor lesions were determined to be serous carcinoma, mature teratoma or metastasis. CA 125 serum level and maximum tumor diameter are useful markers for the differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors.
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Affiliation(s)
- Naoko Mukuda
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Chie Inoue
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Takeru Fukunaga
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Tetsuro Oishi
- †Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Tasuku Harada
- †Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Sahin H, Abdullazade S, Sanci M. Mature cystic teratoma of the ovary: a cutting edge overview on imaging features. Insights Imaging 2017; 8:227-241. [PMID: 28105559 PMCID: PMC5359144 DOI: 10.1007/s13244-016-0539-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/11/2016] [Accepted: 12/16/2016] [Indexed: 01/30/2023] Open
Abstract
Mature cystic teratoma (MCT) is the most common neoplasm of the ovary and includes at least two well- differentiated germ cell layers. Different combinations of mature tissue derivatives with varying arrangements in the tumour cause a wide spectrum of radiological presentation ranging from a purely cystic mass to a complex cystic mass with a considerable solid component. In different imaging modalities, each radiological feature reflects a specific pathologic equivalent that forms because of diverse compositions of histological components. Understanding uncommon findings as well as the classic signs with basic knowledge of pathological equivalents permits a more accurate diagnosis and guides adequate treatment. In this review, radiological features of MCT in different imaging modalities (US, CT, MR imaging) including specific signs and useful radiological artefacts with brief emphasis on pathological basics are discussed. Teaching points • Ovarian mature cystic teratomas (MCTs) have a wide spectrum of radiological presentation. • Each radiological feature of MCT reflects a specific pathologic equivalent. • Understanding radiological signs with basic knowledge of pathology can permit a more accurate diagnosis.
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Affiliation(s)
- Hilal Sahin
- Department of Radiology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey.
| | - Samir Abdullazade
- Department of Pathology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey
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Braungart S, McCullagh M. Management of Familial Ovarian Teratoma: The Need for Guidance. European J Pediatr Surg Rep 2016; 4:31-33. [PMID: 28018806 PMCID: PMC5177558 DOI: 10.1055/s-0036-1593832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/13/2016] [Indexed: 10/25/2022] Open
Abstract
Ovarian teratomas in prepubertal females are uncommon, but familial ones are exceedingly rare. We report an ovarian teratoma in an 8-year-old girl, her mother, and her maternal grandmother. The risk of a metachronous tumor and subsequent complications (such as torsion) in the contralateral ovary remain unclear. There is no clear guidance on follow-up management of patient and family members in the literature. We have reviewed the literature and discuss the challenges for the pediatric surgeon arising from such cases.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Majella McCullagh
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, United Kingdom of Great Britain and Northern Ireland
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13
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Heo SH, Kim JW, Shin SS, Jeong SI, Lim HS, Choi YD, Lee KH, Kang WD, Jeong YY, Kang HK. Review of Ovarian Tumors in Children and Adolescents: Radiologic-Pathologic Correlation. Radiographics 2014; 34:2039-55. [DOI: 10.1148/rg.347130144] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Nishida M, Kawano Y, Yuge A, Nasu K, Matsumoto H, Narahara H. Three cases of immature teratoma diagnosed after laparoscopic operation. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:91-4. [PMID: 25232281 PMCID: PMC4159361 DOI: 10.4137/ccrep.s17455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/28/2014] [Accepted: 08/04/2014] [Indexed: 11/22/2022]
Abstract
While mature cystic teratoma of the ovary is the most common ovarian tumor in young women, immature teratoma is a very rare tumor, representing only 1% of all ovarian cancers. In the three cases presented here, young women who were suspected to have mature cystic teratoma, based on CT scan and MRI, were ultimately diagnosed with immature teratoma Ic (b) G1 after laparoscopic operation. They underwent salpingo-oophorectomy of the affected side only and have shown no sign of recurrence during follow-up. We sometimes encounter patients with immature teratoma who have no findings pointing to malignancy on CT or MRI. Generally, if the components of immature nerve cells that represent immature teratoma are very few, it is difficult to diagnose the entity as immature teratoma with imaging evaluations such as CT or MRI. In many hospitals, laparoscopic surgery is selected for patients with ovarian mature teratoma. Therefore, it is essential to attempt as much as possible not to disseminate the fluid content of the tumor into the intra-abdominal space during laparoscopic operation, because in rare cases the tumor turns out not to be benign mature teratoma.
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Affiliation(s)
- Masakazu Nishida
- Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan
| | - Yasushi Kawano
- Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan
| | - Akitoshi Yuge
- Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan
| | - Harunobu Matsumoto
- Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan
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15
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Dujardin MI, Sekhri P, Turnbull LW. Struma ovarii: role of imaging? Insights Imaging 2014; 5:41-51. [PMID: 24357453 PMCID: PMC3948908 DOI: 10.1007/s13244-013-0303-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/17/2013] [Accepted: 11/20/2013] [Indexed: 10/31/2022] Open
Abstract
As clinical features in struma ovarii patients in the absence of thyrotoxicosis are generally non-specific and resemble ovarian malignancy, preoperative radiological diagnosis becomes all the more relevant in order to avoid ovarian cancer type surgery (including bilateral salpingo-oophorectomy, hysterectomy, omentectomy and occasionally appendectomy) for this usually benign and rare ovarian mass. As struma ovarii is an uncommon entity, it is all the more important to perform state-of-the-art magnetic resonance (MR) imaging, including high-resolution imaging and diffusion-weighted imaging. The goal of this review paper is to give an update of the key findings of both benign and malignant struma ovarii and to present an unusual case of a purely cystic ovarian struma. Key Points • Clinical features in struma ovarii are generally non-specific and resemble ovarian malignancy.• Pre-operative radiological diagnosis is important to avoid ovarian cancer type surgery (bilateral salpingo-oophorectomy, hysterectomy, omentectomy and occasionally appendectomy).• State-of-the-art MR imaging might help to characterise this unusual ovarian mass.• Struma ovarii can occasionally present as a purely cystic lesion.• However, the role of imaging to identify struma ovarii preoperatively remains limited.
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Affiliation(s)
- Martine I. Dujardin
- Centre for MR Investigations, University of Hull in association with Hull York Medical School, Anlaby Road, Hull, HU3 2JZ East Yorkshire UK
| | - Priti Sekhri
- Hull and East Yorkshire Hospitals NHS Trust, Histopathology Department, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Lindsay W. Turnbull
- Centre for MR Investigations, University of Hull in association with Hull York Medical School, Anlaby Road, Hull, HU3 2JZ East Yorkshire UK
- Centre for MR Investigations, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
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Poncelet E, Delpierre C, Kerdraon O, Lucot JP, Collinet P, Bazot M. Value of dynamic contrast-enhanced MRI for tissue characterization of ovarian teratomas: correlation with histopathology. Clin Radiol 2013; 68:909-16. [PMID: 23726654 DOI: 10.1016/j.crad.2013.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/24/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
AIM To analyse the value of double contrast-enhanced (DCE) magnetic resonance imaging (MRI) in addition to conventional MRI to characterize ovarian teratomas subtypes with histological correlation. MATERIALS AND METHODS From January 2005 to December 2008, 38 women undergoing MRI and subsequent resection of ovarian teratomas were identified [40 mature cystic teratomas (MCT), two struma ovarii, three immature teratomas]. MRI images were analysed blindly by two radiologists according to morphological and vascular abnormalities. An experienced histopathologist reviewed all slides to determine the presence and histological composition of Rokitansky protuberances. RESULTS Thirty-one MCT (77%) had at least one small, regular Rokitansky protuberance presenting at an acute angle with the cyst wall. Ten out of 31 MCT did not display any enhancement on contrast-enhanced MRI related to sebaceous glands, adipose lobules, keratin, and pilosebaceous adnexa at histology. Three different time-intensity curve (TIC), types 1, 2, and 3, were related to presence of smooth muscular cells and fibrous, neuroglial, or thyroid tissue, respectively, found at histology of MCT. Type 3 TIC was also present in one struma ovarii and two immature teratomas. CONCLUSION TIC types are related to the specific content of the solid tissue of ovarian teratomas but cannot be used to differentiate benign and malignant ovarian teratomas.
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Affiliation(s)
- E Poncelet
- Departments of Radiology, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille and Université de Lille Nord de France, Lille, France
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17
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Jalaguier-Coudray A, Thomassin-Naggara I, Perrot N, Sarran A, Bazot M. Masses pelviennes : comment je raisonne ? IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Takagi H, Ichigo S, Murase T, Ikeda T, Imai A. Early diagnosis of malignant-transformed ovarian mature cystic teratoma: fat-suppressed MRI findings. J Gynecol Oncol 2012; 23:125-8. [PMID: 22523630 PMCID: PMC3325347 DOI: 10.3802/jgo.2012.23.2.125] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 10/07/2011] [Accepted: 10/09/2011] [Indexed: 11/30/2022] Open
Abstract
The most common form of malignant transformation developing from a mature cystic teratoma is squamous cell carcinoma, representing 80% of malignant transformations, while adenocarcinoma accounts for approximately 5%. Because of this rarity, few reports exist of preoperative diagnosis of this tumor by magnetic resonance imaging, in particular with fat suppression techniques. Here, we report magnetic resonance imaging findings and clinical features of a 79-year-old woman with mucinous adenocarcinoma arising from a mature cystic teratoma (measuring 5×6 cm), classified as surgical stage IA. Because of the poor prognosis of malignant transformation, when mature cystic teratomas are detected (even smaller than 5 cm tumor size) in postmenopausal women, serum tumor marker carcinoembryonic antigen levels and fat-suppressed magnetic resonance imaging may be potential indicators of malignant transformation.
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Affiliation(s)
- Hiroshi Takagi
- Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu, Japan
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HORI M, KIM T, ONISHI H, NAKAMOTO A, TSUBOYAMA T, TATSUMI M, TOMIYAMA N. Ovarian Masses: MR Imaging with T1-weighted 3-dimensional Gradient-echo IDEAL Water-fat Separation Sequence at 3T. Magn Reson Med Sci 2012; 11:117-27. [DOI: 10.2463/mrms.11.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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20
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A calcific pelvic mass in a woman with chronic spinal pain: a case of mature cystic teratoma. J Chiropr Med 2011; 10:327-32. [DOI: 10.1016/j.jcm.2011.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/16/2011] [Accepted: 06/21/2011] [Indexed: 11/20/2022] Open
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21
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Abstract
OBJECTIVE Squamous cell carcinoma (SCC) is the most common type of malignant transformation in mature cystic teratoma (MCT) of the ovary. The SCC is difficult to preoperatively diagnose. We conducted a retrospective study to seek the possible risk/prognostic factors and treatments for SCC arising from MCT of the ovary. METHODS Using an institutional database, we identified 3 women treated for SCC arising from an MCT of the ovary at the Kaohsiung Veteran General Hospital. A retrospective chart review was conducted, with information obtained from radiographs, operative reports, pathology reports, and radiation oncology records. RESULTS A total of 1551 cases of MCT were diagnosed at Kaohsiung Veteran General Hospital from 1990 to 2009, of which, malignant teratoma SCC type was noted in 3 cases (0.19%). The median age of the subjects was 39 years. Abdominal fullness was the most common symptom (3/3 cases). The mean diameter of the ovarian tumor was 17.3 cm, ranging from 16 to 18 cm. All 3 patients received simple right salpingo-oophorectomy or debulking surgery. Two of the patients reached stage IIIC and died. CONCLUSIONS : With our review as basis, we recommend being cautious of the following risk factors: patient age, tumor size, ultrasound characteristics, sonar tumor vessel wave form, computed tomography, and levels of SCC and CA125 tumor markers. We suggest that patients have regular ovarian ultrasound examination. Based on our literature review, stage IA patients who undergo standardized operational procedures do well without adjuvant treatment, but such patients must be confirmed accurately with complete surgical staging to be in stage IA before undergoing conservative management. The optimal approach to the management of patients with advanced stage and recurrent disease is unclear. Surgical cytoreduction with proper staging, adjuvant therapy with platinum-based or paclitaxel-based chemotherapy, and concurrent whole pelvic radiation have been recommended as possible methods of treatment.
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22
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Spencer JA, Ghattamaneni S. MR Imaging of the Sonographically Indeterminate Adnexal Mass. Radiology 2010; 256:677-94. [DOI: 10.1148/radiol.10090397] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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23
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MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol 2010; 194:311-21. [PMID: 20093590 DOI: 10.2214/ajr.09.3522] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the role of MR, CT, and PET/CT in the detection of ovarian cancer and the evaluation of adnexal lesions. CONCLUSION The goal of imaging in ovarian cancer detection is to expeditiously distinguish benign adnexal lesions from those requiring further pathologic evaluation for malignancy. For lesions indeterminate on ultrasound, MRI increases the specificity of imaging evaluation, thus decreasing benign resections. CT is useful in diagnosis and treatment planning of advanced cancer. Although (18)F-FDG-avid ovarian lesions in postmenopausal women are considered suspicious for malignancy, PET/CT is not recommended for primary cancer detection because of high false-positive rates.
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Choudhary S, Fasih N, Mc Innes M, Marginean C. Imaging of ovarian teratomas: appearances and complications. J Med Imaging Radiat Oncol 2010; 53:480-8. [PMID: 19788483 DOI: 10.1111/j.1754-9485.2009.02085.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ovarian teratomas are the most common germ cell neoplasm. Subtypes of teratoma include mature cystic, immature and the monodermal teratomas. The benign cystic teratoma shows typical imaging manifestations and can be complicated by torsion, rupture and uncommonly malignant degeneration. Uncommon subtypes of teratomas include the immature, which is usually malignant at diagnosis. The growing teratoma syndrome is an uncommon complication reported in patients treated for immature teratomas. The monodermal teratomas which include the struma ovarii may also have specific imaging characteristics that should be recognised on imaging. This paper aims to provide a comprehensive review describing the spectrum of imaging findings of these ovarian tumours and associated complications.
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Affiliation(s)
- S Choudhary
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada.
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25
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Asch E, Levine D, Pedrosa I, Hecht JL, Kruskal J. Patterns of misinterpretation of adnexal masses on CT and MR in an academic radiology department. Acad Radiol 2009; 16:969-80. [PMID: 19380241 DOI: 10.1016/j.acra.2009.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 02/21/2009] [Accepted: 02/23/2009] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess potential quality assurance (QA) issues in the diagnosis and characterization of adnexal masses on pelvic computed tomographic (CT) and magnetic resonance (MR) imaging studies. MATERIALS AND METHODS Images from 128 women who had oophorectomies during a 16-month period with CT and/or MR studies within 5 years of surgery (145 CT scans from 103 women and 49 MR studies from 42 women, with 17 having both MR and CT studies) were reviewed by three radiologists who assigned QA scores of 0 (no QA issue), 1 (minor issue with minimal impact on clinical care), or 2 (major issue with potential impact on clinical care). The difficulty of diagnosis was assigned a score of 0 (very difficult diagnosis to make), 1 (difficult but possible to make the diagnosis), or 2 (diagnosis should be made). The incidence of adnexal QA issues was calculated using total CT and MR pelvic examinations performed on women during the interval. RESULTS Twenty-nine QA issues were identified in 28 women in 17 of 145 CT studies (11.7%) and 12 of 49 MR examinations (24.5%) in women having adnexal surgery (17 of 11,194 [0.15%] of female pelvic CT studies and 12 of 603 [2.0%] of female pelvic MR studies performed in the time interval). Issues included missed lesions, lesions misidentified as leiomyomas, fat described in the lesion but not seen histologically, postmenopausal status of patient not considered, ultrasound correlation not recommended, and confusion of right and left sides. CONCLUSION Errors in CT and MR studies regarding the diagnosis and characterization of adnexal masses in a highly enriched population of women undergoing adnexal surgery are common. Knowledge of the types of QA issues found in CT and MR studies of adnexal masses should aid in decreasing future errors.
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26
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Thomassin-Naggara I, Daraï E, Cuenod CA, Fournier L, Toussaint I, Marsault C, Bazot M. Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol 2009; 19:1544-52. [PMID: 19214523 DOI: 10.1007/s00330-009-1299-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 11/05/2008] [Accepted: 11/29/2008] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to prospectively assess the contribution of diffusion-weighted MR imaging (DWI) for characterizing complex adnexal masses. Seventy-seven women (22-87 years old) with complex adnexal masses (30 benign and 47 malignant) underwent MR imaging including DWI before surgery. Conventional morphological MR imaging criteria were recorded in addition to b(1,000) signal intensity and apparent diffusion coefficient (ADC) measurements of cystic and solid components. Positive likelihood ratios (PLR) were calculated for predicting benignity and malignancy. The most significant criteria for predicting benignity were low b(1,000) signal intensity within the solid component (PLR = 10.9), low T2 signal intensity within the solid component (PLR = 5.7), absence of solid portion (PLR = 3.1), absence of ascites or peritoneal implants (PLR = 2.3) and absence of papillary projections (PLR = 2.3). ADC measurements did not contribute to differentiating benign from malignant adnexal masses. All masses that displayed simultaneously low signal intensity within the solid component on T2-weighted and on b(1,000) diffusion-weighted images were benign. Alternatively, the presence of a solid component with intermediate T2 signal and high b(1,000) signal intensity was associated with a PLR of 4.5 for a malignant adnexal tumour. DWI signal intensity is an accurate tool for predicting benignity of complex adnexal masses.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Department of Radiology, Hôpital Tenon, Assistance Publique Hopitaux de Pariss, 4 rue de la Chine, 75020, Paris, France.
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27
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Thomassin-Naggara I, Cuenod CA, Darai E, Marsault C, Bazot M. Dynamic contrast-enhanced MR imaging of ovarian neoplasms: current status and future perspectives. Magn Reson Imaging Clin N Am 2008; 16:661-72, ix. [PMID: 18926429 DOI: 10.1016/j.mric.2008.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
MR imaging is useful for characterizing ovarian tumors. Dynamic contrast-enhanced MR imaging is a promising new technique useful for characterizing perfusion and angiogenesis of ovarian masses. This article describes the dynamic contrast-enhanced MR imaging technique examines the current and future applications of this technique in patients with ovarian tumors.
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28
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Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist Tomogr 2008; 32:712-23. [PMID: 18830100 DOI: 10.1097/rct.0b013e31815881ef] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article reviews the value of magnetic resonance imaging (MRI) for the diagnosis of ovarian tumors especially when ultrasonography is indeterminate. Although ultrasonography is the first imaging technique used to investigate suspected pelvic masses, it has a limited capacity for tissue characterization. In addition to morphological characteristics, many tissue parameters such as T1, T2, perfusion, and diffusion contribute to signal intensity, so MRI is able to identify various types of tissue contained in pelvic masses. Magnetic resonance imaging helps to locate large solid masses and to distinguish benign from malignant ovarian tumors, with an overall accuracy of 88% to 93% for the diagnosis of malignancy. The aims of this review are 3-fold. First, we review state-of-the-art and usual MRI techniques and published findings. Second, we recall the MR features most useful for assessing the main ovarian tumors. Finally, we discuss the relevance of various features for distinguishing between benign, borderline, and invasive ovarian tumors.
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29
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Saba L, Guerriero S, Sulcis R, Virgilio B, Melis G, Mallarini G. Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol 2008; 72:454-63. [PMID: 18804932 DOI: 10.1016/j.ejrad.2008.07.044] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/27/2008] [Accepted: 07/31/2008] [Indexed: 11/25/2022]
Abstract
Ovarian teratomas (OTs) are the most common germ cell neoplasm. They include mature cystic teratomas, monodermal teratomas (neural tumors, struma ovarii, carcinoid tumors) and immature teratomas. Teratomas are the most common benign ovarian neoplasms in women less than 45 years old. OTs are usually characterized by ultrasound (US) and magnetic resonance (MR) whereas they are usually an incidental finding on CT. The purpose of this paper is to review the most common types of teratomas and to describe CT, US and MR imaging features of the various types of mature and immature OTs.
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Affiliation(s)
- Luca Saba
- Department of Science of the Images, Policlinico Universitario (Cagliari), Italy.
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30
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Park SB, Kim JK, Kim KR, Cho KS. Imaging findings of complications and unusual manifestations of ovarian teratomas. Radiographics 2008; 28:969-983. [PMID: 18635624 DOI: 10.1148/rg.284075069] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Ovarian teratomas can be associated with various complications and demonstrate a wide spectrum of clinical and imaging features. The complications include torsion (16% of ovarian teratomas), rupture (1%-4%), malignant transformation (1%-2%), infection (1%), and autoimmune hemolytic anemia (<1%). These complications require different therapeutic strategies; therefore, timely and accurate diagnosis of these complications is important for optimal patient treatment. In cases of complicated ovarian teratomas, the clinical manifestations provide only limited information and often overlap with those of other diseases. Furthermore, ovarian teratomas may have unusual clinical and imaging manifestations, thereby leading to misdiagnosis. These unusual manifestations include immature teratomas, monodermal teratomas (struma ovarii), combination tumors and collision tumors containing teratomas, and mature cystic teratomas without demonstrable fat or with pure fatty components. To provide adequate treatment and prevent misdiagnosis, it is necessary to be familiar with the imaging findings of both the complications and the unusual manifestations of ovarian teratomas.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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31
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Asch E, Levine D, Kim Y, Hecht JL. Histologic, surgical, and imaging correlations of adnexal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:327-342. [PMID: 18314510 DOI: 10.7863/jum.2008.27.3.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to quantify, categorize, and illustrate discrepancies between preoperative radiologic, surgical, and pathologic diagnoses and to assess the potential impact of discrepancies on clinical care. METHODS Adnexal masses reported by pathology during a 16-month period were included if prior imaging at our institution had been performed. Up to 3 sonographic, computed tomographic, and magnetic resonance imaging examinations were reviewed by a gynecologic sonographer and compared with the reported pathologic findings. Cases in which ambiguities were not resolved by consulting the surgical notes were reviewed by a gynecologic pathologist, who confirmed or modified the diagnosis and assigned a score to the pathology quality assurance issue: 0, no pathology quality assurance error; 1, differences in terminology; 2, discrepancy of diagnostic interpretation, benign findings; or 3, discrepancy of diagnostic interpretation, malignant findings. RESULTS Of 418 total masses, there was a discrepancy between imaging and pathology in 73 (17%) masses and 68 (21%) pathology reports. Twenty-five (6%) had pathology discrepancies resolved by correlation with the surgical notes alone (eg, torsion seen during surgery but not evident on pathologic examination). Histologic review was performed for 48 (11%) of 418 masses, with pathology errors identified in 34 (71%) of 48. Quality assurance scores were 0 (n = 14), 1 (n = 14), and 2 (n = 20), with no cases receiving a score of 3. Examples of pathology errors included gross (complex versus simple) and microscopic (neoplastic versus functional versus mesothelial) characterization of cysts, sizes of lesions not being described, characterization of fibrous lesions (cystadenofibroma versus cystadenoma), and lack of correlation with imaging (lesions not described). CONCLUSIONS This study illustrates the importance of imaging, surgical, and histologic correlation in assessing the diagnostic accuracy of sonography of adnexal masses.
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32
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Kalish GM, Patel MD, Gunn MLD, Dubinsky TJ. Computed Tomographic and Magnetic Resonance Features of Gynecologic Abnormalities in Women Presenting With Acute or Chronic Abdominal Pain. Ultrasound Q 2007; 23:167-75. [PMID: 17805165 DOI: 10.1097/ruq.0b013e31815202df] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Advances in technology and improved availability have led to increased use of computed tomography (CT) and magnetic resonance imaging (MRI) to evaluate women presenting to the emergency department or to their primary care provider with abdominal and/or pelvic pain. Computed tomographic examinations are often performed to evaluate the presence of appendicitis or renal stone disease. However, gynecologic abnormalities are frequently identified on these examinations. Although ultrasound remains the primary modality by which complaints specific to the pelvis are evaluated, in many instances, CT and MRI imaging occurs before sonographic evaluation.Historically, because of cost, radiation exposure, and relative ease of use, ultrasound examinations have preceded all other imaging modalities when evaluating pelvic disorders. However, as CT and MRI technology have improved, their use in diagnosing causes of pelvic pain has become equal to that of ultrasound. In some cases, primarily because of historic comfort with sonographic evaluation, gynecologic abnormalities originally diagnosed on CT or MRI may be immediately and unnecessarily reevaluated by ultrasound. For a woman in her reproductive years, the most common adnexal masses are physiological cysts, endometriomas, and cystic teratomas. Although lesions are often asymptomatic and incidentally detected, they can present with pain, and they increase the risk of ovarian torsion. Common causes of chronic pelvic pain in this population include leiomyomata and adenomyosis. In postmenopausal women, ovarian carcinoma, which often does not present clinically until a late stage, has to be included in the differential diagnosis of adnexal masses. If a gynecologic pathology is discovered on CT or MRI, an immediate follow-up ultrasound need not be pursued if the lesion can be characterized as benign, needing immediate surgical intervention, or a variant of normal anatomy. If, on the other hand, findings demonstrate a mass that either is uncharacteristic of a benign lesion, has an indeterminate risk for malignancy, or demonstrates suspicious characteristics for malignancy (such as enhancing mural nodules), further evaluation by serial ultrasound, biochemical marker, and/or CT or MRI is warranted. The purpose of this review is to present a series of commonly encountered gynecologic abnormalities with either CT or MR to make radiologists more familiar with gynecologic pathology on CT and MRI.
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Affiliation(s)
- Grace M Kalish
- Department of Radiology, University of Washington School of Medicine, Seattle, WA 98104-2499, USA
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Park EA, Cho JY, Lee MW, Kim SH, Seong CK, Kim SH. MR features of fluid-fluid levels in ovarian masses. Eur Radiol 2007; 17:3247-54. [PMID: 17639405 DOI: 10.1007/s00330-007-0719-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 06/08/2007] [Accepted: 06/22/2007] [Indexed: 11/25/2022]
Abstract
To evaluate retrospectively the frequency and imaging features of fluid-fluid levels (FFLs) in pathologically proven ovarian masses on magnetic resonance (MR) images. The authors reviewed the preoperative MR findings of 556 ovarian masses in 428 patients. Presence, numbers, and signal intensities (SI) of FFLs were analyzed. In non-teratomas, we assessed whether SI of the FFLs of benign masses and malignant neoplasms differed using the chi(2) test. FFLs were observed in 66 of 556 ovarian masses (11.9%) on MR images, fat-fluid levels were observed in 11 of 80 teratomas, and FFLs attributed to hemorrhage in 54 of 476 non-teratomas and one twisted teratoma. Non-neoplastic cystic lesions were most common non-teratomas to contain FFLs (27/197, 13.7%), followed by malignant neoplasms (23/177, 13.0%). Benign neoplasms rarely contained FFLs (4/102, 3.9%); those that did were commonly associated with complications such as torsion or inflammation. A hypointense supernatant layer together with a hyperintense dependent layer on T1-weighted images (T1WIs) was significantly more common in malignant neoplasms than in benign masses (P < 0.0001). FFLs occurred in various ovarian masses ranging from benign to malignant neoplasms on MR images. In non-teratomas, a hypointense supernatant layer and a hyperintense dependent layer on T1WIs may favor a diagnosis of malignancy.
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Affiliation(s)
- Eun-Ah Park
- Department of Radiology and Institute of Radiation Medicine , Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea
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Abstract
MR imaging has become an important tool in the evaluation of patients with adnexal disease, and its role continues to evolve. Some benign entities can be diagnosed by MR imaging with a high grade of confidence, such as teratomas, endometriomas, simple and hemorrhagic cysts, fibromas, and hydrosalpinx. In cases of malignant lesions, MR imaging may be more accurate than other modalities for lesion characterization, staging, and follow-up.
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Affiliation(s)
- Claudia P Huertas
- Department of Radiology, University of North Carolina, 101 Manning Drive, CB7510, Chapel Hill, NC 27599-7510, USA
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Abstract
The objective of this review is to demonstrate magnetic resonance imaging as an important adjunct to ultrasound and computed tomography in the evaluation of the pregnant patient with abdominal pain. With the advent of ultrafast T2-weighted pulse sequences, fetal and bowel motion cause minimal artifact on the images. An accurate diagnosis can often be made in a few minutes based on these high-contrast images performed in 2 or 3 planes. T1-weighted gradient echo images with and without fat saturation are useful for identifying blood and fat, especially in the case of adnexal masses. Gadolinium-diethylenetriamine pentaacetic acid is rarely used to diagnose inflammatory or obstructive disease and is reserved for those patients with suspected malignancies.
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Affiliation(s)
- Julia R Fielding
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Imaoka I, Wada A, Kaji Y, Hayashi T, Hayashi M, Matsuo M, Sugimura K. Developing an MR imaging strategy for diagnosis of ovarian masses. Radiographics 2006; 26:1431-48. [PMID: 16973774 DOI: 10.1148/rg.265045206] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance (MR) imaging provides useful information for characterization of various ovarian masses as neoplastic or nonneoplastic and, when neoplastic, on a spectrum from benign to malignant. The use of MR imaging for diagnosis of ovarian masses includes consideration of morphologic characteristics and signal intensity characteristics on T1- and T2-weighted images. The morphologic characteristics of cystic masses, cystic and solid masses, and predominantly solid masses provide important information. In general, cystic masses represent benign tumors, whereas cystic and solid masses are strongly associated with malignancy. Predominantly solid masses include benign, borderline malignant, and malignant tumors. T1-weighted images provide useful information for characterization because hemorrhagic adnexal masses (eg, endometriotic cyst) and cystic teratomas can be correctly diagnosed when the mass has high signal intensity. Significant low signal intensity in solid masses on T2-weighted images is indicative of fibrothecomas and Brenner tumors because extensive fibrous tissue produces significant low signal intensity on T2-weighted images. A strategy for diagnosis of ovarian masses with MR imaging incorporates signal intensity characteristics into morphologic characteristics.
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Affiliation(s)
- Izumi Imaoka
- Department of Radiology, Tenri Hospital, Tenri, Nara, Japan.
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Bazot M, Nassar-Slaba J, Thomassin-Naggara I, Cortez A, Uzan S, Daraï E. MR imaging compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors; correlation with final histology. Eur Radiol 2006; 16:2687-99. [PMID: 16547708 DOI: 10.1007/s00330-006-0163-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 12/08/2005] [Accepted: 01/12/2006] [Indexed: 12/27/2022]
Abstract
The aim was to compare the accuracy of magnetic resonance imaging (MRI) and intraoperative consultation (IC) for the diagnosis of adnexal masses, with reference to final histology. MRI was performed in 136 women with sonographically indeterminate adnexal masses. IC included macroscopic and frozen-section examination. Macroscopic examination and MRI determined size, nature, and presence of vegetations or solid portions within masses. All masses were characterized as benign or malignant according to previously published MR imaging and histopathologic criteria. Sensitivities, specificities, and predictive values for the diagnosis of malignancy of MRI and IC were assessed. Histology revealed 168 adnexal masses (99 benign, 23 borderline and 46 invasive). Frozen sections were examined in 151 cases. Among the 151 adnexal masses studied by both MRI and IC, respective sensitivities, specificities, positive and predictive values of both methods for the diagnosis of malignancy were 89.7% and 84.5%, 91.4% and 100%, 86.7% and 100%, and 93.4% and 91.3%. Sensitivities of MR imaging and frozen section for the diagnosis of serous versus mucinous borderline tumors were 33.3% and 93.3%, and 62.5% and 12.5%, respectively. MRI is less accurate than IC for characterizing adnexal masses. However, MRI may increase the relevance of IC for borderline mucinous tumors.
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Affiliation(s)
- Marc Bazot
- Department of Radiology, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Sherer DM, Zinn H, Gavrilescu T, Abdelmalek E, Hellmann M, Sokolovski M, Abulafia O. Transvaginal sonographic diagnosis of a large retroperitoneal pelvic epidermoid cyst (monodermal teratoma). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:265-8. [PMID: 16439792 DOI: 10.7863/jum.2006.25.2.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, 11203-2098 USA.
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Ueno T, Tanaka YO, Nagata M, Tsunoda H, Anno I, Ishikawa S, Kawai K, Itai Y. Spectrum of germ cell tumors: from head to toe. Radiographics 2004; 24:387-404. [PMID: 15026588 DOI: 10.1148/rg.242035082] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Germ cell tumors (GCTs) occur most frequently in the gonads and are relatively rare in other sites, such as the pineal gland, neurohypophysis, mediastinum, and retroperitoneum. GCTs are thought to originate from primordial germ cells, which migrate to the primitive gonadal glands in the urogenital ridge. Extragonadal GCTs might also originate from these cells when the cells are sequestered during their migration. Pathologic subtypes of GCTs vary, and the prevalence of mixed tumors is high. These factors produce a diversity of radiologic findings and make prospective radiologic diagnosis difficult in many cases. However, similar radiologic findings have been observed in pathologically equivalent tumors in varying sites. Seminomas appear as uniformly solid, lobulated masses with fibrovascular septa that enhance intensely. Nonseminomatous GCTs appear as heterogeneous masses with areas of necrosis, hemorrhage, or cystic degeneration. Fat and calcifications are hallmarks of teratomas, most of which are benign. In immature teratomas, scattered fat and calcification within larger solid components are occasionally seen. These imaging characteristics reflect the pathologic features of each tumor, and histologically similar GCTs at varying sites have similar radiologic features. Knowledge of the pathologic appearances of GCTs and their corresponding radiologic appearances will allow radiologists to diagnose these tumors correctly.
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Affiliation(s)
- Teruko Ueno
- Department of Radiology, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
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Sait K, Simpson C. Ovarian teratoma diagnosis and management: case presentations. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004; 26:137-42. [PMID: 14965479 DOI: 10.1016/s1701-2163(16)30489-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ovarian teratomas (OTs) may be of mature or immature morphologies. Mature cystic teratomas (MCTs), often referred to as dermoid cysts, are the most common germ cell tumours of the ovary in women of reproductive age. OTs are usually asymptomatic until they reach considerable size. Frequently, ultrasonography is diagnostic. Women requiring surgery for OTs should be appropriately counselled about the risks and benefits of laparoscopic and open approaches. CASE PRESENTATIONS Case I: An 18-year-old woman presented with hirsutism and irregular menses, both of which reversed after bilateral MCT removal by laparoscopy. Case II: A 47-year-old multigravid woman presented with a large unilateral OT, with a focus of malignancy. Case III: A 19-year-old woman presented with a large unilateral OT associated with gliomatosis peritonei. CONCLUSION Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of OT in selected cases. Women younger than 15 years of age or older than 45 years of age who have large, solid teratomas on ultrasound or positive markers for germ cell tumours are at risk for malignant variants, and for these women laparotomy is the preferred approach.
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Affiliation(s)
- Khalid Sait
- Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Abstract
This article presents an overview of ovarian cancer, which addresses the clinical roles of imaging studies, including US, CT, and MR imaging in the course of diagnosis and treatment of this important disease. US is the modality of choice in the evaluation of patients with suspected adnexal masses. Although its accuracy is not sufficient to avert surgery, morphological analysis of adnexal masses with US helps narrow the differential diagnosis, determining the degree of suspicion for malignancy, usually in concert with a serum CA-125 level. Combined morphological and vascular imaging obtained by US appear to further improve the preoperative assessment of adnexal masses. For uncertain or problematic cases, MR imaging helps to distinguish benign from malignant, with an overall accuracy for the diagnosis of malignancy of 93%. The accuracy of MR imaging in the confident diagnosis of mature cystic teratoma, endometrial cysts, and leiomayomas is very high. CT is not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination, except for fatty tissue and for calcification, and the disadvantages of irradiation. In the staging of ovarian cancer, CT, US, and MR imaging all have a similarly high accuracy. Although it is difficult to suggest a simple algorithm for evaluating the state of women with adnexal masses, the correct preoperative diagnosis and staging of ovarian cancer with the use of any of these imaging studies will lead to an appropriate referral to a specialist in gynecologic oncology and offer a significant survival advantage for patients with ovarian cancer.
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Affiliation(s)
- Kaori Togashi
- Department of Diagnostic and Interventional Imageology, Graduate School of Medicine, Kyoto University, Shogoin-Kawaharacho 54, Sakyo-ku, 606-8507 Kyoto, Japan.
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Pui MH, Wang QY, Xu B, Fan GP. MRI of gynecological neoplasm. Clin Imaging 2004; 28:143-52. [PMID: 15050230 DOI: 10.1016/s0899-7071(03)00116-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2003] [Accepted: 03/27/2003] [Indexed: 11/21/2022]
Abstract
MRI is multiplanar, has large field of view, superior contrast resolution and no known adverse effect on the reproductive potential of ovaries. It is useful for characterizing solid, cystic or necrotic tissue, blood and fat. Contrast-enhanced MRI is also a comprehensive examination of the entire pelvis including lymph nodes, peritoneum, pelvic sidewalls, bone and muscles. It provides information about areas difficult to assess surgically, can refine staging classification, assists in planning surgery or radiotherapy and may be more cost-effective by limiting use of surgery. This is a pictorial essay of MRI assessment of female pelvic neoplasm.
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Affiliation(s)
- Margaret H Pui
- Department of Radiology, McMaster University Medical Center, PO Box 2000 Station A, Hamilton, Ontario, Canada L8N 3Z5.
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Abstract
Magnetic resonance imaging (MRI) plays an important role in localizing and characterizing pelvic masses, particularly adnexal masses. The multiplanar capability of MRI helps to locate an abnormality outside the ovary and facilitate the exclusion of malignancy. Its superior soft-tissue contrast features help to diagnose specific benign masses, including teratoma, endometrioma, and ovarian fibroma. In addition, cystic ovarian neoplastic lesions can be further characterized as benign versus malignant, particularly after gadolinium administration. An approach to adnexal evaluation using MRI is discussed based on these features.
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Togashi K. [Gynecologic imaging with a use of MRI]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2003; 59:895-903. [PMID: 12960940 DOI: 10.6009/jjrt.kj00000921832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
MR imaging enables a physician to make an accurate diagnosis of various benign adnexal masses and helps to obviate unnecessary surgery.
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Affiliation(s)
- Kaori Togashi
- Department of Diagnostic and Interventional Imageology, Graduate School of Medicine, Kyoto University 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto 606-01, Japan.
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Takemori M, Nishimura R. MRI Findings of an Ovarian Dermoid Cyst with Malignant Transformation. Magn Reson Med Sci 2003; 2:105-8. [PMID: 16210827 DOI: 10.2463/mrms.2.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The ovarian dermoid cyst is the most common ovarian tumor. However, malignant transformation developing from a dermoid cyst is very rare. Because of this rarity, few reports exist of preoperative diagnosis of this tumor by MRI. We report MRI findings from a 69-year-old patient with a malignant transformation (squamous cell carcinoma with sarcomatoid features) in a right ovarian dermoid cyst.
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Affiliation(s)
- Masayuki Takemori
- Department of Obstetrics and Gynecology, Hyogo Medical Center for Adults, Akashi, Japan
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Jeung MY, Gasser B, Gangi A, Bogorin A, Charneau D, Wihlm JM, Dietemann JL, Roy C. Imaging of cystic masses of the mediastinum. Radiographics 2002; 22 Spec No:S79-93. [PMID: 12376602 DOI: 10.1148/radiographics.22.suppl_1.g02oc09s79] [Citation(s) in RCA: 219] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cystic masses of the mediastinum are well-marginated round lesions that contain fluid and are lined with epithelium. Major cystic masses include congenital benign cysts (ie, bronchogenic, esophageal duplication, neurenteric, pericardial, and thymic cysts), meningocele, mature cystic teratoma, and lymphangioma. Many tumors (eg, thymomas, Hodgkin disease, germ cell tumors, mediastinal carcinomas, metastases to lymph nodes, nerve root tumors) can undergo cystic degeneration-especially after radiation therapy or chemotherapy-and demonstrate mixed solid and cystic elements at computed tomography (CT) or magnetic resonance (MR) imaging. If degeneration is extensive, such tumors may be virtually indistinguishable from congenital cysts. A mediastinal abscess or pancreatic pseudocyst also appears as a fluid-containing mediastinal cystic mass. However, clinical history and manifestations, anatomic position, and certain details seen at CT or MR imaging allow correct diagnosis in many cases. Familiarity with the radiologic features of mediastinal cystic masses facilitates accurate diagnosis, differentiation from other cystlike lesions, and, thus, optimal patient treatment.
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Affiliation(s)
- Mi-Young Jeung
- Department of Radiology B, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France.
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Rao JR, Shah Z, Patwardhan V, Hanchate V, Thakkar H, Garg A. Ovarian cystic teratoma: determined phenotypic response of keratocytes and uncommon intracystic floating balls appearance on sonography and computed tomography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:687-691. [PMID: 12054308 DOI: 10.7863/jum.2002.21.6.687] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Jhanavi R Rao
- Department of Radiology, King Edward VII Memorial Hospital, Mumbai, India
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Abstract
MR imaging is well suited to evaluation of the pelvis. Ultrasonography remains the study of choice for the initial evaluation of a suspected gynecologic mass. MR imaging and computed tomography remain problem-solving tools that can help to characterize masses and stage gynecologic malignancies. MR imaging has the advantage of higher soft tissue contrast compared with computed tomography. This article reviews the MR findings of congenital anomalies and masses of the adnexa and uterus in adolescent girls.
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Affiliation(s)
- Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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