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Strachowski LM, Jha P, Phillips CH, Blanchette Porter MM, Froyman W, Glanc P, Guo Y, Patel MD, Reinhold C, Suh-Burgmann EJ, Timmerman D, Andreotti RF. O-RADS US v2022: An Update from the American College of Radiology's Ovarian-Adnexal Reporting and Data System US Committee. Radiology 2023; 308:e230685. [PMID: 37698472 DOI: 10.1148/radiol.230685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
First published in 2019, the Ovarian-Adnexal Reporting and Data System (O-RADS) US provides a standardized lexicon for ovarian and adnexal lesions, enables stratification of these lesions with use of a numeric score based on morphologic features to indicate the risk of malignancy, and offers management guidance. This risk stratification system has subsequently been validated in retrospective studies and has yielded good interreader concordance, even with users of different levels of expertise. As use of the system increased, it was recognized that an update was needed to address certain clinical challenges, clarify recommendations, and incorporate emerging data from validation studies. Additional morphologic features that favor benignity, such as the bilocular feature for cysts without solid components and shadowing for solid lesions with smooth contours, were added to O-RADS US for optimal risk-appropriate scoring. As O-RADS US 4 has been shown to be an appropriate cutoff for malignancy, it is now recommended that lower-risk O-RADS US 3 lesions be followed with US if not excised. For solid lesions and cystic lesions with solid components, further characterization with MRI is now emphasized as a supplemental evaluation method, as MRI may provide higher specificity. This statement summarizes the updates to the governing concepts, lexicon terminology and assessment categories, and management recommendations found in the 2022 version of O-RADS US.
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Affiliation(s)
- Lori M Strachowski
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Priyanka Jha
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Catherine H Phillips
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Misty M Blanchette Porter
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Wouter Froyman
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Phyllis Glanc
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Yang Guo
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Maitray D Patel
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Caroline Reinhold
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Elizabeth J Suh-Burgmann
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Dirk Timmerman
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Rochelle F Andreotti
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
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Quesada J, Härmä K, Reid S, Rao T, Lo G, Yang N, Karia S, Lee E, Borok N. Endometriosis: A multimodal imaging review. Eur J Radiol 2023; 158:110610. [PMID: 36502625 DOI: 10.1016/j.ejrad.2022.110610] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Endometriosis is a chronic inflammatory disorder characterized endometrial-like tissue present outside of the uterus, affecting approximately 10% of reproductive age women. It is associated with abdomino-pelvic pain, infertility and other non - gynecologic symptoms, making it a challenging diagnosis. Several guidelines have been developed by different international societies to diagnose and classify endometriosis, yet areas of controversy and uncertainty remains. Transvaginal ultrasound (TV-US) is the first-line imaging modality used to identify endometriosis due to its accessibility and cost-efficacy. Enhanced sonographic techniques are emerging as a dedicated technique to evaluate deep infiltrating endometriosis (DIE), depending on the expertise of the sonographer as well as the location of the lesions. MRI is an ideal complementary modality to ultrasonography for pre-operative planning as it allows for a larger field-of-view when required and it has high levels of reproducibility and tolerability. Typically, endometriotic lesions appear hypoechoic on ultrasonography. On MRI, classical features include DIE T2 hypointensity, endometrioma T2 hypointensity and T1 hyperintensity, while superficial peritoneal endometriosis (SPE) is described as a small focus of T1 hyperintensity. Imaging has become a critical tool in the diagnosis, surveillance and surgical planning of endometriosis. This literature review is based mostly on studies from the last two decades and aims to provide a detailed overview of the imaging features of endometriosis as well as the advances and usefulness of different imaging modalities for this condition.
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Affiliation(s)
- Juan Quesada
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Kirsi Härmä
- Department of Diagnostic, Interventional and Pediatric Radiology - University Hospital of Bern, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Shannon Reid
- Western Sydney University, Faculty of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; Sonacare Women's Health and Ultrasound, Harrington, NSW 2567, Australia
| | - Tanushree Rao
- Department of Obstetrics & Gynecology at Liverpool Hospital, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Glen Lo
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia.
| | - Natalie Yang
- Department of Radiology, The Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.
| | - Sonal Karia
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Emmeline Lee
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia
| | - Nira Borok
- Department of Radiology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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Cathcart AM, Nezhat FR, Emerson J, Pejovic T, Nezhat CH, Nezhat CR. Adnexal masses during pregnancy: diagnosis, treatment, and prognosis. Am J Obstet Gynecol 2022:S0002-9378(22)02179-2. [PMID: 36410423 DOI: 10.1016/j.ajog.2022.11.1291] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Adnexal masses are identified in pregnant patients at a rate of 2 to 20 in 1000, approximately 2 to 20 times more frequently than in the age-matched general population. The most common types of adnexal masses in pregnancy requiring surgical management are dermoid cysts (32%), endometriomas (15%), functional cysts (12%), serous cystadenomas (11%), and mucinous cystadenomas (8%). Approximately 2% of adnexal masses in pregnancy are malignant. Although most adnexal masses in pregnancy can be safely observed and approximately 70% spontaneously resolve, a minority of cases warrant surgical intervention because of symptoms, risk of torsion, or suspicion of malignancy. Ultrasound is the mainstay of evaluation of adnexal masses in pregnancy because of accuracy, safety, and availability. Several ultrasound mass scoring systems, including the Sassone, Lerner, International Ovarian Tumor Analysis Simple Rules, and International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adneXa scoring systems have been validated specifically in pregnant populations. Decisions regarding expectant vs surgical management of adnexal masses in pregnancy must balance the risks of torsion or malignancy with the likelihood of spontaneous resolution and the risks of surgery. Laparoscopic surgery is preferred over open surgery when possible because of consistently demonstrated shorter hospital length of stay and less postoperative pain and some data demonstrating shorter operative time, lower blood loss, and lower risks of fetal loss, preterm birth, and low birthweight. The best practices for laparoscopic surgery during pregnancy include left lateral decubitus positioning after the first trimester of pregnancy, port placement with respect to uterine size and pathology location, insufflation pressure of less than 12 to 15 mm Hg, intraoperative maternal capnography, pre- and postoperative fetal heart rate and contraction monitoring, and appropriate mechanical and chemical thromboprophylaxes. Although planning surgery for the second trimester of pregnancy generally affords time for mass resolution while optimizing visualization with regards to uterine size and pathology location, necessary surgery should not be delayed because of gestational age. When performed at a facility with appropriate obstetrical, anesthetic, and neonatal support, adnexal surgery in pregnancy generally results in excellent outcomes for pregnant patients and fetuses.
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Affiliation(s)
- Ann M Cathcart
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Farr R Nezhat
- Weill Cornell Medical College, Cornell University, New York, NY; New York University Long Island School of Medicine, Mineola, NY.
| | - Jenna Emerson
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Gynecologic Oncology, Oregon Health & Science University, Portland, OR
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Gynecologic Oncology, Oregon Health & Science University, Portland, OR
| | - Ceana H Nezhat
- Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA
| | - Camran R Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA; University of California San Francisco, San Francisco, CA; Stanford University Medical Center, Palo Alto, CA
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Testini V, Eusebi L, Grechi G, Bartelli F, Guglielmi G. Imaging of Endometriosis: The Role of Ultrasound and Magnetic Resonance. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractEndometriosis is a chronic gynecological disease characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus. It causes pelvic pain, dysmenorrhea, dyspareunia, or infertility. Diagnosis requires a combination of clinical history, non-invasive and invasive techniques. The aim of the present review was to evaluate the contribution of imaging techniques, mainly transvaginal sonography and magnetic resonance imaging to diagnose different locations and for the most appropriate treatment planning. Endometriosis requires a multidisciplinary teamwork to manage these patients clinically and surgically.
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Sorrentino F, DE Padova M, Falagario M, D'Alteri O MN, DI Spiezio Sardo A, Pacheco LA, Carugno JT, Nappi L. Endometriosis and adverse pregnancy outcome. Minerva Obstet Gynecol 2022; 74:31-44. [PMID: 34096691 DOI: 10.23736/s2724-606x.20.04718-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Endometriosis is a gynecologic disease affecting approximately 10% of reproductive age women, around 21-47% of women presenting subfertility and 71-87% of women with chronic pelvic pain. Main symptoms are chronic pelvic pain, dysmenorrhea, dyspareunia and infertility that seem to be well controlled by oral contraceptive pill, progestogens, GnRh antagonists. The aim of this review was to illustrate the modern diagnosis of endometriosis during pregnancy, to evaluate the evolution of endometriotic lesions during pregnancy and the incidence of adverse outcomes. EVIDENCE ACQUISITION Published literature was retrieved through searches of the database PubMed (National Center for Biotechnology Information, US National Library of Medicine, Bethesda, MD, USA). We searched for all original articles published in English through April 2020 and decided to extract every notable information for potential inclusion in this review. The search included the following MeSH search terms, alone or in combination: "endometriosis" combined with "endometrioma," "biomarkers," "complications," "bowel," "urinary tract," "uterine rupture," "spontaneous hemoperitoneum in pregnancy" and more "adverse pregnancy outcome," "preterm birth," "miscarriage," "abruption placentae," "placenta previa," "hypertensive disorder," "preeclampsia," "fetal grow restriction," "small for gestation age," "cesarean delivery." EVIDENCE SYNTHESIS Pregnancy in women with endometriosis does not always lead to disappearance of symptoms and decrease in the size of endometriotic lesions, but it may be possible to observe a malignant transformation of ovarian endometriotic lesions. Onset of complications may be caused by many factors: chronic inflammation, adhesions, progesterone resistance and a dysregulation of genes involved in the embryo implantation. As results, the pregnancy can be more difficult because of endometriosis related complications (spontaneous hemoperitoneum [SH], bowel complications, etc.) or adverse outcomes like preterm birth, FGR, hypertensive disorders, obstetrics hemorrhages (placenta previa, abruptio placenta), miscarriage or cesarean section. Due to insufficient knowledge about its pathogenesis, currently literature data are contradictory and do not show a strong correlation between endometriosis and these complications except for miscarriage and cesarean delivery. CONCLUSIONS Future research should focus on the potential biological pathways underlying these relationships in order to inform patients planning a birth about possible complications during pregnancy.
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Affiliation(s)
- Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Maristella DE Padova
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Maddalena Falagario
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Maurizio N D'Alteri O
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Attilio DI Spiezio Sardo
- School of Medicine, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Luis A Pacheco
- Unit of Gynecologic Endoscopy, Gutenberg Center, Xanit International Hospital, Málaga, Spain
| | - Jose T Carugno
- Miller School of Medicine, Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy -
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Vigueras Smith A, Cabrera R, Trippia C, Tessman Zomer M, Kondo W, Ferreira H, Carttaxo Da Silva L, Sumak R. Indirect and atypical imaging signals of endometriosis: A wide range of manifestations. Facts Views Vis Obgyn 2021; 13:339-356. [PMID: 35026096 PMCID: PMC9148709 DOI: 10.52054/fvvo.13.4.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Whilst some imaging signs of endometriosis are common and widely accepted as ‘typical’, a range of ‘subtle’ signs could be present in imaging studies, presenting an opportunity to the radiologist and the surgeon to aid the diagnosis and facilitate preoperative surgical planning. Objective To summarise and analyse the current information related to indirect and atypical signs of endometriosis by ultrasound (US) and magnetic resonance imaging (MRI). Methods Through the use of PubMed and Google scholar, we conducted a comprehensive review of available articles related to the diagnosis of indirect signs in transvaginal US and MRI. All abstracts were assessed and the studies were finally selected by two authors. Results Transvaginal US is a real time dynamic exploration, that can reach a sensitivity of 79-94% and specificity of 94%. It allows evaluation of normal sliding between structures in different compartments, searching for adhesions or fibrosis. MRI is an excellent tool that can reach a sensitivity of 94% and specificity of 77% and allows visualisation of the uterus, bowel loop deviation and peritoneal inclusion cysts. It also allows the categorisation and classification of ovarian cysts, rectovaginal and vesicovaginal septum obliteration, and small bowel endometriotic implants. Conclusion The use of an adequate mapping protocol with systematic evaluation and the reporting of direct and indirect signs of endometriosis is crucial for detailed and safe surgical planning.
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7
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Onder O, Karaosmanoglu AD, Kraeft J, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Hahn PF. Identifying the deceiver: the non-neoplastic mimickers of genital system neoplasms. Insights Imaging 2021; 12:95. [PMID: 34232414 PMCID: PMC8263845 DOI: 10.1186/s13244-021-01046-x] [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: 05/17/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Tumors of the genital system are common and imaging is of crucial importance for their detection and diagnosis. Several non-neoplastic diseases may mimic these tumors and differential diagnosis may be difficult in certain cases. Misdiagnosing non-neoplastic diseases as tumor may prompt unnecessary medical treatment or surgical interventions. In this article, we aimed to present the imaging characteristics of non-neoplastic diseases of the male and female genital systems that may mimic neoplastic processes. Increasing awareness of the imaging specialists to these entities may have a severe positive impact on the management of these patients.
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Affiliation(s)
- Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | | | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, 06010, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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8
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Ștefan RA, Ștefan PA, Mihu CM, Csutak C, Melincovici CS, Crivii CB, Maluțan AM, Hîțu L, Lebovici A. Ultrasonography in the Differentiation of Endometriomas from Hemorrhagic Ovarian Cysts: The Role of Texture Analysis. J Pers Med 2021; 11:jpm11070611. [PMID: 34203314 PMCID: PMC8306221 DOI: 10.3390/jpm11070611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023] Open
Abstract
The ultrasonographic (US) features of endometriomas and hemorrhagic ovarian cysts (HOCs) are often overlapping. With the emergence of new computer-aided diagnosis techniques, this is the first study to investigate whether texture analysis (TA) could improve the discrimination between the two lesions in comparison with classic US evaluation. Fifty-six ovarian cysts (endometriomas, 30; HOCs, 26) were retrospectively included. Four classic US features of endometriomas (low-level internal echoes, perceptible walls, no solid components, and less than five locules) and 275 texture parameters were assessed for every lesion, and the ability to identify endometriomas was evaluated through univariate, multivariate, and receiver operating characteristics analyses. The sensitivity (Se) and specificity (Sp) were calculated with 95% confidence intervals (CIs). The texture model, consisting of seven independent predictors (five variations of difference of variance, image contrast, and the 10th percentile; 100% Se and 100% Sp), was able to outperform the ultrasound model composed of three independent features (low-level internal echoes, perceptible walls, and less than five locules; 74.19% Se and 84.62% Sp) in the diagnosis of endometriomas. The TA showed statistically significant differences between the groups and high diagnostic value, but it remains unclear if the textures reflect the intrinsic histological characteristics of the two lesions.
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Affiliation(s)
- Roxana-Adelina Ștefan
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania;
| | - Paul-Andrei Ștefan
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes, Street, Number 8, 400012 Cluj-Napoca, Romania;
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Correspondence: or
| | - Carmen Mihaela Mihu
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street, Number 3-5, 400006 Cluj-Napoca, Romania
| | - Carmen Stanca Melincovici
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
| | - Carmen Bianca Crivii
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes, Street, Number 8, 400012 Cluj-Napoca, Romania;
| | - Andrei Mihai Maluțan
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania;
- Obstetrics and Gynecology Clinic II, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania
| | - Liviu Hîțu
- Doctoral School, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street, Number 3-5, 400006 Cluj-Napoca, Romania
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9
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Bordonné C, Puntonet J, Maitrot-Mantelet L, Bourdon M, Marcellin L, Dion E, Plu-Bureau G, Santulli P, Chapron C. Imaging for evaluation of endometriosis and adenomyosis. Minerva Obstet Gynecol 2021; 73:290-303. [PMID: 34008384 DOI: 10.23736/s2724-606x.21.04710-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endometriosis and adenomyosis are two frequent diseases that impair women's quality of life by causing pain and infertility. Both endometriosis and adenomyosis are heterogeneous diseases that manifest as different forms. Adenomyosis may be described as diffuse adenomyosis, focal adenomyosis especially of the outer myometrium and cystic adenomyoma. Endometriosis has three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). These two diseases are closely linked, and it is now clear that adenomyosis can either arise on its own or coexist with endometriosis. There is a strong clinical relationship between endometriosis and adenomyosis according to their respective phenotypes. Various classifications are available to describe both diseases. Transvaginal ultrasonography (TVUS) and/or pelvic magnetic resonance imaging (MRI) are the first examination performed when endometriosis or adenomyosis are suspected. These two imaging techniques, used in a combination manner, allow accurate description of both endometriosis and adenomyosis, to assess the diagnosis and to improve clinical and surgical care. In this review, we described the different imaging aspects of endometriosis and adenomyosis to help the less experienced radiologist or gynecologist in the diagnosis and evaluation of those diseases.
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Affiliation(s)
- Corinne Bordonné
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France - .,Faculty of Medicine, University of Paris, Paris, France -
| | - Julien Puntonet
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Lorraine Maitrot-Mantelet
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Mathilde Bourdon
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Louis Marcellin
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Elisabeth Dion
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Geneviève Plu-Bureau
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Pietro Santulli
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Charles Chapron
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
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10
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Bhalla D, Manchanda S, Vyas S. Algorithmic Approach to Sonography of Adnexal Masses: An Evolving Paradigm. Curr Probl Diagn Radiol 2020; 50:703-715. [PMID: 32958313 DOI: 10.1067/j.cpradiol.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/25/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pelvic US remains the workhorse for detection and characterization of adnexal masses in most centers worldwide. While the differentiation of benign from malignant masses remains the foremost concern, it is imperative to narrow the differential diagnosis for management of benign masses as well as prognostication of malignant masses. The IOTA group as well as ACR have described a five category classification system for adnexal lesions based on morphological patterns. In addition, a six category risk stratification has been proposed, incorporating the probability of malignancy as well as management recommendations. LEARNING OBJECTIVES 1) Understand pattern based approach to adnexal lesion classification and the possible entities fitting into each pattern with the help of illustrations. 2) Classify lesions into appropriate risk categories based on diagnostic algorithms provided at the end of each section.
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Affiliation(s)
- Deeksha Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar East, ND, 110029, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar East, ND, 110029, India.
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar East, ND, 110029, India
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11
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Agely A, Bolan C, Metcalfe A, VanBuren W, Menias C. Genitourinary manifestations of endometriosis with emphasis on the urinary tract. Abdom Radiol (NY) 2020; 45:1711-1722. [PMID: 31919646 DOI: 10.1007/s00261-019-02383-8] [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: 01/07/2023]
Abstract
Endometriosis is a common benign condition affecting women. The disease has a broad spectrum of presentations from incidental lesions in asymptomatic women to causing significant and debilitating morbidity in others. Ectopic endometrial glands are located in predictable locations throughout the pelvis, including implantation on the ovaries and in the rectouterine cul-de-sac. Less commonly, the urinary tract may be involved. As genitourinary manifestations may remain symptomatically occult or masquerade as other diagnoses, it is essential for the radiologist to be aware of the imaging features, consider this diagnosis, and potentially save the patient from delayed treatment.
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Affiliation(s)
- A Agely
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - C Bolan
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - A Metcalfe
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - W VanBuren
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - C Menias
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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12
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Abstract
Endometriosis constitutes the presence of ectopic endometrial glands and stroma outside the uterine endometrium, which is hormonally responsive and responds to pregnancy hormones as well. Decidualization is a physiologic process, where the normal endometrium readies itself for optimal accommodation of a pregnancy. A similar hormonal response can be seen with ectopic endometrium as well. As such, ovarian endometriomas and deep endometriosis implants can undergo decidualization. Overall, the progestational state of pregnancy favors an improvement in endometriosis, however, decidualization can lead to findings that can lead to increased size of endometriomas and deep infiltrative endometriosis implants, changes in imaging appearance and even complications, such as spontaneous hemoperitoneum in pregnancy. Awareness of this process can help prevent misdiagnosis of decidualized endometriomas as ovarian malignancy and recognize common imaging manifestations of hormonal effects of pregnancy on endometriosis.
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13
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Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of Endometriosis: Looking Beyond the Endometrioma with a Dedicated Protocol. Radiographics 2020; 39:1549-1568. [PMID: 31498746 DOI: 10.1148/rg.2019190045] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Transvaginal sonography (TVS) is a valuable primary imaging tool for the initial evaluation and management of endometriosis, a complex multifocal disease process with a varied spectrum of clinical and morphologic features that can substantially affect quality of life. The high accuracy of TVS for the detailed mapping of disease extent, an essential process for guiding treatment strategies, is well documented. The dynamic nature of US provides added value, revealing information that is not easily addressed with other imaging modalities. As recognized by the International Deep Endometriosis Analysis Consensus Group, a dedicated standardized protocol that is used by experienced and knowledgeable operators is necessary for a complete evaluation. The four components of a dedicated TVS protocol for evaluation of pelvic endometriosis are (a) evaluation of the uterus and adnexa, (b) dedicated search for deep infiltrating endometriosis, (c) assessment of the sliding sign, and (d) detection of sonographic soft markers. These components are described, and the multiple locations and US findings of endometriosis within the pelvis are reviewed, with emphasis on the unique features of US as an extension of the physical examination. In addition to enabling evaluation of the static findings of adenomyosis, endometrioma, hydrosalpinx, hematosalpinx, and hypoechoic nodules of deep infiltrating endometriosis, dynamic TVS enables assessment of pouch of Douglas obliteration, organ mobility, and site-specific tenderness, as well as tenderness-guided imaging. The benefits of implementing a dedicated TVS protocol in terms of improved patient care are also discussed. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Belinda G Collins
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
| | - Anita Ankola
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
| | - Sparsh Gola
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
| | - Kathryn L McGillen
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
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14
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Abstract
Endometriosis is a disease of reproductive age women that is commonly characterized by symptoms that often negatively impact quality of life. The clinical management of endometriosis remains highly variable and mostly influenced by geographic location, practice patterns, and breadth of clinician experience. This variability in treatment has inspired a trend towards multidisciplinary and specialized care of patients suffering from this disease. Surgical sampling, followed by histologic confirmation of endometrial-like tissue, remains the standard for the definitive diagnosis of endometriosis. However, the high sensitivity and specificity of MRI and ultrasound has shed light on the path towards non-surgical diagnosis of deep infiltrating endometriosis. Molecular variability and intricacy of this disease has limited the development of biologic markers to target for non-invasive diagnosis and pharmacologic therapies. Surgical management of advanced-stage endometriosis can be difficult, mostly secondary to the invasive nature of the disease, and anatomical distortion requiring advanced surgical skills to manage. The high prevalence of chronic pelvic pain and other complex pain syndromes in patients with endometriosis also requires knowledge in the management of these types of issues in order to provide comprehensive care. Menopausal endometriosis, extrapelvic presentation, and potential malignant transformation of lesions are infrequent, requiring a high index of suspicion for timely diagnosis and treatment.
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Affiliation(s)
- Miguel A Luna Russo
- Section of Benign Gynecology, Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA -
| | - Julia N Chalif
- Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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15
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Wall DJ, Reinhold C, Akin EA, Ascher SM, Brook OR, Dassel M, Henrichsen TL, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Uyeda JW, Glanc P. ACR Appropriateness Criteria® Female Infertility. J Am Coll Radiol 2020; 17:S113-S124. [PMID: 32370955 DOI: 10.1016/j.jacr.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Abstract
The most common known causes of female infertility are male factor (26%), ovulatory failure (21%), and tubal damage (14%), while in 28% a couple's infertility remains unexplained. Female-specific causes of infertility include deterioration of oocyte quality with increasing maternal age; ovulatory disorders, most notably polycystic ovarian syndrome; history of salpingitis such as that caused by chlamydia infection; endometriosis; and uterine cavity abnormalities interfering with implantation causing inability to become pregnant or causing recurrent pregnancy loss. These potential causes of female infertility are discussed in this document and the appropriate imaging recommendations for each variant are provided. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | | | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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16
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Galazis N, Mappouridou S, Saso S, Lathouras K, Yazbek J. Applying the vaginal approach for benign ovarian cystectomy: current evidence and future applications. Future Sci OA 2020; 6:FSO470. [PMID: 32518685 PMCID: PMC7273401 DOI: 10.2144/fsoa-2019-0138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vaginal ovarian cystectomy has not gained wide acceptance owing to the potential difficulty in entering the cul-de-sac. We review the current evidence on vaginal approaches to benign ovarian cysts. Outcome measures of interest included time to return to work, patient satisfaction, surgical complications and length of hospital stay. Ten studies were included in this review and involving 525 patients. Vaginal ovarian cystectomy is overall safe and feasible in appropriately selected cases with no evidence of intrapelvic adhesions or endometriosis. These findings will need to be validated in appropriately powered studies, before reliable conclusions can be drawn. Furthermore, we emphasize the importance of ultrasound both preoperatively for case selection optimization and intraoperatively, as a means of guidance during posterior culdotomy. The management of benign ovarian cysts through the vagina (VOC) has not gained wide acceptance by gynecologists worldwide owing to the potential difficulty in accessing the pelvic organs through an incision at the top of the vagina that may cause injury to adjacent structures such as the rectum. This is a review of the literature on the effectiveness of VOC. Various techniques have been described. Overall, VOC is safe and effective in appropriately selected cases. Larger studies will need to be conducted to validate these results. We also emphasize the importance of ultrasound both preoperatively as a tool to select the right patients for VOC as well as during surgery as an adjunct to guide the surgeon.
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Affiliation(s)
- Nicolas Galazis
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Stephanie Mappouridou
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Srdjan Saso
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0HS, UK.,Division of Surgery & Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - Konstantinos Lathouras
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Joseph Yazbek
- West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0HS, UK
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17
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Karadağ C, Demircan S, Turgut A, Çalışkan E. Effects of laparoscopic cystectomy on ovarian reserve in patients with endometrioma and dermoid cyst. Turk J Obstet Gynecol 2020; 17:15-20. [PMID: 32341825 PMCID: PMC7171546 DOI: 10.4274/tjod.galenos.2020.37605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/09/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the effects of laparoscopic cystectomy on ovarian reserve between women with endometrioma and dermoid cyst. Materials and Methods: Thirty-six patients were diagnosed as having endometrioma (group A) and 32 patients with dermoid cyst (group B) using ultrasonography. Preoperative anti-mullerian hormone (AMH) levels were measured and unilateral antral follicle counts (AFC) were calculated for the ovary side containing the cyst. Laparoscopic cystectomy was performed using the stripping technique for all participants. After 3 months, all participants were re-evaluated between the third and sixth day of their menstrual cycle to determine AFC and AMH levels. Results: The mean serum preoperative AMH level and AFC level were significantly lower in group A than in group B (p=0.001, p=0.002), respectively. At 3 months after the surgery, serum AMH levels decreased significantly in group A from 2.04±0.68 to 1.47±0.55 (p=0.001), and from 2.60±0.57 to 2.17±0.56 in group B (p=0.001). In group A, unilateral (operated side) AFC levels decreased significantly from 4.05±1.24 to 2.16±0.94 (p=0.001), and in group B, it decreased significantly from 4.93±0.94 to 3.40±0.87 (p=0.001). The decrease in AMH levels was significantly higher in group A than in group B (p=0.033). The decrease in AFC levels was also significantly higher in group A than in group B (p=0.044). Conclusion: Laparoscopic stripping has destructive effects on serum AMH levels and the operated side AFC levels after surgery for patients with endometrioma and dermoid cysts, and laparoscopic excision of endometrioma has more destructive effects on ovarian reserve than dermoid cysts.
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Affiliation(s)
- Cihan Karadağ
- Okan University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Sinem Demircan
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Abdulkadir Turgut
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Eray Çalışkan
- Okan University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Hindman N, VanBuren W. Imaging Spectrum of Endometriosis (Endometriomas to Deep Infiltrative Endometriosis). Radiol Clin North Am 2020; 58:275-289. [DOI: 10.1016/j.rcl.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
This article provides an overview of the imaging evaluation of benign ovarian and adnexal masses in premenopausal and postmenopausal women and lesions discovered during pregnancy. Current imaging techniques are discussed, including pitfalls and differential diagnosis when necessary, as well as management. It also reviews the now well-established American College of Radiology (ACR)/Society of Radiologists in Ultrasound consensus guidelines and covers the more recently introduced Ovarian-Adnexal Reporting and Data System by the ACR and the recently published ADNEx Scoring System.
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Affiliation(s)
- Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
| | - Tammy Kim
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
| | - Joanna Riess
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
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Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, Bourne T, Brown DL, Coleman BG, Frates MC, Goldstein SR, Hamper UM, Horrow MM, Hernanz-Schulman M, Reinhold C, Rose SL, Whitcomb BP, Wolfman WL, Glanc P. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology 2019; 294:168-185. [PMID: 31687921 DOI: 10.1148/radiol.2019191150] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system is designed to provide consistent interpretations, to decrease or eliminate ambiguity in US reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. It was developed by an international multidisciplinary committee sponsored by the American College of Radiology and applies the standardized reporting tool for US based on the 2018 published lexicon of the O-RADS US working group. For risk stratification, the O-RADS US system recommends six categories (O-RADS 0-5), incorporating the range of normal to high risk of malignancy. This unique system represents a collaboration between the pattern-based approach commonly used in North America and the widely used, European-based, algorithmic-style International Ovarian Tumor Analysis (IOTA) Assessment of Different Neoplasias in the Adnexa model system, a risk prediction model that has undergone successful prospective and external validation. The pattern approach relies on a subgroup of the most predictive descriptors in the lexicon based on a retrospective review of evidence prospectively obtained in the IOTA phase 1-3 prospective studies and other supporting studies that assist in differentiating management schemes in a variety of almost certainly benign lesions. With O-RADS US working group consensus, guidelines for management in the different risk categories are proposed. Both systems have been stratified to reach the same risk categories and management strategies regardless of which is initially used. At this time, O-RADS US is the only lexicon and classification system that encompasses all risk categories with their associated management schemes.
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Affiliation(s)
- Rochelle F Andreotti
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Dirk Timmerman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Lori M Strachowski
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Wouter Froyman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Beryl R Benacerraf
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Genevieve L Bennett
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Tom Bourne
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Douglas L Brown
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Beverly G Coleman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Mary C Frates
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Steven R Goldstein
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Ulrike M Hamper
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Mindy M Horrow
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Marta Hernanz-Schulman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Caroline Reinhold
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Stephen L Rose
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Brad P Whitcomb
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Wendy L Wolfman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Phyllis Glanc
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
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Karadağ C, Yoldemir T, Demircan Karadağ S, Turgut A. The effects of endometrioma size and bilaterality on ovarian reserve. J OBSTET GYNAECOL 2019; 40:531-536. [PMID: 31460808 DOI: 10.1080/01443615.2019.1633518] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aim of this study was to investigate the effects of endometrioma (OMAs) size and bilaterality on ovarian reserve. The patients with OMA were determined by ultrasonographic examination. Fifty patients with unilateral OMA (Group A), 30 patients with bilateral OMA (Group B), and 60 women without ovarian cysts (Group C) were included in this study. AMH levels were measured, and antral follicle count (AFC) was determined. The mean serum AMH levels were significantly lower in Group B than Groups C and A, and were significantly lower in Group A than Group C. There was a significant correlation between serum AMH level and OMA size in Group A (R = -.372, p = .008). OMAs per se appear to be associated with damage to the ovarian reserve. Increased OMA size is related to decreased AMH levels in patients with OMA. Bilateral OMAs have a more destructive effect on ovarian reserve.IMPACT STATEMENTWhat is already known on this subject? Previous Studies have demonstrated the effect of surgery on ovarian reserve but there have been contradictory findings reported about the effects of OMAs per se on serum AMH levels and it has not been clear what the relation between OMAs size and AMH levels is, if any.What the results of this study add? In this study, we found decreased AMH levels in patients with OMA. The results showed significant negative correlation between OMA size and AMH levels. The patients with bilateral OMAs had lower AMH levels than the unilateral ones.What the implications are of these findings for clinical practice and/or further research? Increasing OMA size might be harmful to ovarian reserve. Further studies should be done to evaluate whether increasing the size of the OMA is associated with a progressive decline in ovarian reserve and to better clarify the role of the OMAs per se or of laparoscopic surgery in the determination of damage to the ovarian reserve.
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Affiliation(s)
- Cihan Karadağ
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İstanbul, Turkey
| | - Tevfik Yoldemir
- Department of Obstetrics and Gynecology, Marmara University School of Medicine, İstanbul, Turkey
| | - Sinem Demircan Karadağ
- Department of Obstetrics and Gynecology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Abdulkadir Turgut
- Department of Obstetrics and Gynecology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
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Abstract
Endometriosis is a common disease of reproductive-age women that is often first encountered with ultrasound. Therefore, familiarity with the variety of manifestations of endometriosis is important for appropriate diagnosis and management. The aim of this article is to review the spectrum of appearance of pelvic endometriosis and to discuss potential mimics on ultrasound. Given that magnetic resonance imaging is an important problem-solving tool in female pelvic imaging, magnetic resonance imaging correlation is also provided.
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Abstract
Pelvic ultrasound with endovaginal ultrasound is often the imaging test of choice in the initial evaluation of nonpregnant women with pelvic pain. This article considers the sonographic observations and techniques useful in diagnosis of a variety of gynecologic causes of pelvic pain in these women, including ovarian hemorrhage, ovarian torsion, pelvic inflammatory disease, endometriosis (particularly deeply infiltrating endometriosis), endometriomas, adenomyosis, pelvic congestion syndrome, and malpositioned intrauterine contraceptive devices. Sonographic observations regarding a number of non-gynecologic causes of pelvic pain are also described.
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Affiliation(s)
- Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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Tran-Harding K, Nair RT, Dawkins A, Ayoob A, Owen J, Deraney S, Lee JT, Stevens S, Ganesh H. Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation. Clin Imaging 2018; 52:163-171. [DOI: 10.1016/j.clinimag.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 01/06/2023]
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Andreotti RF, Timmerman D, Benacerraf BR, Bennett GL, Bourne T, Brown DL, Coleman BG, Frates MC, Froyman W, Goldstein SR, Hamper UM, Horrow MM, Hernanz-Schulman M, Reinhold C, Strachowski LM, Glanc P. Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee. J Am Coll Radiol 2018; 15:1415-1429. [DOI: 10.1016/j.jacr.2018.07.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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Seckin B, Ates MC, Kirbas A, Yesilyurt H. Usefulness of hematological parameters for differential diagnosis of endometriomas in adolescents/young adults and older women. Int J Adolesc Med Health 2018; 33:/j/ijamh.ahead-of-print/ijamh-2018-0078/ijamh-2018-0078.xml. [PMID: 30256762 DOI: 10.1515/ijamh-2018-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Inflammatory processes have been considered to be involved in the pathogenesis of endometriosis. However, the predictive role of inflammatory hematological parameters in endometriosis is not clear. The aim of this study was to analyze the clinical value of hematologic markers in the differential diagnosis of endometriomas in younger and older reproductive age women. MATERIALS AND METHODS A retrospective chart review was done for 502 patients who underwent surgery: 267 with endometriomas (endometrioma group) and 235 with other benign adnexal cysts (control group). Patients were placed into subgroups as younger (adolescents/young adults, aged <25 years) and older (aged ≥25 years) women. Total and differential white blood cell count, neutrophil-to-lymphocyte ratio, platelet indices and platelet-to-lymphocyte ratio (PLR) were evaluated with receiver operating characteristic curve analysis for differential diagnosis of endometriomas. RESULTS The mean serum levels of PLR, plateletcrit (PCT), platelet count and CA-125 (reference range below 35 IU/mL) were significantly higher in the endometrioma group (p < 0.001). The area under the curve (AUC) for CA-125 was 0.85 [95% confidence interval (CI), 0.82-0.88] (p < 0.001) for the entire group. However, platelet count, PLR, and PCT showed poor discriminative ability for detecting endometriomas with AUC values of 0.59 (95% CI, 0.55-0.65, p < 0.001), 0.58 (95% CI, 0.53-0.63, p = 0.002) and 0.61 (95% CI, 0.56-0.66, p < 0.001), respectively. In age-stratified analysis, these platelet indices had also low diagnostic performance in both age groups. CONCLUSIONS Hematologic markers do not adequately differentiate ovarian endometriomas from other benign cysts in neither adolescents/young adults nor older women.
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Affiliation(s)
- Berna Seckin
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Talatpasa Bulvarı, Hamamönü, Altındağ, 06230 Ankara, Turkey, Phone: +90-312-3103100, Fax: +90-312-3124931
| | - Mete Can Ates
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Ayse Kirbas
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Huseyin Yesilyurt
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Sánchez Barrancos IM, Guerrero García FJ, Rico López MDC, Fernández Rodríguez V, Vegas Jiménez T, Alonso Roca R, Domínguez Tristancho D. [Usefulness and reliability of abdominal point of care ultrasound in family practice (2): Large abdominal vessels, spleen, nephrourological and gynecological ultrasound]. Aten Primaria 2018; 50:430-442. [PMID: 29858122 PMCID: PMC6837077 DOI: 10.1016/j.aprim.2018.02.011] [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: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 10/28/2022] Open
Abstract
This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound.
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Affiliation(s)
- Ignacio Manuel Sánchez Barrancos
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Consultorio local de Membrilla, Centro de Salud Manzanares 2, Gerencia de Atención Integrada de Manzanares, Ciudad Real, España.
| | - Francisco José Guerrero García
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Unidad de Gestión Clínica Gran Capitán, Distrito Sanitario Granada Metropolitano, Granada, España
| | - María Del Carmen Rico López
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro Médico Adeslas, Almería, España
| | - Vicente Fernández Rodríguez
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Os Rosales, Estructura Organizativa de Xestión Integrada, A Coruña, España
| | - Tomás Vegas Jiménez
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud San Fernando, Gerencia de Atención Primaria de Badajoz, Badajoz, España
| | - Rafael Alonso Roca
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Mar Báltico, Área Este, Madrid, España
| | - Daniel Domínguez Tristancho
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Santa Marta de los Barros, Gerencia de Atención Primaria de Badajoz, Badajoz, España
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28
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[Performances and place of sonography in the diagnostic of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:185-199. [PMID: 29544709 DOI: 10.1016/j.gofs.2018.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 12/27/2022]
Abstract
Endometriosis is difficult to diagnose clinically. Transvaginal sonography (TVS) is a procedure that is known to be operator-dependent, which mean that published evidences has to be balanced with the level of the sonographer that produced the data. The objective of this publication was to assess the performances of the sonography in the diagnosis of endometriosis in order to establish the French national recommendations. We searched the MEDLINE database for publication from January 2000 to September 2017 using keywords associated with endometriosis and sonography. Eighty-four trial and reviews published in English or French were included. Ovarian endometrioma can usually be diagnosed by a non-expert sonographer, especially when its aspect is typical. In case of an ovarian cyst with atypical presentation, it is recommended to control the sonography by a referent or to perform an MRI. In menopaused women, any ovarian cyst should be considered as a cancer until proven otherwise. In the diagnosis of posterior deep invasive endometriosis (DIE), TVS with sensitivity and specificity of 96 and 99% respectively, seems at least equivalent if not superior to MRI. However, these performances are related to expert sonographers. To reach sufficient efficiency in posterior DIE, the estimated learning curve for a sonographer is 44 cases. When posterior DIE is suspected, we recommend proposing a TVS "performed by an expert" or a MRI "at least interpreted by an expert". In anterior DIE, TVS has a good specificity (100%), but its sensitivity is poor in the literature (64%). TVS is therefore not able to eliminate the diagnosis. However a renal ultrasound should be proposed each time a urinary endometriosis is confirmed, and should be considered whenever posterior DIE is diagnosed especially the lesion is superior to 3cm.
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Emergent ultrasound evaluation of the pediatric female pelvis. Pediatr Radiol 2017; 47:1134-1143. [PMID: 28779190 DOI: 10.1007/s00247-017-3843-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
Ultrasound is the primary imaging modality of the pediatric female pelvis and is often requested to evaluate girls with pelvic or abdominal pain or abnormal bleeding. The US interpretation can help guide the clinician toward medical or surgical management. Here we discuss the normal US anatomy of the female pelvis and illustrate, through case examples, conditions encountered when performing emergent pelvic US for common and uncommon clinical scenarios.
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Susceptibility Weighted With Quantitative Phase Magnetic Resonance Imaging in Differentiation of Various Stages of Hemorrhage and Calcification in Female Pelvic Pathologies: A Preliminary Study. J Comput Assist Tomogr 2017; 41:586-591. [PMID: 28722701 DOI: 10.1097/rct.0000000000000551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purposes of this study were to assess the value of phase for characterization of female pelvic lesions with hemorrhage in various stages and to differentiate them from calcified lesions at 3.0-T magnetic resonance imaging (MRI). METHODS Forty-four female patients with hemorrhagic (n = 37) or calcified (n = 7) pelvic pathology underwent conventional MRI including susceptibility-weighted imaging with phase information. Hemorrhagic lesions were grouped into acute, subacute, and chronic, and calcified lesions were detected on the basis of conventional imaging findings. Phase quantification of these hemorrhagic and calcified lesions was performed. RESULTS The phase values significantly differed (P < 0.001) among various stages of hemorrhage, as well as calcification (chronic hemorrhage, -65.09 ± 9.09 degrees; subacute hemorrhage, -11.41 ± 4.4 degrees; acute hemorrhage, -42.30 ± 5.20 degrees; and calcified lesions, 117.55 ± 12.93 degrees). CONCLUSIONS Quantitative phase imaging has the potential to differentiate various stages of hemorrhagic and calcified pathologies. This may add value to the conventional MRI in improved characterization of these entities in female pelvic pathologies.
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Tadros MY, Keriakos NN. Diffusion MRI versus ultrasound in superficial and deep endometriosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fruscio R, de Haan J, Van Calsteren K, Verheecke M, Mhallem M, Amant F. Ovarian cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 41:108-117. [PMID: 28029502 DOI: 10.1016/j.bpobgyn.2016.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Abstract
Although the occurrence of ovarian masses in pregnancy is relatively common, the majority of them is functional and resolve spontaneously; nevertheless, ovarian cancer is the fifth most common malignancy diagnosed in pregnancy. If malignancy is suspected, treatment should be decided on the basis of gestational age, stage of the disease and patient preferences. In early stage, ovarian cancer surgery may be planned preferably after 16 weeks of pregnancy, and chemotherapy can be administered from the second trimester if indicated as in non-pregnant patients. In advanced-stage disease, when complete cytoreduction is not achievable, neoadjuvant chemotherapy could be administered even in pregnancy. Chemotherapy should be a combination of carboplatin and paclitaxel in epithelial ovarian cancer patients and a combination of cisplatin, vinblastin and bleomycin in non-epithelial ovarian cancer. The outcome of patients with ovarian cancer diagnosed in pregnancy is similar to non-pregnant patients, and stage of the disease is the most important prognostic factor.
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Affiliation(s)
- Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy.
| | - Jorine de Haan
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Magali Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium
| | - Mina Mhallem
- Department of Obstetrics and Gynaecology, Cliniques Universitaires St. Luc, UCL, Brussels, Belgium
| | - Frederic Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium; Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
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Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2:CD009591. [PMID: 26919512 PMCID: PMC7100540 DOI: 10.1002/14651858.cd009591.pub2] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND About 10% of women of reproductive age suffer from endometriosis. Endometriosis is a costly chronic disease that causes pelvic pain and subfertility. Laparoscopy, the gold standard diagnostic test for endometriosis, is expensive and carries surgical risks. Currently, no non-invasive tests that can be used to accurately diagnose endometriosis are available in clinical practice. This is the first review of diagnostic test accuracy of imaging tests for endometriosis that uses Cochrane methods to provide an update on the rapidly expanding literature in this field. OBJECTIVES • To provide estimates of the diagnostic accuracy of imaging modalities for the diagnosis of pelvic endometriosis, ovarian endometriosis and deeply infiltrating endometriosis (DIE) versus surgical diagnosis as a reference standard.• To describe performance of imaging tests for mapping of deep endometriotic lesions in the pelvis at specific anatomical sites.Imaging tests were evaluated as replacement tests for diagnostic surgery and as triage tests that would assist decision making regarding diagnostic surgery for endometriosis. SEARCH METHODS We searched the following databases to 20 April 2015: MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP, ClinicalTrials.gov, MEDION, DARE, and PubMed. Searches were not restricted to a particular study design or language nor to specific publication dates. The search strategy incorporated words in the title, abstracts, text words across the record and medical subject headings (MeSH). SELECTION CRITERIA We considered published peer-reviewed cross-sectional studies and randomised controlled trials of any size that included prospectively recruited women of reproductive age suspected of having one or more of the following target conditions: endometrioma, pelvic endometriosis, DIE or endometriotic lesions at specific intrapelvic anatomical locations. We included studies that compared the diagnostic test accuracy of one or more imaging modalities versus findings of surgical visualisation of endometriotic lesions. DATA COLLECTION AND ANALYSIS Two review authors independently collected and performed a quality assessment of data from each study. For each imaging test, data were classified as positive or negative for surgical detection of endometriosis, and sensitivity and specificity estimates were calculated. If two or more tests were evaluated in the same cohort, each was considered as a separate data set. We used the bivariate model to obtain pooled estimates of sensitivity and specificity when sufficient data sets were available. Predetermined criteria for a clinically useful imaging test to replace diagnostic surgery included sensitivity ≥ 94% and specificity ≥ 79%. Criteria for triage tests were set at sensitivity ≥ 95% and specificity ≥ 50%, ruling out the diagnosis with a negative result (SnNout test - if sensitivity is high, a negative test rules out pathology) or at sensitivity ≥ 50% with specificity ≥ 95%, ruling in the diagnosis with a positive result (SpPin test - if specificity is high, a positive test rules in pathology). MAIN RESULTS We included 49 studies involving 4807 women: 13 studies evaluated pelvic endometriosis, 10 endometriomas and 15 DIE, and 33 studies addressed endometriosis at specific anatomical sites. Most studies were of poor methodological quality. The most studied modalities were transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), with outcome measures commonly demonstrating diversity in diagnostic estimates; however, sources of heterogeneity could not be reliably determined. No imaging test met the criteria for a replacement or triage test for detecting pelvic endometriosis, albeit TVUS approached the criteria for a SpPin triage test. For endometrioma, TVUS (eight studies, 765 participants; sensitivity 0.93 (95% confidence interval (CI) 0.87, 0.99), specificity 0.96 (95% CI 0.92, 0.99)) qualified as a SpPin triage test and approached the criteria for a replacement and SnNout triage test, whereas MRI (three studies, 179 participants; sensitivity 0.95 (95% CI 0.90, 1.00), specificity 0.91 (95% CI 0.86, 0.97)) met the criteria for a replacement and SnNout triage test and approached the criteria for a SpPin test. For DIE, TVUS (nine studies, 12 data sets, 934 participants; sensitivity 0.79 (95% CI 0.69, 0.89) and specificity 0.94 (95% CI 0.88, 1.00)) approached the criteria for a SpPin triage test, and MRI (six studies, seven data sets, 266 participants; sensitivity 0.94 (95% CI 0.90, 0.97), specificity 0.77 (95% CI 0.44, 1.00)) approached the criteria for a replacement and SnNout triage test. Other imaging tests assessed in small individual studies could not be statistically evaluated.TVUS met the criteria for a SpPin triage test in mapping DIE to uterosacral ligaments, rectovaginal septum, vaginal wall, pouch of Douglas (POD) and rectosigmoid. MRI met the criteria for a SpPin triage test for POD and vaginal and rectosigmoid endometriosis. Transrectal ultrasonography (TRUS) might qualify as a SpPin triage test for rectosigmoid involvement but could not be adequately assessed for other anatomical sites because heterogeneous data were scant. Multi-detector computerised tomography enema (MDCT-e) displayed the highest diagnostic performance for rectosigmoid and other bowel endometriosis and met the criteria for both SpPin and SnNout triage tests, but studies were too few to provide meaningful results.Diagnostic accuracies were higher for TVUS with bowel preparation (TVUS-BP) and rectal water contrast (RWC-TVS) and for 3.0TMRI than for conventional methods, although the paucity of studies precluded statistical evaluation. AUTHORS' CONCLUSIONS None of the evaluated imaging modalities were able to detect overall pelvic endometriosis with enough accuracy that they would be suggested to replace surgery. Specifically for endometrioma, TVUS qualified as a SpPin triage test. MRI displayed sufficient accuracy to suggest utility as a replacement test, but the data were too scant to permit meaningful conclusions. TVUS could be used clinically to identify additional anatomical sites of DIE compared with MRI, thus facilitating preoperative planning. Rectosigmoid endometriosis was the only site that could be accurately mapped by using TVUS, TRUS, MRI or MDCT-e. Studies evaluating recent advances in imaging modalities such as TVUS-BP, RWC-TVS, 3.0TMRI and MDCT-e were observed to have high diagnostic accuracies but were too few to allow prudent evaluation of their diagnostic role. In view of the low quality of most of the included studies, the findings of this review should be interpreted with caution. Future well-designed diagnostic studies undertaken to compare imaging tests for diagnostic test accuracy and costs are recommended.
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Affiliation(s)
- Vicki Nisenblat
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
| | - Patrick MM Bossuyt
- Academic Medical Center, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsRoom J1b‐217, PO Box 22700AmsterdamNetherlands1100 DE
| | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Neil Johnson
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
| | - M Louise Hull
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
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The utility of ultrasound elastography in differentiation of endometriomas and hemorrhagic ovarian cysts. J Med Ultrason (2001) 2016; 43:395-400. [PMID: 26880060 DOI: 10.1007/s10396-016-0701-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the feasibility of acoustic radiation force impulse imaging in differentiation of endometriomas and hemorrhagic ovarian cysts. MATERIALS AND METHODS We evaluated 84 ovarian cysts with high internal echogenicity diagnosed in 70 consecutive women. We excluded simple cysts and hemorrhagic cysts containing septations or mural nodules with detectable flow on Doppler ultrasonography. We obtained the elastographic shear wave velocity (SWV) value of the cysts that could be endometriomas or hemorrhagic ovarian cysts. RESULTS Among the 78 ovarian cysts in 70 women without any septation or mural nodule, there were 42 endometriomas and 36 hemorrhagic ovarian cysts. Analysis of median SWV values of the ovarian cysts showed that the endometriomas had considerably higher levels of stiffness compared to the hemorrhagic ovarian cysts [median SWV 4.20 ± 0.42 vs 2.54 ± 1.04 m/s, p < 0.001]. A SWV cutoff value greater than 3.81 m/s yielded sensitivity and specificity values of 82.1 and 79.2 % respectively, for differentiation of endometriomas from hemorrhagic ovarian cysts. CONCLUSION Sonoelastography is a novel imaging technique that enables us to evaluate the stiffness of adnexal lesions. The accurate discrimination of endometriomas and hemorrhagic ovarian cysts is important for avoiding unnecessary surgical procedures. ARFI imaging has a high sensitivity and specificity for distinguishing endometrioma from hemorrhagic ovarian cysts.
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DeBenedectis C, Ghosh E, Lazarus E. Pitfalls in imaging of female infertility. Semin Roentgenol 2015; 50:273-83. [PMID: 26542428 DOI: 10.1053/j.ro.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Erica Ghosh
- University of Massachusetts Medical School, Worcester, MA
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Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 2015; 22:70-103. [PMID: 26450609 DOI: 10.1093/humupd/dmv045] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/14/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traditionally, pregnancy was considered to have a positive effect on endometriosis and its painful symptoms due not only to blockage of ovulation preventing bleeding of endometriotic tissue but also to different metabolic, hormonal, immune and angiogenesis changes related to pregnancy. However, a growing literature is emerging on the role of endometriosis in affecting the development of pregnancy and its outcomes and also on the impact of pregnancy on endometriosis. The present article aims to underline the difficulty in diagnosing endometriotic lesions during pregnancy and discuss the options for the treatment of decidualized endometriosis in relation to imaging and symptomatology; to describe all the possible acute complications of pregnancy caused by pre-existing endometriosis and evaluate potential treatments of these complications; to assess whether endometriosis affects pregnancy outcome and hypothesize mechanisms to explain the underlying relationships. METHODS This systematic review is based on material searched and obtained via Pubmed and Medline between January 1950 and March 2015. Peer-reviewed, English-language journal articles examining the impact of endometriosis on pregnancy and vice versa were included in this article. RESULTS Changes of the endometriotic lesions may occur during pregnancy caused by the modifications of the hormonal milieu, posing a clinical dilemma due to their atypical appearance. The management of these events is actually challenging as only few cases have been described and the review of available literature evidenced a lack of formal estimates of their incidence. Acute complications of endometriosis during pregnancy, such as spontaneous hemoperitoneum, bowel and ovarian complications, represent rare but life-threatening conditions that require, in most of the cases, surgical operations to be managed. Due to the unpredictability of these complications, no specific recommendation for additional interventions to the routinely monitoring of pregnancy of women with known history of endometriosis is advisable. Even if the results of the published studies are controversial, some evidence is suggestive of an association of endometriosis with spontaneous miscarriage, preterm birth and small for gestational age babies. A correlation of endometriosis with placenta previa (odds ratio from 1.67 to 15.1 according to various studies) has been demonstrated, possibly linked to the abnormal frequency and amplitude of uterine contractions observed in women affected. Finally, there is no evidence that prophylactic surgery would prevent the negative impact of endometriosis itself on pregnancy outcome. CONCLUSIONS Complications of endometriosis during pregnancy are rare and there is no evidence that the disease has a major detrimental effect on pregnancy outcome. Therefore, pregnant women with endometriosis can be reassured on the course of their pregnancies although the physicians should be aware of the potential increased risk of placenta previa. Current evidence does not support any modification of conventional monitoring of pregnancy in patients with endometriosis.
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Affiliation(s)
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Annalisa Inversetti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Veronica Giorgione
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Via Olgettina 58, 20132 Milano, Italy
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Juhan V. Chronic pelvic pain: An imaging approach. Diagn Interv Imaging 2015; 96:997-1007. [DOI: 10.1016/j.diii.2015.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
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Jung SI. Ultrasonography of ovarian masses using a pattern recognition approach. Ultrasonography 2015; 34:173-82. [PMID: 25797108 PMCID: PMC4484293 DOI: 10.14366/usg.15003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/06/2015] [Accepted: 02/07/2015] [Indexed: 12/26/2022] Open
Abstract
As a primary imaging modality, ultrasonography (US) can provide diagnostic information for evaluating ovarian masses. Using a pattern recognition approach through gray-scale transvaginal US, ovarian masses can be diagnosed with high specificity and sensitivity. Doppler US may allow ovarian masses to be diagnosed as benign or malignant with even greater confidence. In order to differentiate benign and malignant ovarian masses, it is necessary to categorize ovarian masses into unilocular cyst, unilocular solid cyst, multilocular cyst, multilocular solid cyst, and solid tumor, and then to detect typical US features that demonstrate malignancy based on pattern recognition approach.
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Affiliation(s)
- Sung Il Jung
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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Ganeshan D, Morani A, Ladha H, Bathala T, Kang H, Gupta S, Lalwani N, Kundra V. Staging, surveillance, and evaluation of response to therapy in renal cell carcinoma: role of MDCT. ACTA ACUST UNITED AC 2015; 39:92-107. [PMID: 24077815 DOI: 10.1007/s00261-013-0040-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Renal cell carcinoma is the most common malignant renal tumor in the adults. Significant advances have been made in the management of localized and advanced renal cell carcinoma. Surgery is the standard of care and accurate pre-operative staging based on imaging is critical in guiding appropriate patient management. Besides staging, imaging plays a key role in the post-operative surveillance and evaluation of response to systemic therapies. Both CT and MR are useful in the staging and follow up of renal cell carcinoma, but CT is more commonly used due to its lower costs and wider availability. In this article, we discuss and illustrate the role of multi-detector CT in pre-operative staging, post-operative surveillance, and evaluation of response to systemic therapy in renal cell carcinoma.
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Groszmann Y, Howitt BE, Bromley B, Feltmate CM, Benacerraf BR. Decidualized endometrioma masquerading as ovarian cancer in pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1909-1915. [PMID: 25336477 DOI: 10.7863/ultra.33.11.1909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To identify the sonographic features of decidualized endometriomas in patients treated at a single institution and to determine whether sonographic findings can distinguish these lesions from malignant ovarian tumors during pregnancy. METHODS We conducted a retrospective cohort study that included pregnant women with a histologic diagnosis of decidualized endometrioma between January 1, 2005, and December 1, 2012, and had an ovarian cyst or mass seen preoperatively on obstetrical sonography. Sonographic characteristics of these masses were retrospectively evaluated using the International Ovarian Tumor Analysis Group definitions for adnexal masses. RESULTS Seventeen patients with 22 adnexal masses were included in our study. Nine of 22 lesions (41%) were classified as unilocular solid, and 14 of 22 (64%) had solid components, of which 12 of 14 (86%) had substantial blood flow. Septations were present in 8 of 22 masses (36%). Cyst sizes varied from 30 to 120 and 32 to 270 mm at the initial and follow-up scans, respectively. Eight patients had no follow-up scans and underwent surgery within 3 weeks of diagnosis. The other 9 patients (14 masses), had follow-up scans and underwent surgery from 3 to 34 weeks after their initial scans. Eight of these masses showed no notable change in size or appearance, and 1 became smaller. CONCLUSIONS There were no characteristic sonographic features identified to distinguish decidualized endometrioma from ovarian malignancy. However, lesions showing no change in size over 4 weeks or lacking solid components and vascularity are more likely to be benign rather than malignant and may justify delaying surgery until delivery or postpartum.
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Affiliation(s)
- Yvette Groszmann
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.).
| | - Brooke E Howitt
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Bryann Bromley
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Colleen M Feltmate
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
| | - Beryl R Benacerraf
- Diagnostic Ultrasound Associates, PC, Boston Massachusetts USA (Y.G., B.B., B.R.B.); Departments of Obstetrics and Gynecology (Y.G., B.B., C.M.F., B.R.B.), Pathology (B.E.H.), and Radiology (B.B., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Obstetrics and Gynecology, Dana Farber Cancer Institute, Boston, Massachusetts USA (B.B., C.M.F., B.R.B.); and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.)
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Pateman K, Moro F, Mavrelos D, Foo X, Hoo WL, Jurkovic D. Natural history of ovarian endometrioma in pregnancy. BMC WOMENS HEALTH 2014; 14:128. [PMID: 25315259 PMCID: PMC4287586 DOI: 10.1186/1472-6874-14-128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 10/06/2014] [Indexed: 12/25/2022]
Abstract
Background Ovarian endometriomas are classified as benign ovarian lesions. During pregnancy endometriomas may undergo major morphological changes which are referred to as ‘decidualisation’. Decidualised ovarian endometrioma may resemble malignant ovarian tumours on ultrasound examination. The aim was to study variations in the morphology and size of ovarian endometriomas diagnosed on ultrasound during pregnancy. Methods We searched our database to identify pregnant women who were diagnosed with ovarian endometriomas on ultrasound in order to study the effect of pregnancy on their morphological characteristics. In women who underwent serial scans during pregnancy we examined the changes in the size of endometriomas with advancing gestation. Results Twenty four patients with a total of 34 endometriomas were included in the analysis. All women were managed expectantly during pregnancy. On the first ultrasound scan 29/34 (85.3%, 95% CI 73.4 - 97.2) endometriomas appeared unilocular with fine internal echoes (‘ground glass’ contents) and they were poorly vascularised on Doppler examination. 1/34 (2.9% 95% CI 0.0 - 8.5) endometrioma was multilocular, with regular margins, ‘ground glass’ contents and it was also poorly vascularised. 4/34 (11.8%, 95% CI 1.0 - 22.6) had sonographic features suggestive of decidualisation such as thick and irregular inner wall, papillary projections and highly vascular on Doppler examination. The endometriomas showed a tendency to decrease in size during pregnancy. Conclusions Pregnancy has a major effect on the size and morphological appearances of ovarian endometriomas. Rapid regression of decidualised endometriomas is a helpful feature which could be used to confirm their benign nature.
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Affiliation(s)
| | | | | | | | | | - Davor Jurkovic
- Department of Obstetrics and Gynaecology, University College London Hospital, 235 Euston Road, London NW1 2BU, UK.
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Piessens S, Healey M, Maher P, Tsaltas J, Rombauts L. Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Aust N Z J Obstet Gynaecol 2014; 54:462-8. [DOI: 10.1111/ajo.12242] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/26/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Sofie Piessens
- Women's and Children's Program; Monash Health; Clayton Victoria Australia
| | - Martin Healey
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Victoria Australia
- Department of Gynaecology; Royal Women's Hospital; Parkville Victoria Australia
| | - Peter Maher
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Victoria Australia
- Department Gynaecology; Mercy Hospital for Women; Heidelberg Victoria Australia
| | - Jim Tsaltas
- Women's and Children's Program; Monash Health; Clayton Victoria Australia
| | - Luk Rombauts
- Women's and Children's Program; Monash Health; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
- Monash IVF; Clayton Victoria Australia
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Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol 2014; 28:655-81. [DOI: 10.1016/j.bpobgyn.2014.04.010] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 01/21/2023]
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Saeng-Anan U, Pantasri T, Neeyalavira V, Tongsong T. Sonographic pattern recognition of endometriomas mimicking ovarian cancer. Asian Pac J Cancer Prev 2014; 14:5409-13. [PMID: 24175835 DOI: 10.7314/apjcp.2013.14.9.5409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the accuracy of ultrasound in differentiating endometrioma from ovarian cancer and to describe pattern recognition for atypical endometriomas mimicking ovarian cancers. MATERIALS AND METHODS Patients scheduled for elective surgery for adnexal masses were sonographically evaluated for endometrioma within 24 hours of surgery. All examinations were performed by the same experienced sonographer, who had no any information of the patients, to differentiate between endometriomas and non-endometriomas using a simple rule (classic ground-glass appearance) and subjective impression (pattern recognition). The final diagnosis as a gold standard relied on either pathological or post-operative findings. RESULTS Of 638 patients available for analysis, 146 were proven to be endometriomas. Of them, the simple rule and subjective impression could sonographically detect endometriomas with sensitivities of 64.4% (94/146) and 89.7% (131/146), respectively. Of 52 endometriomas with false negative tests by the simple rule, 13 were predicted as benign masses and 39 were mistaken for malignancy. Solid masses and papillary projections were the most common forms mimicking ovarian cancer, consisting of 38.5% of the missed diagnoses. However, with pattern recognition (subjective impression), 32 from 39 cases mimicking ovarian cancer were correctly predicted for endometriomas. All endometriomas subjectively predicted for ovarian malignancy were associated with high vascularization in the solid masses. CONCLUSIONS Pattern recognition of endometriomas by subjective assessment had a higher sensitivity than the simple rule in characterization of endometriomas. Most endometriomas mimicking ovarian malignancy could be correctly predicted by subjective impression based on familiarity of pattern recognition.
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Affiliation(s)
- Ubol Saeng-Anan
- Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Thailand E-mail :
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Corwin MT, Gerscovich EO, Lamba R, Wilson M, McGahan JP. Differentiation of Ovarian Endometriomas from Hemorrhagic Cysts at MR Imaging: Utility of the T2 Dark Spot Sign. Radiology 2014; 271:126-32. [DOI: 10.1148/radiol.13131394] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Guerriero S, Ajossa S, Gerada M, Virgilio B, Pilloni M, Galvan R, Laparte MC, Alcázar JL, Melis GB. Transvaginal ultrasonography in the diagnosis of extrauterine pelvic diseases. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.6.731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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