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Lamghare P, Paidlewar S, Arkar R, Rangankar V, Sharma O, Julakanti S, Pandey A. MRI Evaluation and Characterization of Ovarian Lesions Based on Ovarian-Adnexal Reporting and Data System MRI. Cureus 2024; 16:e67904. [PMID: 39328653 PMCID: PMC11426925 DOI: 10.7759/cureus.67904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Background Managing ovarian lesions requires differentiating between benign and malignant cases. The development of a multiparametric MRI approach combining anatomical and functional criteria has led to the creation of the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI scoring system, which enhances diagnostic accuracy. Objectives To study ovarian lesions and their characteristics, along with their risk stratification based on MRI O-RADS. Methods A prospective study used the O-RADS MRI criteria to categorize ovarian lesions. Clinical findings and MRI results were compared with histopathological outcomes to assess diagnostic accuracy. Results We identified abdominal pain as the most prevalent clinical finding among our cases (64, 91.43%), followed by a lump in the abdomen (33, 47.5%), dysmenorrhea (33, 47.5%), bleeding per vaginal (15, 21.43%), and weight loss (11, 15.71%). A total of 80 ovarian lesions were examined and characterized on the basis of the O-RADS MRI risk stratification system. Among the 80 ovarian lesions, 54 were histopathologically confirmed ovarian lesions (39 (72.22%) were benign, and 15 (27.77%) were malignant). The most common benign lesions were ovarian serous cystadenoma (28.20%) and ovarian mucinous cystadenoma (20.51%), while the most common malignant lesions were serous carcinoma (33.33%) and mucinous carcinoma (20%). Using the O-RADS MRI scoring system, we categorized six lesions (7.5%) as O-RADS 1 (all benign), 34 lesions (42.50%) as O-RADS 2 (32 benign and 2 malignant), 24 lesions (30%) as O-RADS 3 (23 benign and 1 malignant), seven lesions (8.75%) as O-RADS 4 (four benign and three malignant), and nine lesions (11.25%) as O-RADS 5 (all malignant). Our findings revealed significant differences in the size of lesions, the presence of thick septa, high T2-weighted signal intensity within solid tissue, and patterns of solid component enhancement and wall irregularity between malignant and benign lesions. The MRI cut-off score of ≥4 for malignancy demonstrated a sensitivity of 94.59%, a specificity of 97.5%, an accuracy of 97.62%, a positive predictive value of 94.5%, and a negative predictive value of 97.5%. The positive likelihood ratio was 32.7, while the negative likelihood ratio was 0.025. These results affirm the high diagnostic accuracy of the O-RADS MRI scoring system in distinguishing benign from malignant ovarian lesions. Conclusion The O-RADS MRI score is a highly accurate tool for differentiating between benign and malignant ovarian lesions. Its application can significantly enhance the management and treatment outcomes for patients with adnexal masses. The study confirms the scoring system's high sensitivity, specificity, and overall diagnostic accuracy.
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Affiliation(s)
- Purnachandra Lamghare
- Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Sayali Paidlewar
- Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Rahul Arkar
- Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Varsha Rangankar
- Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Ojasvi Sharma
- Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Sravya Julakanti
- Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
| | - Ankita Pandey
- Radiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, IND
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Cabedo L, Sebastià C, Munmany M, Fusté P, Gaba L, Saco A, Rodriguez A, Paño B, Nicolau C. O-RADS MRI scoring system: key points for correct application in inexperienced hands. Insights Imaging 2024; 15:107. [PMID: 38609573 PMCID: PMC11014836 DOI: 10.1186/s13244-024-01670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To evaluate the efficacy of the O-RADS MRI criteria in the stratification of risk of malignancy of solid or sonographically indeterminate ovarian masses and assess the interobserver agreement of this classification between experienced and inexperienced radiologists. METHODS This single-centre retrospective study included patients from 2019 to 2022 with sonographically indeterminate or solid ovarian masses who underwent MRI with a specific protocol for characterisation according to O-RADS MRI specifications. Each study was evaluated using O-RADS lexicon by two radiologists, one with 17 years of experience in gynaecological radiology and another with 4 years of experience in general radiology. Findings were classified as benign, borderline, or malignant according to histology or stability over time. Diagnostic performance and interobserver agreement were assessed. RESULTS A total of 183 patients with US indeterminate or solid adnexal masses were included. Fifty-seven (31%) did not have ovarian masses, classified as O-RADS 1. The diagnostic performance for scores 2-5 was excellent with a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 96.2%, and 100%, respectively by the experienced radiologist and 96.1%, 92.0%, 93.9%, and 94.8% by the inexperienced radiologist. Interobserver concordance was very high (Kappa index 0.92). Almost all the misclassified cases were due to misinterpretation of the classification similar to reports in the literature. CONCLUSION The diagnostic performance of O-RADS MRI determined by either experienced or inexperienced radiologists is excellent, facilitating decision-making with high diagnostic accuracy and high reproducibility. Knowledge of this classification and use of assessment tools could avoid frequent errors due to misinterpretation. CRITICAL RELEVANCE STATEMENT Up to 31% of ovarian masses are considered indeterminate by transvaginal US and 32% of solid lesions considered malignant by transvaginal US are benign. The O-RADs MRI accurately classifies these masses, even when used by inexperienced radiologists, thereby avoiding incorrect surgical approaches. KEY POINTS • O-RADS MRI accurately classifies indeterminate and solid ovarian masses by ultrasound. • There is excellent interobserver agreement between experienced and non-experienced radiologists. • O-RADS MRI is a helpful tool to assess clinical decision-making in ovarian tumours.
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Affiliation(s)
- Lledó Cabedo
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carmen Sebastià
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain.
| | - Meritxell Munmany
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Pere Fusté
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Lydia Gaba
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Adela Rodriguez
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Paño
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carlos Nicolau
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
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Manganaro L, Ciulla S, Celli V, Ercolani G, Ninkova R, Miceli V, Cozzi A, Rizzo SM, Thomassin-Naggara I, Catalano C. Impact of DWI and ADC values in Ovarian-Adnexal Reporting and Data System (O-RADS) MRI score. LA RADIOLOGIA MEDICA 2023; 128:565-577. [PMID: 37097348 PMCID: PMC10181975 DOI: 10.1007/s11547-023-01628-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/27/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Introduce DWI and quantitative ADC evaluation in O-RADS MRI system and observe how diagnostic performance changes. Assess its validity and reproducibility between readers with different experience in female pelvic imaging. Finally, evaluate any correlation between ADC value and histotype in malignant lesions. MATERIALS AND METHODS In total, 173 patients with 213 indeterminate adnexal masses (AMs) on ultrasound were subjected to MRI examination, from which 140 patients with 172 AMs were included in the final analysis. Standardised MRI sequences were used, including DWI and DCE sequences. Two readers, blinded to histopathological data, retrospectively classified AMs according to the O-RADS MRI scoring system. A quantitative analysis method was applied by placing a ROI on the ADC maps obtained from single-exponential DWI sequences. AMs considered benign (O-RADS MRI score 2) were excluded from the ADC analysis. RESULTS Excellent inter-reader agreement was found in the classification of lesions according to the O-RADS MRI score (K = 0.936; 95% CI). Two ROC curves were created to determine the optimal cut-off value for the ADC variable between O-RADS MRI categories 3-4 and 4-5, respectively, 1.411 × 10-3 mm2/sec and 0.849 × 10-3 mm2/sec. Based on these ADC values, 3/45 and 22/62 AMs were upgraded, respectively, to score 4 and 5, while 4/62 AMs were downgraded to score 3. ADC values correlated significantly with the ovarian carcinoma histotype (p value < 0.001). CONCLUSION Our study demonstrates the prognostic potential of DWI and ADC values in the O-RADS MRI classification for better radiological standardisation and characterisation of AMs.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberta Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valentina Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Piazza Malan 2, 20097, San Donato Milanese, Italy
| | - Stefania Maria Rizzo
- Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Via Buffi 13, 6900, Lugano, Switzerland
- Service of Radiology, Imaging Institute of Southern Switzerland, Clinica Di Radiologia EOC, 6900, Lugano, Switzerland
| | - Isabelle Thomassin-Naggara
- Service de Radiologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Rizzo S, Cozzi A, Dolciami M, Del Grande F, Scarano AL, Papadia A, Gui B, Gandolfo N, Catalano C, Manganaro L. O-RADS MRI: A Systematic Review and Meta-Analysis of Diagnostic Performance and Category-wise Malignancy Rates. Radiology 2022; 307:e220795. [PMID: 36413127 DOI: 10.1148/radiol.220795] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background US-indeterminate adnexal lesions remain an important indication for gynecologic surgery. MRI can serve as a problem-solving tool through the use of the Ovarian-Adnexal Imaging Reporting and Data System (O-RADS) MRI lexicon, which is based on the ADNEX MR scoring system. Purpose To perform a systematic review and meta-analysis of the diagnostic performance of pelvic MRI interpreted using the ADNEX or O-RADS MRI stratification systems to characterize US-indeterminate adnexal lesions and of the category-wise malignancy rates. Materials and Methods A systematic literature search from May 2013 (publication of the ADNEX MR score) to September 2022 was performed. Studies reporting the use of pelvic MRI interpreted with the ADNEX or O-RADS MRI systems to characterize US-indeterminate adnexal lesions, with pathologic examination and/or follow-up as the reference standard, were included. Summary estimates of diagnostic performance were obtained with the bivariate random-effects model, while category-wise summary malignancy rates of O-RADS MRI 2, 3, 4, and 5 lesions were obtained with a random-effects model. Effects of covariates on heterogeneity and diagnostic performance were investigated through meta-regression. Results Thirteen study parts from 12 studies (3731 women, 4520 adnexal lesions) met the inclusion criteria. Diagnostic performance meta-analysis for 4012 lesions found a 92% summary sensitivity (95% CI: 88, 95) and a 91% summary specificity (95% CI: 89, 93). The meta-analysis of malignancy rates for 3641 lesions showed summary malignancy rates of 0.1% (95% CI: 0, 1) among O-RADS MRI 2 lesions, 6% (95% CI: 3, 9) among O-RADS MRI 3 lesions, 60% (95% CI: 52, 67) among O-RADS MRI 4 lesions, and 96% (95% CI: 92, 99) among O-RADS MRI 5 lesions. Conclusion Pelvic MRI interpreted with the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI lexicon had high diagnostic performance for the characterization of US-indeterminate adnexal lesions. Summary estimates of malignancy rates in the O-RADS MRI 4 and O-RADS MRI 5 categories were higher than predicted ones. © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Lee and Kang in this issue.
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Affiliation(s)
- Stefania Rizzo
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Andrea Cozzi
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Miriam Dolciami
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Filippo Del Grande
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Angela L Scarano
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Andrea Papadia
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Benedetta Gui
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Nicoletta Gandolfo
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Carlo Catalano
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
| | - Lucia Manganaro
- From the Imaging Institute of Southern Switzerland (S.R., F.D.G., A.L.S.) and Department of Gynecology and Obstetrics (A.P.), Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (S.R., F.D.G., A.P.); Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy (A.C.); Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy (M.D., C.C., L.M.); Department of Bioimaging, Radiation Oncology, and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (B.G.); and Department of Diagnostic Imaging, Ospedale Villa Scassi ASL 3, Genoa, Italy (N.G.)
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