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Zhai D, Wang X, Wang J, Zhang Z, Sheng Y, Jiao R, Liu Y, Liu P. Apparent Diffusion Coefficient on Diffusion-Weighted Magnetic Resonance Imaging to Predict the Prognosis of Patients with Endometrial Cancer: A Meta-Analysis. Reprod Sci 2024; 31:2667-2675. [PMID: 38773026 DOI: 10.1007/s43032-024-01595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
Apparent diffusion coefficient (ADC) derived from diffusion-weighted magnetic resonance imaging (DWI) may help diagnose endometrial cancer (EC). However, the association between ADC and the recurrence and survival of EC remains unknown. We performed a systematic review and meta-analysis to investigate whether pretreatment ADC on DWI could predict the prognosis of women with EC. PubMed, Embase, and Cochrane's Library were searched for relevant cohort studies comparing the clinical outcomes between women with EC having low versus high ADC on pretreatment DWI. Two authors independently conducted data collection, literature searching, and statistical analysis. Using a heterogeneity-incorporating random-effects model, we analyzed the results. In the meta-analysis, 1358 women with EC were included from eight cohort studies and followed for a median duration of 40 months. Pooled results showed that a low pretreatment ADC on DWI was associated with poor disease-free survival (DFS, hazard ratio [HR]: 3.29, 95% CI: 2.04 to 5.31, p < 0.001; I2 = 41%). Subgroup analysis according to study design, tumor stage, MRI Tesla strength, ADC cutoff, follow-up duration, and study quality score showed consistent results (p for subgroup analysis all > 0.05). The predictive value of low ADC for poor DFS in women with EC decreased in multivariate studies compared to univariate studies (HR: 2.59 versus 32.57, p = 0.002). Further studies showed that a low ADC was also associated with poor overall survival (HR: 3.36, 95% CI: 1.33 to 8.50, p = 0.01, I2 = 0). In conclusion, a low ADC on pretreatment DWI examination may predict disease recurrence and survival in women with EC.
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Affiliation(s)
- Deyin Zhai
- Department of Internal Medicine, Laizhou People's Hospital, Laizhou, China
| | - Xiujie Wang
- Imaging Department, Zhaoyuan People's Hospital, Zhaoyuan, China
| | - Junlian Wang
- Department of Nursing, Laizhou People's Hospital, Laizhou, China
| | - Zheng Zhang
- Imaging Department, Laizhou People's Hospital, Laizhou, China
| | - Yangang Sheng
- Ultrasound Department, Laizhou People's Hospital, Laizhou, China
| | - Ruining Jiao
- Ultrasound Department, Laizhou People's Hospital, Laizhou, China
| | - Yihua Liu
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, China.
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Zhifu District, Yantai, China.
| | - Peng Liu
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, China.
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Zhifu District, Yantai, China.
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Ignat RM, Fekete Z, Csutak C, Todor N, Ignat FL, Ignat PD, Badea R. The value of contrast-enhanced ultrasound in cervical cancer assessed in comparison with magnetic resonance imaging. Med Pharm Rep 2024; 97:255-262. [PMID: 39234448 PMCID: PMC11370863 DOI: 10.15386/mpr-2746] [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: 04/01/2024] [Accepted: 05/20/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Currently, magnetic resonance imaging (MRI) is the most commonly used imaging method in the assessment of the loco-regional extension in cervical cancer. Contrast-enhanced ultrasound (abbreviated CEUS) is being investigated as an alternative or complement to the MRI investigation. Objectives To evaluate the performance of CEUS in identifying loco-regional invasion of cervical cancer compared to MRI, considered the accepted reference standard. Methods Sixty-one patients with histopathologically confirmed cervical cancer were investigated as part of the pre-treatment workup by CEUS and MRI. We calculated the accuracy and concordance of CEUS versus MRI for tumor invasion in the vagina, bladder, rectum, parametrium, and uterus. For the time-intensity curve associated parameters analyzed (TTPK, AUC, peak intensity, wash in and wash out gradient) we calculated sensitivity, specificity and threshold value of positivity, for tumor invasion at the above-mentioned sites, with graphical representation of the ROC (receiver operating characteristic) curve. Results CEUS was highly accurate in detecting bladder (93.4%, 95% CI: 87.2-99.6) and uterine invasion (88.5%, 95% CI: 80.5-96.5). Substantial agreement between CEUS and MRI was observed for invasion in the uterine body (k=0.77, 95% CI: 0.56-0.98) and bladder (k=0.56, 95% CI: 0.35-0.77). ROC curve analysis for loco-regional invasions showed that the wash in gradient at a cut-off value of 2.23 had a sensitivity of 76% and a specificity of 67% in predicting uterine invasion. Conclusions Our results demonstrate high accuracy and good agreement between CEUS and MRI regarding especially uterine and bladder invasion. This imaging method could help select patients in early stages for fertility sparing surgery, and also be of use in cases in which early bladder invasion is suspected.
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Affiliation(s)
- Radu-Mihai Ignat
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Zsolt Fekete
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Radiotherapy, ”Prof. Dr. Ion Chiricuţă” Oncology Institute, Cluj-Napoca, Romania
| | - Csaba Csutak
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Todor
- ”Prof. Dr. I. Chiricuţă” Oncology Institute, Cluj-Napoca, Romania
| | - Florin Laurentiu Ignat
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Surgical and Gynecological Oncology, “Prof. Dr. Ion Chiricuţă” Oncological Institute, Cluj-Napoca, Romania
| | - Patricia Delia Ignat
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Radiotherapy, ”Prof. Dr. Ion Chiricuţă” Oncology Institute, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Medical Imaging, ”Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology, Cluj-Napoca, Romania
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Weykamp F, Meixner E, Arians N, Hoegen-Saßmannshausen P, Kim JY, Tawk B, Knoll M, Huber P, König L, Sander A, Mokry T, Meinzer C, Schlemmer HP, Jäkel O, Debus J, Hörner-Rieber J. Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial. J Clin Med 2024; 13:957. [PMID: 38398270 PMCID: PMC10889253 DOI: 10.3390/jcm13040957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/13/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: External beam radiotherapy (EBRT) and concurrent chemotherapy, followed by brachytherapy (BT), offer a standard of care for patients with locally advanced cervical carcinoma. Conventionally, large safety margins are required to compensate for organ movement, potentially increasing toxicity. Lately, daily high-quality cone beam CT (CBCT)-guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Thus, online treatment plans can be adapted to the current position of the tumor and the adjacent organs at risk (OAR), while the patient is lying on the treatment couch. We sought to evaluate the potential of this new technology, including a weekly shuttle-based 3T-MRI scan in various treatment positions for tumor evaluation and for decreasing treatment-related side effects. (2) Methods: This is a prospective one-armed phase-II trial consisting of 40 patients with cervical carcinoma (FIGO IB-IIIC1) with an age ≥ 18 years and a Karnofsky performance score ≥ 70%. EBRT (45-50.4 Gy in 25-28 fractions with 55.0-58.8 Gy simultaneous integrated boosts to lymph node metastases) will be accompanied by weekly shuttle-based MRIs. Concurrent platinum-based chemotherapy will be given, followed by 28 Gy of BT (four fractions). The primary endpoint will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher (CTCAE v5.0). Secondary outcomes include clinical feasibility, quality of life, and imaging-based response assessment.
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Affiliation(s)
- Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Philipp Hoegen-Saßmannshausen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ji-Young Kim
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Bouchra Tawk
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Peter Huber
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany
| | - Theresa Mokry
- Department of Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Clara Meinzer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Yue XN, He XY, Wu JJ, Fan W, Zhang HJ, Wang CW. Endometrioid adenocarcinoma: combined multiparametric MRI and tumour marker HE4 to evaluate tumour grade and lymphovascular space invasion. Clin Radiol 2023; 78:e574-e581. [PMID: 37183140 DOI: 10.1016/j.crad.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/06/2022] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
AIM To assess the value of semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and quantitative diffusion-weighted imaging parameters combined with human epididymis protein 4 (HE4) in predicting the pathological grade and lymphovascular space invasion (LVSI) of endometrioid adenocarcinoma (EAC). MATERIALS AND METHODS Between October 2018 and December 2021, 60 women (mean age, 55 [range, 32-77] years) with EAC underwent preoperative pelvic MRI and HE4 level measurements. The positive enhancement integral (PEI), time to peak, maximum slope of increase (MSI), and maximum slope of decrease were measured by manually drawing a region of interest on the neoplastic tissue. The receiver operating characteristic curve was used to calculate the diagnostic efficiency of the single parameter and combined factors. RESULTS Lower apparent diffusion coefficients (ADCs) were observed in high-grade tumours (G3) than in low-grade tumours (G1/G2). PEI, MSI, and HE4 levels were higher in the high-grade tumours than in the low-grade tumours (p<0.05). The area under the curve (AUC) for G3 diagnosis using multiparametric MRI combined with HE4 was 0.929. ADC values were significantly lower in the EAC with LVSI than in those without LVSI. Tumours with LVSI showed higher PEI and HE4 levels than those without LVSI (p<0.05). The AUC for LVSI-positive diagnosis using multiparametric MRI combined with HE4 was 0.814. CONCLUSION Semi-quantitative DCE-MRI, ADC values, and serum HE4 levels can be used to predict tumour grade and LVSI, and the prediction efficiency of multiparametric MRI combined with serum HE4 is better than that of any single factor.
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Affiliation(s)
- X N Yue
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - X Y He
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - J J Wu
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - W Fan
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - H J Zhang
- Department of Pathology, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - C W Wang
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China.
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MRI-based radiomics for pretreatment prediction of response to concurrent chemoradiotherapy in locally advanced cervical squamous cell cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:367-376. [PMID: 36222869 DOI: 10.1007/s00261-022-03665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate the value of magnetic resonance imaging (MRI)-based radiomics in predicting the treatment response to concurrent chemoradiotherapy (CCRT) in patients with locally advanced cervical squamous cell cancer (LACSC). METHODS In total, 198 patients (training: n = 138; testing: n = 60) with LACSC treated with CCRT between January 2014 and December 2019 were retrospectively enrolled in this study. Responses were evaluated by MRI and clinical data performed at one month after completion of CCRT according to RECIST standards, and patients were divided into the residual group and nonresidual group. Overall, 200 radiomics features were extracted from T2-weighted imaging and apparent diffusion coefficient maps. The radiomics score (Rad-score) was constructed with a feature selection strategy. Logistic regression analysis was used for multivariate analysis of radiomics features and clinical variables. The performance of all models was assessed using receiver operating characteristic curves. RESULTS Among the clinical variables, tumor grade and FIGO stage were independent risk factors, and the areas under the curve (AUCs) of the clinical model were 0.741 and 0.749 in the training and testing groups. The Rad-score, consisting of 4 radiomics features selected from 200 radiomics features, showed good predictive performance with an AUC of 0.819 in the training group and 0.776 in the testing group, which were higher than the clinical model, but the difference was not statistically significant. The combined model constructed with tumor grade, FIGO stage, and Rad-score achieved the best performance, with an AUC of 0.857 in the training group and 0.842 in the testing group, which were significantly higher than the clinical model. CONCLUSION MRI-based radiomics features could be used as a noninvasive biomarker to improve the ability to predict the treatment response to CCRT in patients with LACSC.
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Ciulla S, Celli V, Aiello AA, Gigli S, Ninkova R, Miceli V, Ercolani G, Dolciami M, Ricci P, Palaia I, Catalano C, Manganaro L. Post treatment imaging in patients with local advanced cervical carcinoma. Front Oncol 2022; 12:1003930. [PMID: 36465360 PMCID: PMC9710522 DOI: 10.3389/fonc.2022.1003930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer (CC) is the fourth leading cause of death in women worldwide and despite the introduction of screening programs about 30% of patients presents advanced disease at diagnosis and 30-50% of them relapse in the first 5-years after treatment. According to FIGO staging system 2018, stage IB3-IVA are classified as locally advanced cervical cancer (LACC); its correct therapeutic choice remains still controversial and includes neoadjuvant chemo-radiotherapy, external beam radiotherapy, brachytherapy, hysterectomy or a combination of these modalities. In this review we focus on the most appropriated therapeutic options for LACC and imaging protocols used for its correct follow-up. We explore the imaging findings after radiotherapy and surgery and discuss the role of imaging in evaluating the response rate to treatment, selecting patients for salvage surgery and evaluating recurrence of disease. We also introduce and evaluate the advances of the emerging imaging techniques mainly represented by spectroscopy, PET-MRI, and radiomics which have improved diagnostic accuracy and are approaching to future direction.
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Affiliation(s)
- S Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - A A Aiello
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Gigli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - R Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - G Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - M Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - P Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - I Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
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de Bree E, Michelakis D, Anagnostopoulou E. The current role of secondary cytoreductive surgery for recurrent ovarian cancer. Front Oncol 2022; 12:1029976. [PMID: 36338689 PMCID: PMC9633943 DOI: 10.3389/fonc.2022.1029976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
Ovarian cancer represents worldwide the second most frequent and the most fatal gynecological malignancy, with approximately two thirds of the patients presenting with advanced disease. Cytoreductive surgery, primary or after neoadjuvant chemotherapy, in combination with platinum-based chemotherapy is the standard of care for these patients. Despite the improvement in quality of cytoreductive surgery as well as development of novel drugs and chemotherapy regimens, still most women with ovarian cancer will ultimately develop recurrent disease and die of their disease. In contrast to the management of primary disease, the standard treatment of patients with recurrent ovarian cancer remains a topic of debate. While platinum-based or second line systemic chemotherapy, depending on the time after last platinum treatment, is standard of care, the role of secondary cytoreductive surgery has been a controversial issue for the last decades. Potential outcome benefit must be also weighed against the risk of severe surgical morbidity, impairment of quality of life and costs. In platinum-resistant recurrent disease, i.e., relapse after less than 6 months from the last platinum-based chemotherapy for primary disease, secondary cytoreduction seems generally not to be indicated due to its aggressive biological behavior and the absence of effective systemic treatment. In this comprehensive review, the current role of cytoreductive surgery in platinum-sensitive recurrent ovarian cancer is discussed thoroughly in view of the results of most recent randomized trials and a meta-analysis. There seems to be definitely a role for secondary cytoreductive surgery in selected patients with ovarian cancer recurrence in whom complete resection of macroscopic disease is feasible. However, its role should be continuously reviewed due to the changing systemic treatment of patients with ovarian cancer recurrence over time.
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Usman A, Sultan A, Rehman S, Rehman A. Non-Hodgkin's Vaginal Lymphoma: A Rare Presentation. Cureus 2022; 14:e28364. [PMID: 36168387 PMCID: PMC9508324 DOI: 10.7759/cureus.28364] [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] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Vaginal non-Hodgkin's lymphoma (NHL) is a rare entity. We report a case of a 38-year-old lady who presented with complaints of lower abdominal pain for three to four months and vaginal bleeding for one month. Her examination under general anesthesia revealed a hard vaginal mass which was biopsied and immunohistochemistry was performed. Diagnosis of diffuse B‑cell NHL (DLBCL) was made. Imaging plays an important role to reach the diagnosis. Chemotherapy is the treatment of choice.
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Added-Value of Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced (DCE-MRI) Magnetic Resonance Imaging in the Preoperative Assessment of Cervical Cancer. J Obstet Gynaecol India 2022; 72:330-340. [PMID: 35923516 PMCID: PMC9339443 DOI: 10.1007/s13224-021-01488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the added-value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the preoperative assessment of carcinoma cervix. Methods This prospective study was carried out on histopathologically proven 45 patients of carcinoma cervix presented to a tertiary care hospital with bleeding per vagina between August 2017 and July 2018. Relevant local per vaginal examination and MRI examination of the pelvis were performed. Results A total of 45 patients with carcinoma of the cervix, having 11 patients (24.4%) in Stage-I, 22 patients (48.9%) in Stage-II, 3 patients (6.7%) in Stage-III and 9 patients (20%) in stage-IV, were included in this study sample. The mean ADC value of the carcinoma of cervix was 0.802 ± 0.123 [SD] × 10-3 mm2/s. The stage-I carcinoma cervix had a mean ADC value of 0.915 ± 0.109 [SD] × 10-3 mm2/s, Stage-II 0.778 ± 0.099 [SD] × 10-3 mm2/s, Stage-III 0.762 ± 0.123 [SD] × 10-3 mm2/s and Stage-IV 0.737 ± 0.116 [SD] × 10-3 mm2/s. ROC curve analysis showed the percentage of signal intensity changes within cervical tumor on arterial phase of DCE-MRI had a threshold value of 42.25 in differentiating Stage-I carcinoma of cervix from other stages with a sensitivity of 81.8% and specificity of 44.1%. Conclusion The DWI and DCE-MRI added valuable inputs over conventional MR sequences in the early diagnosis and preoperative staging of carcinoma cervix. DCE-MRI had a high accuracy for assessing the cervical stromal and parametrial invasions, which helps in selecting the optimal therapeutic protocol and prognostication in gynecological malignancies.
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Ye Z, Ning G, Li X, Koh TS, Chen H, Bai W, Qu H. Endometrial carcinoma: use of tracer kinetic modeling of dynamic contrast-enhanced MRI for preoperative risk assessment. Cancer Imaging 2022; 22:14. [PMID: 35264244 PMCID: PMC8908697 DOI: 10.1186/s40644-022-00452-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/24/2022] [Indexed: 01/07/2023] Open
Abstract
Background To compare two tracer kinetic models in predicting of preoperative risk types in endometrial carcinoma (EC) using DCE-MRI. Methods A prospective study of patients with EC was conducted with institutional ethics approval and written informed consent. DCE-MRI data was analyzed using the extended Tofts (ET) and the distributed parameter (DP) models. DCE parameters blood flow (F), mean transit time, blood volume (Vp), extravascular extracellular volume (Ve), permeability surface area product (PS), extraction fraction, transfer constant (Ktrans), and efflux rate (Kep) between high- and low-risk EC were compared using the Mann–Whitney test. Bland–Altman analysis was utilized to compare parameter consistency and Spearman test to assess parameter correlation. Diagnostic performance of DCE parameters was analyzed by receiver-operating characteristic curve and compared with traditional MRI assessment. Results Fifty-one patients comprised the study group. Patients with high-risk EC exhibited significantly lower Ktrans, Kep, F, Vp and PS (P < 0.001). ET-derived Ktrans and DP-derived F attained AUC of 0.92 and 0.91, respectively. Bland–Altman analysis showed that the consistency of Ve or Vp between the two models was low (P < 0.001) while Spearman test showed a strong correlation (r = 0.719, 0.871). Both Ktrans and F showed higher accuracy in predicting EC risk types than traditional MRI assessment. Conclusions Kinetic parameters derived from DCE-MRI revealed a more hypovascular microenvironment for high risk EC than to low- risk ones, providing potential imaging biomarkers in preoperative risk assessment that might improve individualized surgical planning and management of EC.
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Affiliation(s)
- Zhijun Ye
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Gang Ning
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China.
| | - Xuesheng Li
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Tong San Koh
- Department of Oncologic Imaging, National Cancer Center, Singapore, 169610, Singapore
| | - Huizhu Chen
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Wanjing Bai
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Haibo Qu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
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11
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Zhang X, Nakajima T, Mizoi K, Tsushima Y, Ogihara T. Imaging modalities for monitoring acute therapeutic effects after near-infrared photoimmunotherapy in vivo. JOURNAL OF BIOPHOTONICS 2022; 15:e202100266. [PMID: 34783185 DOI: 10.1002/jbio.202100266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
Near-infrared photoimmunotherapy (NIR-PIT) induces immediate cell death after irradiation with near-infrared (NIR) light. Acute therapeutic effects caused by NIR-PIT before the change of tumor size is essential to be monitored by imaging modalities. We summarized and compared the imaging modalities for evaluating acute therapeutic effects after NIR-PIT, and aimed to provide a better understanding of advantages and disadvantages of each modality for evaluation in clinical applications. Fluorescence imaging and fluorescence lifetime, with high resolution, remains high accumulation of fluorescence dyes in the normal organs. High resolution and noninvasiveness are the major advantages of magnetic resonance imaging, while 18 F-fluorodeoxyglucose positron emission tomography provides information about the glucose metabolism. Optical coherence tomography provided more information about the blood vessels. Thus, all of the imaging modalities play an important role in evaluating acute therapeutic effects after NIR-PIT. Clinicians should choose suitable modality according to specific purpose and conditions in clinical application.
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Affiliation(s)
- Xieyi Zhang
- Laboratory of Biopharmaceutics, Department of Pharmacology, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
| | - Takahito Nakajima
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kenta Mizoi
- Laboratory of Biopharmaceutics, Department of Pharmacology, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
| | - Takuo Ogihara
- Laboratory of Biopharmaceutics, Department of Pharmacology, Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
- Laboratory of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
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12
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Albano D, Bruno F, Agostini A, Angileri SA, Benenati M, Bicchierai G, Cellina M, Chianca V, Cozzi D, Danti G, De Muzio F, Di Meglio L, Gentili F, Giacobbe G, Grazzini G, Grazzini I, Guerriero P, Messina C, Micci G, Palumbo P, Rocco MP, Grassi R, Miele V, Barile A. Dynamic contrast-enhanced (DCE) imaging: state of the art and applications in whole-body imaging. Jpn J Radiol 2021; 40:341-366. [PMID: 34951000 DOI: 10.1007/s11604-021-01223-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022]
Abstract
Dynamic contrast-enhanced (DCE) imaging is a non-invasive technique used for the evaluation of tissue vascularity features through imaging series acquisition after contrast medium administration. Over the years, the study technique and protocols have evolved, seeing a growing application of this method across different imaging modalities for the study of almost all body districts. The main and most consolidated current applications concern MRI imaging for the study of tumors, but an increasing number of studies are evaluating the use of this technique also for inflammatory pathologies and functional studies. Furthermore, the recent advent of artificial intelligence techniques is opening up a vast scenario for the analysis of quantitative information deriving from DCE. The purpose of this article is to provide a comprehensive update on the techniques, protocols, and clinical applications - both established and emerging - of DCE in whole-body imaging.
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Affiliation(s)
- Domenico Albano
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Agostini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Clinical, Special and Dental Sciences, Department of Radiology, University Politecnica delle Marche, University Hospital "Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi", Ancona, Italy
| | - Salvatore Alessio Angileri
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Benenati
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Oncologia ed Ematologia, RadioterapiaRome, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Vito Chianca
- Ospedale Evangelico Betania, Naples, Italy
- Clinica Di Radiologia, Istituto Imaging Della Svizzera Italiana - Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giuliana Giacobbe
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Pasquale Guerriero
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Giuseppe Micci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Abruzzo Health Unit 1, Department of diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, L'Aquila, Italy
| | - Maria Paola Rocco
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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13
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Dhamija E, Gulati M, Manchanda S, Singhal S, Sharma D, Kumar S, Bhatla N. Imaging in Carcinoma Cervix and Revised 2018 FIGO Staging System: Implications in Radiology Reporting. Indian J Radiol Imaging 2021; 31:623-634. [PMID: 34790308 PMCID: PMC8590564 DOI: 10.1055/s-0041-1735502] [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] [Indexed: 12/09/2022] Open
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) staging system of carcinoma cervix saw a radical change in 2018 with the inclusion of cross-sectional imaging tools for the assessment of disease extent and staging. One of the major revisions is the inclusion of lymph node status, detected either on imaging or pathological evaluation, in the staging system. The changes were based on long-term patient follow-up and survival rates reported in literature. Thus, it becomes imperative for a radiologist to be well versed with the recent staging system, its limitations, and implications on the patient management.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Malvika Gulati
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dayanand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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14
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Harry VN, Persad S, Bassaw B, Parkin D. Diffusion-weighted MRI to detect early response to chemoradiation in cervical cancer: A systematic review and meta-analysis. Gynecol Oncol Rep 2021; 38:100883. [PMID: 34926764 PMCID: PMC8651768 DOI: 10.1016/j.gore.2021.100883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/26/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Diffusion-weighted magnetic resonance imaging (DWI) has shown promise in predicting response to therapy in several malignancies. This systematic review and meta-analysis aimed to evaluate DWI in the prediction of response to treatment in patients with cervical cancer. METHODS A systematic search was conducted on PubMed, Web of Science, Cochrane and Google Scholar databases Studies that evaluated DWI and apparent diffusion coefficient (ADC) for response evaluation before, during and after treatment with a correlation to conventional response criteria were included. The primary endpoint was the mean ADC values of cervical cancer at these timepoints. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of the studies. RESULTS Nine studies, comprising 270 patients, were included. Pre-treatment ADC values showed no correlation with eventual response. However, in our meta-analysis, there was a significant correlation with early treatment ADC values obtained within the first 3 weeks of therapy and response, as well as a significant correlation with the percentage change in ADC (ΔADC) and response. In addition, the pooled mean ΔADC percentage was also significantly higher in responders than in non-responders (49.7% vs 19.7%, respectively, p = 0.016). CONCLUSION DWI shows potential as a biomarker of early treatment response in patients with cervical carcinoma. Use of the change in ADC particularly within the first 3 weeks of therapy seems to be predictive of response and may serve as a suitable marker in the determination of early response.
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Affiliation(s)
- Vanessa N Harry
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sunil Persad
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Bharat Bassaw
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - David Parkin
- Department of Gynecological Oncology, NHS Grampian, UK
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15
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Stein R, Ganeshan D, Gopireddy DR, Chaudhry A, Kumar S, Bande K, Bhosale P, Lall C. Current update on vaginal malignancies. Abdom Radiol (NY) 2021; 46:5353-5368. [PMID: 34338815 DOI: 10.1007/s00261-021-03228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022]
Abstract
Primary vaginal cancers are rare and account for 1-3% of all gynecologic malignancies. There are several histological subtypes that affect a wide range of the population. Imaging plays an important role in the diagnosis, staging, and treatment planning of vaginal cancers. This article reviews the relevant anatomy, clinical findings, imaging characteristics, and recent advances in the management of vaginal malignancies.
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Affiliation(s)
- Rachel Stein
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA.
| | | | - Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sindhu Kumar
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
| | - Karthik Bande
- Department of Radiology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Priya Bhosale
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
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16
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Friedman SN, Itani M, Dehdashti F. PET Imaging for Gynecologic Malignancies. Radiol Clin North Am 2021; 59:813-833. [PMID: 34392921 DOI: 10.1016/j.rcl.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review article summarizes the clinical applications of established and emerging PET tracers in the evaluation of the 5 most common gynecologic malignancies: endometrial, ovarian, cervical, vaginal, and vulvar cancers. Emphasis is given to 2-deoxy-2-[18F]fluoro-d-glucose as the most widely used and studied tracer, with additional clinical tracers also explored. The common imaging protocols are discussed, including standard dose ranges and uptake times, established roles, as well as the challenges and future directions of these imaging techniques. The key points are emphasized with images from selected cases.
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Affiliation(s)
- Saul N Friedman
- Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Malak Itani
- Section of Abdominal Imaging, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Farrokh Dehdashti
- Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
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17
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Current update on malignant epithelial ovarian tumors. Abdom Radiol (NY) 2021; 46:2264-2280. [PMID: 34089360 DOI: 10.1007/s00261-021-03081-0] [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] [Received: 01/23/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023]
Abstract
Epithelial ovarian cancer (EOC) represents the most frequently occurring gynecological malignancy, accounting for more than 70% of ovarian cancer deaths. Preoperative imaging plays an important role in assessing the extent of disease and guides the next step in surgical decision-making and operative planning. In this article, we will review the multimodality imaging features of various subtypes of EOC. We will also discuss the role of imaging in the staging, management, and surveillance of EOC.
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18
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Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018. Eur Radiol 2021; 31:7802-7816. [PMID: 33852049 DOI: 10.1007/s00330-020-07632-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The recommendations cover indications for MRI examination including acquisition planes, patient preparation, imaging protocol including multi-parametric approaches such as diffusion-weighted imaging (DWI-MR), dynamic contrast-enhanced imaging (DCE-MR) and standardised reporting. The document also underscores the value of whole-body 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) and highlights potential future methods. METHODS In 2019, the ESUR female pelvic imaging working group reviewed the revised 2018 FIGO staging system, the up-to-date clinical management guidelines, and the recent imaging literature. The RAND-UCLA Appropriateness Method (RAM) was followed to develop the current ESUR consensus guidelines following methodological steps: literature research, questionnaire developments, panel selection, survey, data extraction and analysis. RESULTS The updated ESUR guidelines are recommendations based on ≥ 80% consensus among experts. If ≥ 80% agreement was not reached, the action was indicated as optional. CONCLUSIONS The present ESUR guidelines focus on the main role of MRI in the initial staging, response monitoring and evaluation of disease recurrence. Whole-body FDG-PET plays an important role in the detection of lymph nodes (LNs) and distant metastases. KEY POINTS • T2WI and DWI-MR are now recommended for initial staging, monitoring of response and evaluation of recurrence. • DCE-MR is optional; its primary role remains in the research setting. • T2WI, DWI-MRI and whole-body FDG-PET/CT enable comprehensive assessment of treatment response and recurrence.
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Gennigens C, De Cuypere M, Hermesse J, Kridelka F, Jerusalem G. Optimal treatment in locally advanced cervical cancer. Expert Rev Anticancer Ther 2021; 21:657-671. [PMID: 33472018 DOI: 10.1080/14737140.2021.1879646] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Locally advanced cervical cancer (LACC) (International Federation of Gynecology and Obstetrics (FIGO) 2009/2018 - stages IB2-IVA/IB3-IVA, respectively) is treated using a multimodal approach that includes chemoradiotherapy followed by brachytherapy.Areas covered: This review provides an overview of the progress made over the past decade in the treatment of LACC. Prognostic factors, FIGO classification and the role of imaging staging will be discussed. Efficacy of external-beam radiotherapy, brachytherapy and chemotherapy will be detailed. Indications for para-aortic staging lymphadenectomy and adjuvant hysterectomy, as well as follow-up and special population, will be covered.Expert opinion: The initial workup is one of the most crucial steps in the optimal care of patients, which should be realized by a multidisciplinary expert team. With the implementation of modern conformal radiotherapy techniques, the local control rate has been optimized. Nevertheless, 40% of patients experience recurrence with distant metastasis and a dismal prognosis. Currently, a clear benefit of neo- and adjuvant chemotherapy has not been established. The future likely involves (1) improved selection of patients for whom treatment intensification is justified, (2) a combination of new drugs with chemoradiation that are currently being tested in trials, and (3) the development of tailored treatment based on molecular characteristics.
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Affiliation(s)
| | | | | | - Frédéric Kridelka
- Department of Obstetrics and Gynecology, CHU Liège and Liège University, Liège, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, CHU Liège and Liège University, Liège, Belgium
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20
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Conte C, Fagotti A, Avesani G, Trombadori C, Federico A, D'Indinosante M, Giudice MT, Pelligra S, Lodoli C, Marchetti C, Ferrandina G, Scambia G, Gallotta V. Update on the secondary cytoreduction in platinum-sensitive recurrent ovarian cancer: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:510. [PMID: 33850907 PMCID: PMC8039681 DOI: 10.21037/atm-20-4690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The ovarian cancer recurrence occurs in 75% of patients with advanced FIGO stage, and its treatment is a challenge for the oncologist in gynecology. The standard treatment of recurrent ovarian cancer (ROC) usually includes intravenous chemotherapy according to platinum sensitivity. Furthermore, maintenance treatment with target therapies [e.g., anti-angiogenic drug or PARP inhibitors (PARPi)], should be provided if not precedently administrated. In this scenario, secondary cytoreductive surgery (SCS) remains a practical but controversial option for platinum-sensitive ROC (PSROC). So far, several retrospective series and a Cochrane meta-analysis had concluded that SCS could determine better survival outcomes in ROC with favorable prognostic characteristics, such as the presence of a single anatomical site of recurrence, or when patients are accurately selected for surgery based on complete resection’s predictive models. Recently, three randomized clinical trials (RCTs) investigated the role of SCS in PSROC patients selected with different criteria. All the three RCTs showed a significant statistical advantage in progression-free survival (PFS) in the SCS group, with an even more significant difference in patients with complete cytoreduction (about 7-month PFS increased). Data on overall survival (OS) are different in the two completed trials. The GOG213 study has documented a longer OS of PSROC patients who received chemotherapy alone compared to surgery plus chemotherapy. Contrarily, the DESKTOP III trial showed 7.7 months of increased OS in the surgery group vs. chemotherapy alone, with a more difference in the complete tumor cytoreduction (CTC) group (12 months). These RCTs thereby suggest that undergoing complete cytoreduction may not be the only key and that the disease biology may also matter. Few recent retrospective series investigated the role of SCS according to BRCA mutation status and the effect of SCS in patients receiving emerging PARPi. A consequence of the developments in SCS and knowledge of different molecular pathways influencing the recurrent disease is that the future research objective should be to individualize and personalize the surgical approach.
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Affiliation(s)
- Carmine Conte
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Avesani
- Department of Diagnostic Imaging, Radiation Therapy and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Charlotte Trombadori
- Department of Diagnostic Imaging, Radiation Therapy and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alex Federico
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco D'Indinosante
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Pelligra
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Lodoli
- Department of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Marchetti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Gallotta
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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21
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Saleh GA, Alghandour R, Rashad EY, Tawfik AM, Elmokadem AH. The adjunctive value of diffusion weighted imaging in diagnosis and follow up of uterovaginal diffuse B-cell lymphoma: A case report and literature review. Curr Med Imaging 2021; 17:1159-1166. [PMID: 33494680 DOI: 10.2174/1573405617666210120094711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lymphoma of the female gynecologic tract is extremely rare. Typically, lymphoma is managed non surgically unlike other non-lymphomatous malignant tumors raising the importance to differentiate between both entities. CASE REPORT We describe the magnetic resonance imaging (MRI) features of a case of uterovaginal diffuse large B-cell lymphoma in a 50-year-old postmenopausal woman emphasizing Diffusion-Weighted Imaging (DWI) as a diagnostic and follow up tool. We reviewed the literature regarding the diagnostic methods for female genital lymphoma. Forty-five cases including our patient were reviewed with age range from 22 to 85 years. Vaginal bleeding was the most common presentation. The diagnosis was established by Papanicolaou smear, cervical biopsy (25/45), endometrial biopsy (6/45), vaginal biopsy (2/45), pelvic mass biopsy (2/45), iliac LN biopsy (1/45) and surgical diagnosis (8/45). Diffuse large B-cell lymphomas (DLBCL) constitute the vast majority of the cases (82%). The uterine cervix was involved at diagnosis in the majority of these cases (68%) while uterine body (42%) and vagina (28%) were less involved. Pelvic lymphadenopathy was found in 15 cases while extra genital lymphomatous infiltration in 13 cases. Sonographic findings were nonspecific while CT provided excellent data about extra-genital involvement. Thirteen cases underwent pelvic MRI that displayed superior detection of disease extension and parametric involvement. Diffusion restriction was reported only in one case without quantitative analysis of ADC map. CONCLUSION MRI shows unique features that help to differentiate uterovaginal lymphoma from the much more common carcinomas and discriminate post-operative changes from tumor recurrence. It exhibits a marked restricted diffusion pattern with lower ADC values than carcinomas and post-operative changes.
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Affiliation(s)
- Gehad A Saleh
- Diagnostic radiology Department, Mansoura University. Egypt
| | | | | | - Ahmed M Tawfik
- Diagnostic radiology Department, Mansoura University. Egypt
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Arezzo F, La Forgia D, Venerito V, Moschetta M, Tagliafico AS, Lombardi C, Loizzi V, Cicinelli E, Cormio G. A Machine Learning Tool to Predict the Response to Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer. APPLIED SCIENCES 2021; 11:823. [DOI: 10.3390/app11020823] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Despite several studies having identified factors associated with successful treatment outcomes in locally advanced cervical cancer, there is the lack of accurate predictive modeling for progression-free survival (PFS) in patients who undergo radical hysterectomy after neoadjuvant chemotherapy (NACT). Here we investigated whether machine learning (ML) may have the potential to provide a tool to predict neoadjuvant treatment response as PFS. In this retrospective observational study, we analyzed patients with locally advanced cervical cancer (FIGO stages IB2, IB3, IIA1, IIA2, IIB, and IIIC1) who were followed in a tertiary center from 2010 to 2018. Demographic and clinical characteristics were collected at either treatment baseline or at 24-month follow-up. Furthermore, we recorded data about magnetic resonance imaging (MRI) examinations and post-surgery histopathology. Proper feature selection was used to determine an attribute core set. Three different machine learning algorithms, namely Logistic Regression (LR), Random Forest (RFF), and K-nearest neighbors (KNN), were then trained and validated with 10-fold cross-validation to predict 24-month PFS. Our analysis included n. 92 patients. The attribute core set used to train machine learning algorithms included the presence/absence of fornix infiltration at pre-treatment MRI as well as of either parametrium invasion and lymph nodes involvement at post-surgery histopathology. RFF showed the best performance (accuracy 82.4%, precision 83.4%, recall 96.2%, area under receiver operating characteristic curve (AUROC) 0.82). We developed an accurate ML model to predict 24-month PFS.
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Thureau S, Briens A, Decazes P, Castelli J, Barateau A, Garcia R, Thariat J, de Crevoisier R. PET and MRI guided adaptive radiotherapy: Rational, feasibility and benefit. Cancer Radiother 2020; 24:635-644. [PMID: 32859466 DOI: 10.1016/j.canrad.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Adaptive radiotherapy (ART) corresponds to various replanning strategies aiming to correct for anatomical variations occurring during the course of radiotherapy. The goal of the article was to report the rational, feasibility and benefit of using PET and/or MRI to guide this ART strategy in various tumor localizations. The anatomical modifications defined by scanner taking into account tumour mobility and volume variation are not always sufficient to optimise treatment. The contribution of functional imaging by PET or the precision of soft tissue by MRI makes it possible to consider optimized ART. Today, the most important data for both PET and MRI are for lung, head and neck, cervical and prostate cancers. PET and MRI guided ART appears feasible and safe, however in a very limited clinical experience. Phase I/II studies should be therefore performed, before proposing cost-effectiveness comparisons in randomized trials and before using the approach in routine practice.
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Affiliation(s)
- S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, QuantIF EA 4108, université de Rouen, 76000 Rouen, France.
| | - A Briens
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France
| | - P Decazes
- Département de médecine nucléaire, center Henri-Becquerel, QuantIF EA 4108, université de Rouen, Rouen, France
| | - J Castelli
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - A Barateau
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - R Garcia
- Service de physique médicale, institut Sainte-Catherine, 84918 Avignon, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie université, 14000 Caen, France; ARCHADE Research Community, 14000 Caen, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
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Garza A, Elsherif SB, Faria SC, Sagebiel T, Sun J, Ma J, Bhosale PR. Staging MRI of uterine malignant mixed Müllerian tumors versus endometrial carcinomas with emphasis on dynamic enhancement characteristics. Abdom Radiol (NY) 2020; 45:1141-1154. [PMID: 31190089 DOI: 10.1007/s00261-019-02096-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine whether staging pelvic magnetic resonance imaging (MRI) can distinguish malignant mixed Müllerian tumor (MMMT) from EC. METHODS Thirty-seven treatment-naïve patients with histologically proven uterine MMMT and 42 treatment-naïve patients with EC, treated at our institution, were included in our retrospective study. Staging pelvic MRI scans were reviewed for tumor size, prolapse through cervical os, and other features. Time-intensity curves for tumor and surrounding myometrium regions of interest were generated, and positive enhancement integral (PEI), maximum slope of increase (MSI), and signal enhancement ratio (SER) were measured. The Fisher's exact test or Wilcoxon rank-sum test was used to compare characteristics between disease groups. Multivariate and univariate logistic regression models were used to distinguish MMMT from EC. Receiver operating characteristic analysis and the area under the curve (AUC) were used to evaluate prediction ability. RESULTS MMMTs were larger than ECs with higher rate of tumor prolapse and more heterogeneous tumor enhancement compared to ECs. During the late phase of contrast enhancement, 100% of ECs, but only 84% of MMMTs, had lower signal intensity than the myometrium. Threshold PEI ratio ≥ 0.67 predict MMMT with 76% sensitivity, 84%, specificity and 0.83 AUC. Threshold SER ≤ 125 predict MMMT with 90% sensitivity, 50% specificity, and 0.72 AUC. CONCLUSION MMMTs may show more frequent tumor prolapse, more heterogeneous enhancement, delayed iso- or hyper-enhancement, higher PEI ratios, and lower tumor SERs compared with EC. MRI can be used as a biomarker to distinguish MMMT from EC based on the enhancement pattern.
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Affiliation(s)
- Alheli Garza
- Radiology Associates of North Texas, Dallas, TX, USA
| | - Sherif B Elsherif
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA.
| | - Silvana C Faria
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Tara Sagebiel
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Jia Sun
- The Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jingfei Ma
- The Department of Imaging Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Priya R Bhosale
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
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25
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Feng Y, Liu H, Ding Y, Zhang Y, Liao C, Jin Y, Ai C. Combined dynamic DCE-MRI and diffusion-weighted imaging to evaluate the effect of neoadjuvant chemotherapy in cervical cancer. TUMORI JOURNAL 2019; 106:155-164. [PMID: 31736439 DOI: 10.1177/0300891619886656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To prospectively investigate changes in quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in patients with cervical cancer before and after neoadjuvant chemotherapy (NACT). METHODS Thirty-eight patients with cervical cancer underwent DCE-MRI and DWI 1 week before and 4 weeks after NACT. The patients were classified into 2 groups: significant reaction (sCR) group and the non-sCR group. DCE-MRI parameters and ADC values were measured and compared between the 2 groups. RESULTS Before NACT, the mean Ktrans value was higher, but the mean Ve was lower, in the sCR group compared with the non-sCR group; these differences were statistically significant (p<0.05). After NACT, the mean Ktrans value and the delta (i.e., changed) value of Ktrans were significantly lower in the sCR group compared with the non-sCR group (p<0.05). However, the mean ADC and the delta value of the mean ADC between the 2 groups were slightly higher in the sCR group compared with the non-sCR group (p<0.05). The area under the curve of pre-mean Ktrans, DKtrans, and pre-mean Ktrans combined with post-mean ADC values were 0.801, 0.955, and 0.878, respectively (p<0.05). The optimal cutoff values for distinguishing sCR from non-sCR were pretreatment Ktrans (0.7020 min-1) and DKtrans (0.0437 min-1). CONCLUSIONS Quantitative parameters (pre-mean Ktrans, DKtrans, and pre-mean Ktrans) combined with post-mean ADC could predict treatment efficacy more precisely. However, quantitative DCE-MRI combined with DWI could not significantly improve prognostic efficacy.
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Affiliation(s)
- Yusen Feng
- Department of Radiology, Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Kunming Yan'an Hospital, Kunming, China
| | - Hui Liu
- Department of Radiology, Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Kunming Yan'an Hospital, Kunming, China
| | - Yingying Ding
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ya Zhang
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chengde Liao
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yan Jin
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Conghui Ai
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Faria S, Devine C, Rao B, Sagebiel T, Bhosale P. Imaging and Staging of Endometrial Cancer. Semin Ultrasound CT MR 2019; 40:287-294. [DOI: 10.1053/j.sult.2019.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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Haldorsen IS, Lura N, Blaakær J, Fischerova D, Werner HMJ. What Is the Role of Imaging at Primary Diagnostic Work-Up in Uterine Cervical Cancer? Curr Oncol Rep 2019; 21:77. [PMID: 31359169 PMCID: PMC6663927 DOI: 10.1007/s11912-019-0824-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW For uterine cervical cancer, the recently revised International Federation of Gynecology and Obstetrics (FIGO) staging system (2018) incorporates imaging and pathology assessments in its staging. In this review we summarize the reported staging performances of conventional and novel imaging methods and provide an overview of promising novel imaging methods relevant for cervical cancer patient care. RECENT FINDINGS Diagnostic imaging during the primary diagnostic work-up is recommended to better assess tumor extent and metastatic disease and is now reflected in the 2018 FIGO stages 3C1 and 3C2 (positive pelvic and/or paraaortic lymph nodes). For pretreatment local staging, imaging by transvaginal or transrectal ultrasound (TVS, TRS) and/or magnetic resonance imaging (MRI) is instrumental to define pelvic tumor extent, including a more accurate assessment of tumor size, stromal invasion depth, and parametrial invasion. In locally advanced cervical cancer, positron emission tomography-computed tomography (PET-CT) or computed tomography (CT) is recommended, since the identification of metastatic lymph nodes and distant metastases has therapeutic consequences. Furthermore, novel imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for further improving risk stratification and individualization of treatment. Diagnostic imaging by MRI/TVS/TRS and PET-CT/CT is instrumental for pretreatment staging in uterine cervical cancer and guides optimal treatment strategy. Novel imaging techniques may also provide functional biomarkers with potential relevance for developing more targeted treatment strategies in cervical cancer.
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Affiliation(s)
- Ingfrid S Haldorsen
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway.
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
| | - Njål Lura
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway
| | - Jan Blaakær
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | - Daniela Fischerova
- Gynecological Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Henrica M J Werner
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
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28
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Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F, Debus J, Guckenberger M, Hörner-Rieber J, Lagerwaard FJ, Mazzola R, Palacios MA, Philippens MEP, Raaijmakers CPJ, Terhaard CHJ, Valentini V, Niyazi M. MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol 2019; 14:92. [PMID: 31167658 PMCID: PMC6551911 DOI: 10.1186/s13014-019-1308-y] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022] Open
Abstract
Magnetic Resonance-guided radiotherapy (MRgRT) marks the beginning of a new era. MR is a versatile and suitable imaging modality for radiotherapy, as it enables direct visualization of the tumor and the surrounding organs at risk. Moreover, MRgRT provides real-time imaging to characterize and eventually track anatomical motion. Nevertheless, the successful translation of new technologies into clinical practice remains challenging. To date, the initial availability of next-generation hybrid MR-linac (MRL) systems is still limited and therefore, the focus of the present preview was on the initial applicability in current clinical practice and on future perspectives of this new technology for different treatment sites.MRgRT can be considered a groundbreaking new technology that is capable of creating new perspectives towards an individualized, patient-oriented planning and treatment approach, especially due to the ability to use daily online adaptation strategies. Furthermore, MRL systems overcome the limitations of conventional image-guided radiotherapy, especially in soft tissue, where target and organs at risk need accurate definition. Nevertheless, some concerns remain regarding the additional time needed to re-optimize dose distributions online, the reliability of the gating and tracking procedures and the interpretation of functional MR imaging markers and their potential changes during the course of treatment. Due to its continuous technological improvement and rapid clinical large-scale application in several anatomical settings, further studies may confirm the potential disruptive role of MRgRT in the evolving oncological environment.
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Affiliation(s)
- S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - F. Alongi
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - N. Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - C. Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - L. Boldrini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - F. Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - J. Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - J. Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F. J. Lagerwaard
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - R. Mazzola
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - M. A. Palacios
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - M. E. P. Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. P. J. Raaijmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. H. J. Terhaard
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - V. Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - M. Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Shen Y, Lv F, Xiao Z, Bi Q. Utility of the relative apparent diffusion coefficient for preoperative assessment of low risk endometrial carcinoma. Clin Imaging 2019; 56:28-32. [PMID: 30851496 DOI: 10.1016/j.clinimag.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Lymphadenectomy is not recommended for low risk stage I endometrial carcinoma (EC) patients. This study was to investigate the predictive value of apparent diffusion coefficient (ADC) values in predicting patients with low risk EC, and to identify an optimum ADC measurement for preoperative assessment. MATERIALS AND METHODS Eighty-one patients with stage I EC who underwent diffusion-weighted imaging (DWI) at 1.5T were included and divided into low group and intermediate-high risk group based on the ESMO-ESGO-ESTRO classification. Clinical indexes, conventional MRI parameters, minimum ADC values (minADC), mean ADC values (meanADC) and relative ADC values (rADC) were compared between those two groups. rADC was calculated using the equation ADC (cancer)/ADC (reference) with the obturator internus muscle as reference. The optimal ADC measurement and cut-off ADC value for low risk EC were calculated using the receiver operating characteristic (ROC) curve. RESULTS The low risk group had significantly higher meanADC, minADC, and rADC values than did the intermediate-high risk group (1.095 vs. 0.902 × 10-3 mm2/s, 0.755 vs. 0.657 × 10-3 mm2/s, 0.754 vs. 0.603, respectively). In assessments of low risk EC patients, the area under the curve (AUC) values for meanADC, minADC, and rADC were 0.840 (95%CI, 0.749,0.931), 0.681 (95% CI: 0.561,0.800), and 0.876(95% CI: 0.798,0.954), respectively. The optimal cut-off rADC value for prediction was 0.669, the maximum Youden index, sensitivity, specificity, and accuracy values were 0.683, 81.8%, 86.5%, and 84.0%, respectively. CONCLUSIONS rADC is superior to minADC and meanADC for predicting patients with low risk EC, and could potentially aid to the surgical management of these patients in avoiding unnecessary lymphadenectomy.
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Affiliation(s)
- Yiqing Shen
- Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
| | - Fajin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China.
| | - Zhibo Xiao
- Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
| | - Qiu Bi
- Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
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Abstract
Ovarian cancer is one of the most aggressive gynaecologic malignancies in women worldwide. The lack of proper screening programs and the characteristic abdominal spreading with minimal clinical symptoms give rise of its high lethality. Most patients show advanced disease at diagnosis and have a poor prognosis. The surveillance of ovarian cancer patients after initial treatment is a challenging question in clinical practice and there is no consensus in literature about the most appropriate follow-up strategy for these women. The role of Imaging has become increasingly important, allowing to properly monitor patients, distinguishing the different relapse patterns, thus guiding the correct management and therapy. In this review, we report and analyze the scientific evidence about the role of the different imaging modalities now available in the follow-up strategy and management of Epithelial Ovarian Cancer patients with recurrent disease.
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31
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Otero-García MM, Mesa-Álvarez A, Nikolic O, Blanco-Lobato P, Basta-Nikolic M, de Llano-Ortega RM, Paredes-Velázquez L, Nikolic N, Szewczyk-Bieda M. Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers. Insights Imaging 2019; 10:19. [PMID: 30758678 PMCID: PMC6375059 DOI: 10.1186/s13244-019-0696-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis.
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Affiliation(s)
- María Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain.
| | - Alicia Mesa-Álvarez
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Olivera Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Patricia Blanco-Lobato
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Marijana Basta-Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | | | - Laura Paredes-Velázquez
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Nikola Nikolic
- Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Magda Szewczyk-Bieda
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
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Xu X, Li N, Chen Y, Ouyang H, Zhao X, Zhou J. Diagnostic efficacy of MRI for pre-operative assessment of ovarian malignancy in endometrial carcinoma: A decision tree analysis. Magn Reson Imaging 2018; 57:285-292. [PMID: 30580078 DOI: 10.1016/j.mri.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/17/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022]
Abstract
AIM Accurate preoperative assessment of ovarian malignancy in endometrial carcinoma helps in determining the decision to preserve the ovaries in individualized treatment. This study adopted decision tree method to evaluate the diagnostic efficiency of pelvic MRI and clinical data of patients for preoperative identification of endometrial carcinoma-combined ovarian malignancy (EC-OM). MATERIAL AND METHODS This retrospective study included a total of 801 patients, and postoperative pathological examinations identified 58 EC-OM group and 743 endometrial carcinoma cases without ovarian malignancy (EC group). Diagnostic efficiency of pelvic MRI in EC-OM was calculated by comparing the clinical data and imaging features of patients in the two groups. Decision tree analysis was performed to screen out associative indexes and establish a diagnostic model for EC-OM. RESULTS Pelvic MRI showed that, EC-OM group showed deeper invasion into the myometrium, and higher percentages of patients with cervical or cornual involvement, or metastasis of lymph nodes or peritoneum than EC group (P = 0.00). Preoperative pelvic MRI showed a sensitivity of 51.72% and a specificity of 99.87% when detecting ovarian malignancy in endometrial carcinoma. Decision tree model obtained a sensitivity of 89.66%, with an AUC (area under ROC curve) of 0.949 (95% CI 0.906, 0.993, P < 0.001). CONCLUSION Decision tree analysis based on pelvic MRI and clinical data of patients showed that the detection rate of ovarian malignancy could be increased for patients with endometrial carcinoma.
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Affiliation(s)
- Xiaojuan Xu
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yan Chen
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Ouyang
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Imaging, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhou
- Department of Gynecology, The Central Hospital of Karamay, Xinjiang, Uyghur Autonomous Region, China.
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El Beltagi AH, Elsotouhy AH, Own AM, Abdelfattah W, Nair K, Vattoth S. Functional magnetic resonance imaging of head and neck cancer: Performance and potential. Neuroradiol J 2018; 32:36-52. [PMID: 30396315 DOI: 10.1177/1971400918808546] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Functional magnetic resonance imaging (MRI) of tumors of the head and neck usually encompasses diffusion-weighted imaging (DWI) and intravenous (IV) contrast T1 dynamic perfusion imaging (DCE-MRI or PWI). Both techniques can characterize different tissues by probing into their microstructure, providing a novel approach in oncological imaging. In this pictorial review, we will cover the important technical aspects of DWI and PWI, the pathophysiological background and the current applications and potential of these functional MRI techniques in the imaging of head and neck cancer.
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Affiliation(s)
- Ahmed H El Beltagi
- 1 Weill Cornell Medical College, Education City, Ar-Rayyan, Qatar.,2 Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed H Elsotouhy
- 1 Weill Cornell Medical College, Education City, Ar-Rayyan, Qatar.,2 Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed M Own
- 3 Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Kavitha Nair
- 4 Kuwait Cancer Control Center (KCCC), MOH, Kuwait
| | - Surjith Vattoth
- 1 Weill Cornell Medical College, Education City, Ar-Rayyan, Qatar.,2 Neuroradiology Department, Hamad Medical Corporation, Doha, Qatar
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Cree A, Livsey J, Barraclough L, Dubec M, Hambrock T, Van Herk M, Choudhury A, McWilliam A. The Potential Value of MRI in External-Beam Radiotherapy for Cervical Cancer. Clin Oncol (R Coll Radiol) 2018; 30:737-750. [PMID: 30209010 DOI: 10.1016/j.clon.2018.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023]
Abstract
The reference standard treatment for cervical cancer is concurrent chemoradiotherapy followed by magnetic resonance imaging (MRI)-guided brachytherapy. Improvements in brachytherapy have increased local control rates, but late toxicity remains high with rates of 11% grade ≥3. The primary clinical target volume (CTV) for external-beam radiotherapy includes the cervix and uterus, which can show significant inter-fraction motion. This means that generous margins are required to cover the primary CTV, increasing the radiation dose to organs at risk and, therefore, toxicity. A number of image-guided radiotherapy techniques (IGRT) have been developed, but motion can be random and difficult to predict prior to treatment. In light of the development of integrated MRI linear accelerators, this review discusses the potential value of MRI in external-beam radiotherapy. Current solutions for managing pelvic organ motion are reviewed, including the potential for online adaptive radiotherapy. The impacts of the use of MRI in tumour delineation and in the delivery of stereotactic ablative body radiotherapy (SABR) are highlighted. The potential role and challenges of using multi parametric MRI to guide radiotherapy are also discussed.
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Affiliation(s)
- A Cree
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - J Livsey
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - L Barraclough
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - M Dubec
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - T Hambrock
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - M Van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - A Choudhury
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - A McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK.
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The role of dynamic contrast enhanced MR imaging in the assessment of inconclusive ovarian masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Khan SR, Arshad M, Wallitt K, Stewart V, Bharwani N, Barwick TD. What’s New in Imaging for Gynecologic Cancer? Curr Oncol Rep 2017; 19:85. [DOI: 10.1007/s11912-017-0640-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Dappa E, Elger T, Hasenburg A, Düber C, Battista MJ, Hötker AM. The value of advanced MRI techniques in the assessment of cervical cancer: a review. Insights Imaging 2017; 8:471-481. [PMID: 28828723 PMCID: PMC5621992 DOI: 10.1007/s13244-017-0567-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To assess the value of new magnetic resonance imaging (MRI) techniques in cervical cancer. METHODS We searched PubMed and MEDLINE and reviewed articles published from 1990 to 2016 to identify studies that used MRI techniques, such as diffusion weighted imaging (DWI), intravoxel incoherent motion (IVIM) and dynamic contrast enhancement (DCE) MRI, to assess parametric invasion, to detect lymph node metastases, tumour subtype and grading, and to detect and predict tumour recurrence. RESULTS Seventy-nine studies were included. The additional use of DWI improved the accuracy and sensitivity of the evaluation of parametrial extension. Most studies reported improved detection of nodal metastases. Functional MRI techniques have the potential to assess tumour subtypes and tumour grade differentiation, and they showed additional value in detecting and predicting treatment response. Limitations included a lack of technical standardisation, which limits reproducibility. CONCLUSIONS New advanced MRI techniques allow improved analysis of tumour biology and the tumour microenvironment. They can improve TNM staging and show promise for tumour classification and for assessing the risk of tumour recurrence. They may be helpful for developing optimised and personalised therapy for patients with cervical cancer. TEACHING POINTS • Conventional MRI plays a key role in the evaluation of cervical cancer. • DWI improves tumour delineation and detection of nodal metastases in cervical cancer. • Advanced MRI techniques show promise regarding histological grading and subtype differentiation. • Tumour ADC is a potential biomarker for response to treatment.
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Affiliation(s)
- Evelyn Dappa
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Tania Elger
- Department of Gynaecology and Obstetrics, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynaecology and Obstetrics, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Marco J Battista
- Department of Gynaecology and Obstetrics, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andreas M Hötker
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany
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Ohliger MA, Hope TA, Chapman JS, Chen LM, Behr SC, Poder L. PET/MR Imaging in Gynecologic Oncology. Magn Reson Imaging Clin N Am 2017; 25:667-684. [DOI: 10.1016/j.mric.2017.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Eitan R, Peled Y, Sabah G, Krissi H, Haroush AB, Meizner I, Danon D, Bardin R, Jakobson-Setton A, Salzer L, Mashiach R. Diagnosis of deep pelvic masses on a gynaecology service: Trans-vaginal ultrasound-guided needle aspiration of pelvic solid and cystic lesions. Aust N Z J Obstet Gynaecol 2017; 57:197-200. [DOI: 10.1111/ajo.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/28/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Ram Eitan
- Gynaecologic Oncology Division; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yoav Peled
- Gynaecologic Oncology Division; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gad Sabah
- Gynaecologic Oncology Division; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Haim Krissi
- Gynaecologic Oncology Division; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Avi Ben Haroush
- Gynaecologic Oncology Division; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Israel Meizner
- Ultrasound Unit; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - David Danon
- Ultrasound Unit; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ron Bardin
- Ultrasound Unit; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ariella Jakobson-Setton
- Gynaecologic Oncology Division; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Liat Salzer
- Gynaecologic Oncology Division; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Reuven Mashiach
- Ultrasound Unit; Beilinson Campus; Rabin Medical Center; Petah Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Abstract
This article summarizes recent advances in PET/MR imaging in gynecologic cancers and the emerging clinical value of PET/MR imaging in the management of the 3 most common gynecologic malignancies: cervical, endometrial, and ovarian cancers. PET/MR imaging offers superior soft tissue contrast, improved assessment of primary tumor involvement because of high-resolution multiplanar reformats, and functional MR techniques such as diffusion-weighted MR imaging and dynamic contrast-enhanced MR imaging. This article discusses the challenges, future directions, and technical advances of PET/MR imaging, and the emerging new multimodality, multiparametric imaging techniques for integrating morphologic, functional, and molecular imaging data.
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Park SB. Functional MR imaging in gynecologic malignancies: current status and future perspectives. Abdom Radiol (NY) 2016; 41:2509-2523. [PMID: 27743019 DOI: 10.1007/s00261-016-0924-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Using functional MR imaging techniques, we can approach the functional assessment of gynecologic malignancies. Among them, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MR imaging (DCE-MRI) are two important techniques. This article provides an overview of functional MR imaging techniques, focusing DWI and DCE-MRI on clinical application in gynecologic malignancies. Functional MR imaging techniques play an important role in detection, characterization, staging, treatment response, and outcome prediction, as well as providing conventional morphologic imaging. Familiarity with the characteristics and imaging features of functional MR imaging in gynecologic malignancies will facilitate prompt and accurate diagnosis and treatment.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea.
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Mahajan A, Sable NP, Popat PB, Bhargava P, Gangadhar K, Thakur MH, Arya S. Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management. Semin Ultrasound CT MR 2016; 38:231-268. [PMID: 28705370 DOI: 10.1053/j.sult.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Nilesh P Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Palak B Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
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Low RN. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. J Gastrointest Oncol 2016; 7:58-71. [PMID: 26941984 DOI: 10.3978/j.issn.2078-6891.2015.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
MR imaging provides considerable advantages for imaging patients with peritoneal tumor. Its inherently superior contrast resolution compared to CT allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms including diffusion-weighted (DW) MRI and gadolinium-enhanced MRI provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC).
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Affiliation(s)
- Russell N Low
- Department of Radiology and Sharp and Children's MRI Center, Sharp Memorial Hospital, San Diego, CA 92123, USA
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Three-Dimensional Power Doppler Ultrasound for Predicting Response and Local Recurrence After Concomitant Chemoradiation Therapy for Locally Advanced Carcinoma of the Cervix. Int J Gynecol Cancer 2016; 26:534-8. [PMID: 26745701 DOI: 10.1097/igc.0000000000000641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the potential role of 3-dimensional power Doppler ultrasound (3D-PDUS) for predicting clinical response and recurrence after chemoradiotherapy in advanced-stage cervical cancer. METHODS This is a prospective study comprising a series of women with histological proven diagnosis of locally advanced stage (stage IB2-IVA) carcinoma of the cervix and submitted to chemoradiaton therapy. Before the start of chemoradiation therapy, all women were submitted to undergo transvaginal 3D-PDUS for assessing tumor volume and tumor vascularization. After finishing chemoradiation, all women were evaluated to assess clinical response. Complete clinical response was determined when no residual tumor was apparent. Partial clinical response (PCR) was determined when persistent residual tumor was observed and confirmed by histological analysis. Patients with PCR underwent salvage surgery. Local recurrence was defined as reappearance of the tumor within the pelvis at any time during follow-up. RESULTS Thirty-nine women (mean age, 50.3 years; ranging from 30 to 81 years) were included in the study. Complete clinical response was achieved in 29 women (70.7%), whereas 10 women (24.4%) had PCR. Eight women (20.5%) had local recurrence during follow-up. We did not find statistical significant differences in tumor size, volume, and vascularization between those women who had complete clinical response and those who had PCR and between those who had local recurrence and those who had not. CONCLUSIONS A single 3D-PDUS assessment of tumor size and vascularization before treatment seems to be of limited value for predicting tumor response to chemoradiation therapy and for predicting tumor recurrence in women with locally advanced carcinoma of the cervix.
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Das S, Chandramohan A, Rami Reddy JK, Mukhopadhyay S, Kumar RM, Isiah R, John S, Oommen R, Jeyaseelan V. Role of conventional and diffusion weighted MRI in predicting treatment response after low dose radiation and chemotherapy in locally advanced carcinoma cervix. Radiother Oncol 2015; 117:288-93. [DOI: 10.1016/j.radonc.2015.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/26/2015] [Accepted: 10/03/2015] [Indexed: 11/28/2022]
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