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Patel-Lippmann KK, Wasnik AP, Akin EA, Andreotti RF, Ascher SM, Brook OR, Eskander RN, Feldman MK, Jones LP, Martino MA, Patel MD, Patlas MN, Revzin MA, VanBuren W, Yashar CM, Kang SK. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms: 2023 Update. J Am Coll Radiol 2024; 21:S79-S99. [PMID: 38823957 DOI: 10.1016/j.jacr.2024.02.017] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Asymptomatic adnexal masses are commonly encountered in daily radiology practice. Although the vast majority of these masses are benign, a small subset have a risk of malignancy, which require gynecologic oncology referral for best treatment outcomes. Ultrasound, using a combination of both transabdominal, transvaginal, and duplex Doppler technique can accurately characterize the majority of these lesions. MRI with and without contrast is a useful complementary modality that can help characterize indeterminate lesions and assess the risk of malignancy is those that are suspicious. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Susan M Ascher
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ramez N Eskander
- University of California, San Diego, San Diego, California; American College of Obstetricians and Gynecologists
| | | | - Lisa P Jones
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin A Martino
- Ascension St. Vincent's, Jacksonville, Florida; University of South Florida, Tampa, Florida, Gynecologic oncologist
| | | | - Michael N Patlas
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margarita A Revzin
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | | | - Catheryn M Yashar
- University of California, San Diego, San Diego, California; Commission on Radiation Oncology
| | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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2
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Cabedo L, Sebastià C, Munmany M, Fusté P, Gaba L, Saco A, Rodriguez A, Paño B, Nicolau C. O-RADS MRI scoring system: key points for correct application in inexperienced hands. Insights Imaging 2024; 15:107. [PMID: 38609573 PMCID: PMC11014836 DOI: 10.1186/s13244-024-01670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To evaluate the efficacy of the O-RADS MRI criteria in the stratification of risk of malignancy of solid or sonographically indeterminate ovarian masses and assess the interobserver agreement of this classification between experienced and inexperienced radiologists. METHODS This single-centre retrospective study included patients from 2019 to 2022 with sonographically indeterminate or solid ovarian masses who underwent MRI with a specific protocol for characterisation according to O-RADS MRI specifications. Each study was evaluated using O-RADS lexicon by two radiologists, one with 17 years of experience in gynaecological radiology and another with 4 years of experience in general radiology. Findings were classified as benign, borderline, or malignant according to histology or stability over time. Diagnostic performance and interobserver agreement were assessed. RESULTS A total of 183 patients with US indeterminate or solid adnexal masses were included. Fifty-seven (31%) did not have ovarian masses, classified as O-RADS 1. The diagnostic performance for scores 2-5 was excellent with a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 96.2%, and 100%, respectively by the experienced radiologist and 96.1%, 92.0%, 93.9%, and 94.8% by the inexperienced radiologist. Interobserver concordance was very high (Kappa index 0.92). Almost all the misclassified cases were due to misinterpretation of the classification similar to reports in the literature. CONCLUSION The diagnostic performance of O-RADS MRI determined by either experienced or inexperienced radiologists is excellent, facilitating decision-making with high diagnostic accuracy and high reproducibility. Knowledge of this classification and use of assessment tools could avoid frequent errors due to misinterpretation. CRITICAL RELEVANCE STATEMENT Up to 31% of ovarian masses are considered indeterminate by transvaginal US and 32% of solid lesions considered malignant by transvaginal US are benign. The O-RADs MRI accurately classifies these masses, even when used by inexperienced radiologists, thereby avoiding incorrect surgical approaches. KEY POINTS • O-RADS MRI accurately classifies indeterminate and solid ovarian masses by ultrasound. • There is excellent interobserver agreement between experienced and non-experienced radiologists. • O-RADS MRI is a helpful tool to assess clinical decision-making in ovarian tumours.
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Affiliation(s)
- Lledó Cabedo
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carmen Sebastià
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain.
| | - Meritxell Munmany
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Pere Fusté
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Lydia Gaba
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Adela Rodriguez
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Paño
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carlos Nicolau
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
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Roseland ME, Maturen KE, Shampain KL, Wasnik AP, Stein EB. Adnexal Mass Imaging: Contemporary Guidelines for Clinical Practice. Radiol Clin North Am 2023; 61:671-685. [PMID: 37169431 DOI: 10.1016/j.rcl.2023.02.002] [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: 05/13/2023]
Abstract
Several recent guidelines have been published to improve accuracy and consistency of adnexal mass imaging interpretation and to guide management. Guidance from the American College of Radiology (ACR) Appropriateness Criteria establishes preferred adnexal imaging modalities and follow-up. Moreover, the ACR Ovarian-Adnexal Reporting Data System establishes a comprehensive, unified set of evidence-based guidelines for classification of adnexal masses by both ultrasound and MR imaging, communicating risk of malignancy to further guide management.
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Affiliation(s)
- Molly E Roseland
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Katherine E Maturen
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Kimberly L Shampain
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Ashish P Wasnik
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Erica B Stein
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
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Guarino M, La Bella S, Santoro M, Caposiena D, Di Lembo E, Chiarelli F, Iannetti G. The Leading Role of Brain and Abdominal Radiological Features in the Work-Up of Anti-NMDAR Encephalitis in Children: An Up-To-Date Review. Brain Sci 2023; 13:brainsci13040662. [PMID: 37190627 DOI: 10.3390/brainsci13040662] [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: 04/02/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (NMDARe) is the most common cause of nonviral encephalitis, mostly affecting young women and adolescents with a strong female predominance (F/M ratio of around 4:1). NMDARe is characterized by the presence of cerebrospinal fluid (CSF) antibodies against NMDARs, even though its pathophysiological mechanisms have not totally been clarified. The clinical phenotype of NMDARe is composed of both severe neurological and neuropsychiatric symptoms, including generalized seizures with desaturations, behavioral abnormalities, and movement disorders. NMDARe is often a paraneoplastic illness, mainly due to the common presence of concomitant ovarian teratomas in young women. Abdominal ultrasonography (US) is a key imaging technique that should always be performed in suspected patients. The timely use of abdominal US and the peculiar radiological features observed in NMDARe may allow for a quick diagnosis and a good prognosis, with rapid improvement after the resection of the tumor and the correct drug therapy.
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Affiliation(s)
- Miriana Guarino
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Saverio La Bella
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Marco Santoro
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Daniele Caposiena
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Enza Di Lembo
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Giovanni Iannetti
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
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Performance of IOTA Simple Rules Risks, ADNEX Model, Subjective Assessment Compared to CA125 and HE4 with ROMA Algorithm in Discriminating between Benign, Borderline and Stage I Malignant Adnexal Lesions. Diagnostics (Basel) 2023; 13:diagnostics13050885. [PMID: 36900029 PMCID: PMC10000903 DOI: 10.3390/diagnostics13050885] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Borderline ovarian tumors (BOTs) and early clinical stage malignant adnexal masses can make sonographic diagnosis challenging, while the clinical utility of tumor markers, e.g., CA125 and HE4, or the ROMA algorithm, remains controversial in such cases. OBJECTIVE To compare the IOTA group Simple Rules Risk (SRR), the ADNEX model and the subjective assessment (SA) with serum CA125, HE4 and the ROMA algorithm in the preoperative discrimination between benign tumors, BOTs and stage I malignant ovarian lesions (MOLs). METHODS A multicenter retrospective study was conducted with lesions classified prospectively using subjective assessment and tumor markers with the ROMA. The SRR assessment and ADNEX risk estimation were applied retrospectively. The sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) were calculated for all tests. RESULTS In total, 108 patients (the median age: 48 yrs, 44 postmenopausal) with 62 (79.6%) benign masses, 26 (24.1%) BOTs and 20 (18.5%) stage I MOLs were included. When comparing benign masses with combined BOTs and stage I MOLs, SA correctly identified 76% of benign masses, 69% of BOTs and 80% of stage I MOLs. Significant differences were found for the presence and size of the largest solid component (p = 0.0006), the number of papillary projections (p = 0.01), papillation contour (p = 0.008) and IOTA color score (p = 0.0009). The SRR and ADNEX models were characterized by the highest sensitivity (80% and 70%, respectively), whereas the highest specificity was found for SA (94%). The corresponding likelihood ratios were as follows: LR+ = 3.59 and LR- = 0.43 for the ADNEX; LR+ = 6.40 and LR- = 0.63 for SA and LR+ = 1.85 with LR- = 0.35 for the SRR. The sensitivity and specificity of the ROMA test were 50% and 85%, respectively, with LR+ = 3.44 and LR- = 0.58. Of all the tests, the ADNEX model had the highest diagnostic accuracy of 76%. CONCLUSIONS This study demonstrates the limited value of diagnostics based on CA125 and HE4 serum tumor markers and the ROMA algorithm as independent modalities for the detection of BOTs and early stage adnexal malignant tumors in women. SA and IOTA methods based on ultrasound examination may present superior value over tumor marker assessment.
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Melamud K, Hindman N, Sadowski E. Ovarian-Adnexal Reporting and Data Systems MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:79-91. [DOI: 10.1016/j.mric.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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O-RADS MRI After Initial Ultrasound for Adnexal Lesions: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 220:6-15. [PMID: 35975887 DOI: 10.2214/ajr.22.28084] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) and MRI risk stratification systems were developed by an international group of experts in adnexal imaging to aid radiologists in assessing adnexal lesions. The goal of imaging is to appropriately triage patients with adnexal lesions. US is the first-line imaging modality for assessment, whereas MRI can be used as a problem-solving tool. Both US and MRI can accurately characterize benign lesions such as simple cysts, endometriomas, hemorrhagic cysts, and dermoid cysts, avoiding unnecessary or inappropriate surgery. In patients with a lesion that does not meet criteria for one of these benign diagnoses, MRI can further characterize the lesion with an improved specificity for cancer and the ability to provide a probable histologic subtype in the presence of certain MRI features. This allows personalized treatment, including avoiding overly extensive surgery or allowing fertility-sparing procedures for suspected benign, borderline, or low-grade tumors. When MRI findings indicate a risk of an invasive cancer, patients can be expeditiously referred to a gynecologic oncologic surgeon. This narrative review provides expert opinion on the utility of multiparametric MRI when using the O-RADS US and MRI management systems.
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Arezzo F, Cormio G, La Forgia D, Santarsiero CM, Mongelli M, Lombardi C, Cazzato G, Cicinelli E, Loizzi V. A machine learning approach applied to gynecological ultrasound to predict progression-free survival in ovarian cancer patients. Arch Gynecol Obstet 2022; 306:2143-2154. [PMID: 35532797 PMCID: PMC9633520 DOI: 10.1007/s00404-022-06578-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
In a growing number of social and clinical scenarios, machine learning (ML) is emerging as a promising tool for implementing complex multi-parametric decision-making algorithms. Regarding ovarian cancer (OC), despite the standardization of features that can support the discrimination of ovarian masses into benign and malignant, there is a lack of accurate predictive modeling based on ultrasound (US) examination for progression-free survival (PFS). This retrospective observational study analyzed patients with epithelial ovarian cancer (EOC) who were followed in a tertiary center from 2018 to 2019. Demographic features, clinical characteristics, information about the surgery and post-surgery histopathology were collected. Additionally, we recorded data about US examinations according to the International Ovarian Tumor Analysis (IOTA) classification. Our study aimed to realize a tool to predict 12 month PFS in patients with OC based on a ML algorithm applied to gynecological ultrasound assessment. 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 five-fold cross-validation to predict 12 month PFS. Our analysis included n. 64 patients and 12 month PFS was achieved by 46/64 patients (71.9%). The attribute core set used to train machine learning algorithms included age, menopause, CA-125 value, histotype, FIGO stage and US characteristics, such as major lesion diameter, side, echogenicity, color score, major solid component diameter, presence of carcinosis. RFF showed the best performance (accuracy 93.7%, precision 90%, recall 90%, area under receiver operating characteristic curve (AUROC) 0.92). We developed an accurate ML model to predict 12 month PFS.
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Affiliation(s)
- Francesca Arezzo
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gennaro Cormio
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Daniele La Forgia
- Department of Breast Radiology, Giovanni Paolo II I.R.C.C.S. Cancer Institute, via Orazio Flacco 65, 70124 Bari, Italy
| | - Carla Mariaflavia Santarsiero
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michele Mongelli
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Claudio Lombardi
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Vera Loizzi
- Interdisciplinar Department of Medicine, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Leng X, Kou S, Lin Y, Hagemann AR, Hagemann IS, Thaker PH, Kuroki LM, McCourt CK, Mutch DG, Siegel C, Powell MA, Zhu Q. Quantification of ovarian lesion and fallopian tube vasculature using optical-resolution photoacoustic microscopy. Sci Rep 2022; 12:15850. [PMID: 36151126 PMCID: PMC9508221 DOI: 10.1038/s41598-022-19778-1] [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] [Received: 06/29/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
The heterogeneity in the pathological and clinical manifestations of ovarian cancer is a major hurdle impeding early and accurate diagnosis. A host of imaging modalities, including Doppler ultrasound, MRI, and CT, have been investigated to improve the assessment of ovarian lesions. We hypothesized that pathologic conditions might affect the ovarian vasculature and that these changes might be detectable by optical-resolution photoacoustic microscopy (OR-PAM). In our previous work, we developed a benchtop OR-PAM and demonstrated it on a limited set of ovarian and fallopian tube specimens. In this study, we collected data from over 50 patients, supporting a more robust statistical analysis. We then developed an efficient custom analysis pipeline for characterizing the vascular features of the samples, including the mean vessel diameter, vascular density, global vascular directionality, local vascular definition, and local vascular tortuosity/branchedness. Phantom studies using carbon fibers showed that our algorithm was accurate within an acceptable error range. Between normal ovaries and normal fallopian tubes, we observed significant differences in five of six extracted vascular features. Further, we showed that distinct subsets of vascular features could distinguish normal ovaries from cystic, fibrous, and malignant ovarian lesions. In addition, a statistically significant difference was found in the mean vascular tortuosity/branchedness values of normal and abnormal tubes. The findings support the proposition that OR-PAM can help distinguish the severity of tubal and ovarian pathologies.
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Affiliation(s)
- Xiandong Leng
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Sitai Kou
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Yixiao Lin
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Andrea R Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ian S Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Premal H Thaker
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Lindsay M Kuroki
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Carolyn K McCourt
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Cary Siegel
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matthew A Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Quing Zhu
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA. .,Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Antil N, Raghu PR, Shen L, Tiyarattanachai T, Chang EM, Ferguson CWK, Ho AA, Lutz AM, Mariano AJ, Morimoto LN, Kamaya A. Interobserver agreement between eight observers using IOTA simple rules and O-RADS lexicon descriptors for adnexal masses. Abdom Radiol (NY) 2022; 47:3318-3326. [PMID: 35763052 PMCID: PMC9388428 DOI: 10.1007/s00261-022-03580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate interobserver agreement in assigning imaging features and classifying adnexal masses using the IOTA simple rules versus O-RADS lexicon and identify causes of discrepancy. METHODS Pelvic ultrasound (US) examinations in 114 women with 118 adnexal masses were evaluated by eight radiologists blinded to the final diagnosis (4 attendings and 4 fellows) using IOTA simple rules and O-RADS lexicon. Each feature category was analyzed for interobserver agreement using intraclass correlation coefficient (ICC) for ordinal variables and free marginal kappa for nominal variables. The two-tailed significance level (a) was set at 0.05. RESULTS For IOTA simple rules, interobserver agreement was almost perfect for three malignant lesion categories (M2-4) and substantial for the remaining two (M1, M5) with k-values of 0.80-0.82 and 0.68-0.69, respectively. Interobserver agreement was almost perfect for two benign feature categories (B2, B3), substantial for two (B4, B5) and moderate for one (B1) with k-values of 0.81-0.90, 0.69-0.70 and 0.60, respectively. For O-RADS, interobserver agreement was almost perfect for two out of ten feature categories (ascites and peritoneal nodules) with k-values of 0.89 and 0.97. Interobserver agreement ranged from fair to substantial for the remaining eight feature categories with k-values of 0.39-0.61. Fellows and attendings had ICC values of 0.725 and 0.517, respectively. CONCLUSION O-RADS had variable interobserver agreement with overall good agreement. IOTA simple rules had more uniform interobserver agreement with overall excellent agreement. Greater reader experience did not improve interobserver agreement with O-RADS.
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Affiliation(s)
- Neha Antil
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Preethi R Raghu
- Department of Radiology, University of CA - San Francisco, San Francisco, CA, USA.
| | - Luyao Shen
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | | | - Edwina M Chang
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Craig W K Ferguson
- Department of Radiology, University of Alberta Hostpial, Edmonton, Alberta, Canada
| | - Amanzo A Ho
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Amelie M Lutz
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Aladin J Mariano
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - L Nayeli Morimoto
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Aya Kamaya
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
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Bullock B, Larkin L, Turker L, Stampler K. Management of the Adnexal Mass: Considerations for the Family Medicine Physician. Front Med (Lausanne) 2022; 9:913549. [PMID: 35865172 PMCID: PMC9294310 DOI: 10.3389/fmed.2022.913549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 01/27/2023] Open
Abstract
Ovarian cancer is the most deadly gynecological cancer, so proper assessment of a pelvic mass is necessary in order to determine which are at high risk for malignancy and should be referred to a gynecologic oncologist. However, in a family medicine setting, evaluation and treatment of these masses can be challenging due to a lack of resources. A number of risk assessment tools are available to family medicine physicians, including imaging techniques, imaging systems, and blood-based biomarker assays each with their respective pros and cons, and varying ability to detect malignancy in pelvic masses. Effective utilization of these assessment tools can inform the care pathway for patients which present with an adnexal mass, such as expectant management for those with a low risk of malignancy, or referral to a gynecologic oncologist for surgery and staging, for those at high risk of malignancy. Triaging patients to the appropriate care pathway improves patient outcomes and satisfaction, and family medicine physicians can play a key role in this decision-making process.
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Affiliation(s)
| | - Lisa Larkin
- Lisa Larkin, MD, and Associates, Cincinnati, OH, United States
- Ms. Medicine Healthcare Organization, Cincinnati, OH, United States
- Cincinnati Sexual Health Consortium, Cincinnati, OH, United States
| | | | - Kate Stampler
- Einstein Healthcare Network, Philadelphia, PA, United States
- *Correspondence: Kate Stampler,
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Jha P, Gupta A, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski EA. Diagnostic Performance of the Ovarian-Adnexal Reporting and Data System (O-RADS) Ultrasound Risk Score in Women in the United States. JAMA Netw Open 2022; 5:e2216370. [PMID: 35679042 PMCID: PMC9185186 DOI: 10.1001/jamanetworkopen.2022.16370] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) risk scoring system has been studied in a selected population of women referred for suspected or known adnexal lesions. This population has a higher frequency of malignant neoplasms than women presenting to radiology departments for pelvic ultrasonography for a variety of indications, potentially impacting the diagnostic performance of the risk scoring system. OBJECTIVE To evaluate the risk of malignant neoplasm and diagnostic performance of O-RADS US risk scoring system in a multi-institutional, nonselected cohort. DESIGN, SETTING, AND PARTICIPANTS This multi-institutional cohort study included a population of nonselected women in the United States who presented to radiology departments for routine pelvic ultrasonography between 2011 and 2014, with pathology confirmation imaging follow up or 2 years of clinical follow up. EXPOSURE Analysis of 1014 adnexal lesions using the O-RADS US risk stratification system. MAIN OUTCOMES AND MEASURES Frequency of ovarian cancer and diagnostic performance of the O-RADS US risk stratification system. RESULTS This study included 913 women with 1014 adnexal lesions. The mean (SD) age of the patients was 42.4 (13.9 years), and 674 of 913 (73.8%) were premenopausal. The overall frequency of malignant neoplasm was 8.4% (85 of 1014 adnexal lesions). The frequency of malignant neoplasm for O-RADS US 2 was 0.5% (3 of 657 lesions; <1% expected); O-RADS US 3, 4.5% (5 of 112 lesions; <10% expected); O-RADS US 4, 11.6% (18 of 155; 10%-50% expected); and O-RADS 5, 65.6% (59 of 90 lesions; >50% expected). O-RADS US 4 was the optimum cutoff for diagnosing cancer with sensitivity of 90.6% (95% CI, 82.3%-95.9%), specificity of 81.9% (95% CI, 79.3%-84.3%), positive predictive value of 31.4% (95% CI, 25.7%-37.7%) and negative predictive value of 99.0% (95% CI, 98.0%-99.6%). CONCLUSIONS AND RELEVANCE In this cohort study of a nonselected patient population, the O-RADS US risk stratification system performed within the expected range as published by the ACR O-RADS US committee. The frequency of malignant neoplasm was at the lower end of the published range, partially because of the lower prevalence of cancer in a nonselected population. However, a high negative predictive value was maintained, and when a lesion can be classified as an O-RADS US 2, the risk of cancer is low, which is reassuring for both clinician and patient.
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Affiliation(s)
- Priyanka Jha
- University of California, San Francisco, San Francisco
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- Stanford University, Stanford, California
| | - Neha Antil
- Stanford University, Stanford, California
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Gupta A, Jha P, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski E. Ovarian Cancer Detection in Average-Risk Women: Classic- versus Nonclassic-appearing Adnexal Lesions at US. Radiology 2022; 303:603-610. [PMID: 35315722 DOI: 10.1148/radiol.212338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Several US risk stratification schemas for assessing adnexal lesions exist. These multiple-subcategory systems may be more multifaceted than necessary for isolated adnexal lesions in average-risk women. Purpose To explore whether a US-based classification scheme of classic versus nonclassic appearance can be used to help appropriately triage women at average risk of ovarian cancer without compromising diagnostic performance. Materials and Methods This retrospective multicenter study included isolated ovarian lesions identified at pelvic US performed between January 2011 and June 2014, reviewed between September 2019 and September 2020. Lesions were considered isolated in the absence of ascites or peritoneal implants. Lesions were classified as classic or nonclassic based on sonographic appearance. Classic lesions included simple cysts, hemorrhagic cysts, endometriomas, and dermoids. Otherwise, lesions were considered nonclassic. Outcomes based on histopathologic results or clinical or imaging follow-up were recorded. Diagnostic performance and frequency of malignancy were calculated. Frequency of malignancy between age groups was compared using the χ2 test, and Poisson regression was used to explore relationships between imaging features and malignancy. Results A total of 970 isolated lesions in 878 women (mean age, 42 years ± 14 [SD]) were included. The malignancy rate for classic lesions was less than 1%. Of 970 lesions, 53 (6%) were malignant. The malignancy rate for nonclassic lesions was 32% (33 of 103) when blood flow was present and 8% (16 of 194) without blood flow (P < .001). For women older than 60 years, the malignancy rate was 50% (10 of 20 lesions) when blood flow was present and 13% (five of 38) without blood flow (P = .004). The sensitivity, specificity, positive predictive value, and negative predictive value of the classic-versus-nonclassic schema was 93% (49 of 53 lesions), 73% (669 of 917 lesions), 17% (49 of 297 lesions), and 99% (669 of 673 lesions), respectively, for detection of malignancy. Conclusion Using a US classification schema of classic- or nonclassic-appearing adnexal lesions resulted in high sensitivity and specificity in the diagnosis of malignancy in ovarian cancer. The highest risk of cancer was in isolated nonclassic lesions with blood flow in women older than 60 years. © RSNA, 2022 See also the editorial by Baumgarten in this issue.
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Affiliation(s)
- Akshya Gupta
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Priyanka Jha
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Timothy M Baran
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Katherine E Maturen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Krupa Patel-Lippmann
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Hanna M Zafar
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Aya Kamaya
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Neha Antil
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Lisa Barroilhet
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Elizabeth Sadowski
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
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Wengert GJ, Dabi Y, Kermarrec E, Jalaguier-Coudray A, Poncelet E, Porcher R, Thomassin-Naggara I, Rockall AG. O-RADS MRI Classification of Indeterminate Adnexal Lesions: Time-Intensity Curve Analysis Is Better Than Visual Assessment. Radiology 2022; 303:566-575. [PMID: 35230183 DOI: 10.1148/radiol.210342] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background The MRI Ovarian-Adnexal Reporting and Data System (O-RADS) enables risk stratification of sonographically indeterminate adnexal lesions, partly based on time-intensity curve (TIC) analysis, which may not be universally available. Purpose To compare the diagnostic accuracy of visual assessment with that of TIC assessment of dynamic contrast-enhanced MRI scans to categorize adnexal lesions as benign or malignant and to evaluate the influence on the O-RADS MRI score. Materials and Methods The European Adnex MR Study Group, or EURAD, database, a prospective multicenter study of women undergoing MRI for indeterminate adnexal lesions between March 2013 and March 2018, was queried retrospectively. Women undergoing surgery for an adnexal lesion with solid tissue were included. Solid tissue enhancement relative to outer myometrium was assessed visually and with TIC. Contrast material washout was recorded. Lesions were categorized according to the O-RADS MRI score with visual and TIC assessment. Per-lesion diagnostic accuracy was calculated. Results A total of 320 lesions (207 malignant, 113 benign) in 244 women (mean age, 55.3 years ± 15.8 [standard deviation]) were analyzed. Sensitivity for malignancy was 96% (198 of 207) and 76% (157 of 207) for TIC and visual assessment, respectively. TIC was more accurate than visual assessment (86% [95% CI: 81, 90] vs 78% [95% CI: 73, 82]; P < .001) for benign lesions, predominantly because of higher specificity (95% [95% CI: 92, 98] vs 76% [95% CI: 68, 81]). A total of 21% (38 of 177) of invasive lesions were rated as low risk visually. Contrast material washout and high-risk enhancement (defined as earlier enhancement than in the myometrium) were highly specific for malignancy for both TIC (97% [95% CI: 91, 99] and 94% [95% CI: 90, 97], respectively) and visual assessment (97% [95% CI: 92, 99] and 93% [95% CI: 88, 97], respectively). O-RADS MRI score was more accurate with TIC than with visual assessment (area under the receiver operating characteristic curve, 0.87 [95% CI: 0.83, 0.90] vs 0.73 [95% CI: 0.68, 0.78]; P < .001). Conclusion Time-intensity curve analysis was more accurate than visual assessment for achieving optimal diagnostic accuracy with the Ovarian-Adnexal Reporting and Data System MRI score. Clinical trial registration no. NCT01738789 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Vargas and Woo in this issue.
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Affiliation(s)
- Georg J Wengert
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
| | - Yohann Dabi
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
| | - Edith Kermarrec
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
| | - Aurélie Jalaguier-Coudray
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
| | - Edouard Poncelet
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
| | - Raphaël Porcher
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
| | - Isabelle Thomassin-Naggara
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
| | - Andrea G Rockall
- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
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- From the Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, London, United Kingdom (G.J.W., A.G.R.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria (G.J.W.); Departments of Obstetrics and Gynecology (Y.D.) and Radiology (E.K., I.T.N.), Sorbonne University, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Paoli Calmettes, Marseille, France (A.J.C.); Department of Women's Imaging, Centre Hospitalier de Valenciennes, Valenciennes, France (E.P.); Centre of Research Epidemiology and Statistics, Université de Paris, INSERM U1153, Paris, France (R.P.); Clinical Epidemiology Center, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France (R.P.); Institute for Computing and Data Sciences, Sorbonne University, Paris, France (I.T.N.); and Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom (A.G.R.)
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Sadowski EA, Thomassin-Naggara I, Rockall A, Maturen KE, Forstner R, Jha P, Nougaret S, Siegelman ES, Reinhold C. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology 2022; 303:35-47. [PMID: 35040672 PMCID: PMC8962917 DOI: 10.1148/radiol.204371] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
MRI plays an important role as a secondary test or problem-solving modality in the evaluation of adnexal lesions depicted at US. MRI has increased specificity compared with US, decreasing the number of false-positive diagnoses for malignancy and thereby avoiding unnecessary or over-extensive surgery in patients with benign lesions or borderline tumors, while women with possible malignancies can be expeditiously referred for oncologic surgical evaluation. The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI Committee is an international collaborative effort formed under the direction of the American College of Radiology and includes a diverse group of experts on adnexal imaging and management who developed the O-RADS MRI risk stratification system. This scoring system assigns a probability of malignancy based on the MRI features of an adnexal lesion and provides information to facilitate optimal patient management. The widespread implementation of a codified reporting system will lead to improved interpretation agreement and standardized communication between radiologists and referring physicians. In addition, it will allow for high-quality multi-institutional collaborations-an important unmet need that has hampered the performance of high-quality research in this area in the past. This article provides guidelines on using the O-RADS MRI risk stratification system in clinical practice, as well as in the educational and research settings.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Andrea Rockall
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Katherine E Maturen
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Rosemarie Forstner
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Priyanka Jha
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Stephanie Nougaret
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Evan S Siegelman
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Caroline Reinhold
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
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16
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Avesani G, Caliolo G, Gui B, Petta F, Panico C, Manna VL, Moro F, Testa AC, Scambia G, Manfredi R. Pearls and Potential Pitfalls for Correct Diagnosis of Ovarian Cystadenofibroma in MRI: A Pictorial Essay. Korean J Radiol 2021; 22:1809-1821. [PMID: 34668348 PMCID: PMC8546138 DOI: 10.3348/kjr.2020.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/20/2021] [Accepted: 07/03/2021] [Indexed: 12/28/2022] Open
Abstract
Ovarian cystadenofibroma is a benign ovarian tumor that is characterized by a consistent percentage of masses, which remain indeterminate in ultrasonography and require magnetic resonance (MR) investigation; they may mimic borderline or malignant lesions. Three main morphologic patterns, resembling different ovarian neoplasms, can be identified in cystadenofibromas: multilocular solid lesions, unilocular cystic lesions with parietal thickening, and purely cystic masses. However, a cystoadenofibroma has typical features, such as T2-weighted hypointensity associated with no restrictions in diffusion-weighted imaging (the so-called "dark-dark appearance") and progressive post-contrast enhancement (type I perfusion curve). The purpose of this study was to review the features of ovarian cystadenofibromas in MR imaging and to suggest pearls and pitfalls regarding their correct diagnosis.
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Affiliation(s)
- Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Gianluca Caliolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Benedetta Gui
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
| | - Federica Petta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Camilla Panico
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Viviana La Manna
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Francesca Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Antonia Carla Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
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17
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Diagnostic accuracy and inter-observer reliability of the O-RADS scoring system among staff radiologists in a North American academic clinical setting. Abdom Radiol (NY) 2021; 46:4967-4973. [PMID: 34185128 DOI: 10.1007/s00261-021-03193-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The objective of this study is to evaluate the diagnostic accuracy, interobserver variability, and common lexicon pitfalls of the ACR O-RADS scoring system among staff radiologists without prior experience to O-RADS. MATERIALS AND METHODS After independent review of the ACR O-RADS publications and 30 training cases, three fellowship-trained, board-certified staff radiologists scored 50 pelvic ultrasound exams using the O-RADS system. The diagnostic accuracy and area under receiver operating characteristic were analyzed for each reader. Overall agreement and pair-wise agreement between readers were also analyzed. RESULTS Excellent specificities (92 to 100%), NPVs (92 to 100%), and variable sensitivities (72 to 100%), PPVs (66 to 100%) were observed. Considering O-RADS 4 and O-RADS 5 as predictors of malignancy, individual reader AUC values range from 0.94 to 0.98 (p < 0.001). Overall inter-reader agreement for all 3 readers was "very good," k = 0.82 (0.73 to 0.90, 95% CI, p < 0.001). Pair-wise agreement between readers were also "very good," k = 0.86-0.92. 14 out of 150 lesions were misclassified, with the most common error being down-scoring of a solid lesion with irregular outer contours. CONCLUSION Even without specific training, experienced ultrasound readers can achieve excellent diagnostic performance and high inter-reader reliability with self-directed review of guidelines and cases. The study highlights the effectiveness of ACR O-RADS as a stratification tool for radiologists and supports its continued use in practice.
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18
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Xu A, Nie F, Liu T, Dong T, Bu L, Yang D. Adnexal masses: Diagnostic performance of contrast-enhanced ultrasound using the simple rules from the International Ovarian Tumor Analysis group. Int J Gynaecol Obstet 2021; 157:568-573. [PMID: 34510439 DOI: 10.1002/ijgo.13926] [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: 05/28/2021] [Revised: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the role of the Simple Rules (SR) from the International Ovarian Tumor Analysis group in contrast-enhanced ultrasound (CEUS) of for the differential diagnosis of benign and malignant adnexal tumors. METHODS A total of 180 patients with suspected malignant adnexal masses admitted to Lanzhou University Second Hospital were included, all of whom received conventional ultrasound (US) and CEUS examination before surgery. All masses were assessed using SR in US and SR in CEUS. To compare the diagnostic performance, the sensitivity, specificity, negative and positive predictive values, Youden index, and area under the curves values of SR in US and SR in CEUS were obtained. RESULTS Sensitivity, negative predictive values, Youden index, and area under the curves were better for SR in CEUS than SR in US. The specificity and negative predictive value of SR in CEUS were lower than that of SR in US. Compared with SR in US, SR in CEUS significantly reduced the number of uncertain masses (21, 36.7% vs. 66, 11.7%). CONCLUSION We concluded that SR in CEUS performed well in the diagnosis of malignant adnexal masses. SR in CEUS is a supplement to SR in US.
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Affiliation(s)
- Ailing Xu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Ting Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Lan Bu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Dan Yang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
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19
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Nougaret S, McCague C, Tibermacine H, Vargas HA, Rizzo S, Sala E. Radiomics and radiogenomics in ovarian cancer: a literature review. Abdom Radiol (NY) 2021; 46:2308-2322. [PMID: 33174120 DOI: 10.1007/s00261-020-02820-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 01/25/2023]
Abstract
Ovarian cancer remains one of the most lethal gynecological cancers in the world despite extensive progress in the areas of chemotherapy and surgery. Many studies have postulated that this is because of the profound heterogeneity that underpins response to therapy and prognosis. Standard imaging evaluation using CT or MRI does not take into account this tumoral heterogeneity especially in advanced stages with peritoneal carcinomatosis. As such, newly emergent fields in the assessment of tumor heterogeneity have been proposed using radiomics to evaluate the whole tumor burden heterogeneity as opposed to single biopsy sampling. This review provides an overview of radiomics, radiogenomics, and proteomics and examines the use of these newly emergent fields in assessing tumor heterogeneity and its implications in ovarian cancer.
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Affiliation(s)
- S Nougaret
- IRCM, Montpellier Cancer Research Institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France. .,Department of Radiology, Montpellier Cancer institute, 208 Ave des Apothicaires, 34295, Montpellier, France.
| | - Cathal McCague
- Department of Radiology, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Hichem Tibermacine
- IRCM, Montpellier Cancer Research Institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France.,Department of Radiology, Montpellier Cancer institute, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Stefania Rizzo
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, CH, Switzerland.,Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, CH, Switzerland
| | - E Sala
- Department of Radiology, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
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20
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Borderline ovarian tumor in pregnancy: can surgery wait? A case series. Arch Gynecol Obstet 2021; 304:1561-1568. [PMID: 33950305 DOI: 10.1007/s00404-021-06080-0] [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: 09/08/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the characteristics of borderline tumors (BOT) diagnosed during pregnancy, as either first diagnosis or relapse, to evaluate safety of expectant management. METHODS 15 women affected by BOT during pregnancy were included, to evaluate clinical and histo-pathological characteristics. Age of patient, parity, gestational age, follow-up time, size of tumor, surgical approach, type and timing of surgery, FIGO stage, and histologic type were obtained through retrospective review. RESULTS All patients except one were diagnosed with serous BOT (BOTs). Median follow-up time was 147 ± 57 months. Eight women received first diagnosis of BOT and seven had diagnosis of BOT recurrence during pregnancy, including three with a second relapse and four with a third relapse. BOT were diagnosed at FIGO stage I in most patients (75%) of the first group and in 14.3% of the second group, respectively. Micropapillary pattern was present in 71.4% of patients with first diagnosis of BOT, but only in 14.2% in case of relapse. All relapses were BOTs. No patient with BOT and concomitant pregnancy developed an invasive recurrence later. Overall, 24 relapses occurred in 10 patients (66.7%). Altogether 24 pregnancies occurred during follow-up, with a high livebirth rate (91.6%) and only 2 spontaneous miscarriages. CONCLUSION According to our experience, an "expectation management" could be a safe option in case of both relapse of BOTs during pregnancy and first suspicion of BOT in pregnant women at advanced gestational age.
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21
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Stein EB, Roseland ME, Shampain KL, Wasnik AP, Maturen KE. Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update. Abdom Radiol (NY) 2021; 46:2127-2139. [PMID: 33079254 DOI: 10.1007/s00261-020-02812-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
Incidental adnexal masses are commonly encountered at ultrasound, computed tomography, and magnetic resonance imaging. Since many of these lesions are surgically resected and ultimately found to be benign, patients may be exposed to personal and economic costs related to unnecessary oophorectomy. Thus, accurate non-invasive risk stratification of adnexal masses is essential for optimal management and outcomes. Multiple consensus guidelines in radiology have been published to assist in characterization of these masses as benign, indeterminate, or likely malignant. In the last two years, several new and updated stratification systems for assessment of incidental adnexal masses have been published. The purpose of this article is to offer a concise review of four recent publications: ACR 2020 update on the management of incidental adnexal findings on CT and MRI, SRU 2019 consensus update on simple adnexal cysts, O-RADS ultrasound risk stratification system (2020), and O-RADS MRI risk stratification system (2020).
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Affiliation(s)
- Erica B Stein
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Molly E Roseland
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kimberly L Shampain
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ashish P Wasnik
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Katherine E Maturen
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Obstetrics & Gynecology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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22
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Sadowski EA, Maturen KE, Rockall A, Reinhold C, Addley H, Jha P, Bharwani N, Thomassin-Naggara I. Ovary: MRI characterisation and O-RADS MRI. Br J Radiol 2021; 94:20210157. [PMID: 33929901 DOI: 10.1259/bjr.20210157] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ultrasound has a high specificity for the diagnosis of a benign lesion in cases of classic appearing simple cyst, hemorrhagic cyst, endometrioma and dermoid. However, ultrasound can sometimes be limited for definitive characterisation and risk stratification of other types of lesions, including those with echogenic content that may appear solid, with or without blood flow. Frequently, MRI can be used to further characterise these types of lesions, due to its ability to distinguish solid tissue from non-tissue solid components such as fat, blood, or debris. Incorporating the MR imaging into the evaluation of adnexal lesions can improve diagnostic certainty and guide clinical management potentially avoiding inappropriate surgery for benign lesions and expediting appropriate treatment for malignant lesions, particularly in the females with sonographically indeterminate adnexal lesions.
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Affiliation(s)
- Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Katherine E Maturen
- Department of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Rockall
- Division of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline Reinhold
- McGill University Health Center, McGill University, Montreal, Canada
| | - Helen Addley
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Priyanka Jha
- Department of Radiology, University of California San Francisco, San francisco, CA, USA
| | - Nishat Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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23
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Reinhold C, Rockall A, Sadowski EA, Siegelman ES, Maturen KE, Vargas HA, Forstner R, Glanc P, Andreotti RF, Thomassin-Naggara I. Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee. J Am Coll Radiol 2021; 18:713-729. [PMID: 33484725 DOI: 10.1016/j.jacr.2020.12.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 01/27/2023]
Abstract
MRI is used in the evaluation of ovarian and adnexal lesions. MRI can further characterize lesions seen on ultrasound to help decrease the number of false-positive lesions and avoid unnecessary surgery in benign lesions. Currently, the reporting of ovarian and adnexal findings on MRI is inconsistent because of the lack of standardized descriptor terminology. The development of uniform reporting descriptors can lead to improved interpretation agreement and communication between radiologists and referring physicians. The Ovarian-Adnexal Reporting and Data Systems MRI Committee was formed under the direction of the ACR to create a standardized lexicon for adnexal lesions with the goal of improving the quality and consistency of imaging reports. This white paper describes the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions for MRI and the resultant lexicon.
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Affiliation(s)
- Caroline Reinhold
- Codirector, Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Center, McGill University, Montreal, Canada.
| | - Andrea Rockall
- Division of Surgery and Cancer, Imperial College London and Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Evan S Siegelman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine E Maturen
- Departments of Radiology and Obstetrics and Gynecology, University of Michigan Hospitals, Ann Arbor, Michigan
| | | | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria
| | - Phyllis Glanc
- University of Toronto, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Rochelle F Andreotti
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Imagerie, Paris, France
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24
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Grover SB, Patra S, Grover H, Mittal P, Khanna G. Prospective revalidation of IOTA "two-step", "alternative two-step" and "three-step" strategies for characterization of adnexal masses - An Indian study focussing the radiology context. Indian J Radiol Imaging 2020; 30:304-318. [PMID: 33273764 PMCID: PMC7694716 DOI: 10.4103/ijri.ijri_279_20] [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: 04/20/2020] [Revised: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: The purpose of this study was to revalidate the diagnostic performance of IOTA “two step” (Simple Descriptors and Simple Rules), “ alternative two step” (Simple Rules Risk Calculation tool / SRrisk score), and three step (two step with subjective assessment) strategies, for characterization of adnexal masses as benign or malignant, using histopathology as gold standard. Materials and Methods: This prospective, study comprised of 100 patients with newly diagnosed adnexal masses, who underwent ultrasound evaluation first by a level I and then by a level III investigator (EFSUMB criteria). Initially, the level I investigator evaluated each adnexal mass, applying IOTA “two-step” strategy and simultaneously assigned a risk category, by applying the simple rules risk score (SRrisk score) or performing the “alternative two step” strategy. Subsequently the inconclusive masses were evaluated by the level III investigator using “real time subjective assessment”, thereby performing the third step. Following histopathology diagnosis, the performance of each strategy was evaluated using diagnostic tests. Results: The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of “two-step” strategy were 87.5%, 79.2%, 89.4%, 76%, and 84.7%, respectively; those of “alternative two-step” strategy were 91.5%, 75.6%, 84.4%, 86.1% and 88%; and those of “three-step” strategy were 98.2%, 93.3%, 94.7%, 97.7% and 96%, respectively. Conclusion: All IOTA strategies showed good diagnostic performance for characterization of adnexal masses and the “three-step” strategy performed best. We believe this is the first ever prospective re-validation and comparative evaluation of all three IOTA strategies by Indian Radiologists. Since ultrasound is the primary modality for evaluation of adnexal masses, based on the good results of our study, a recommendation for henceforth standard application, of the three-step IOTA strategy in routine Radiology practice appears justified. Although, IOTA strategies been proposed and validated mainly by Gynaecologists and Oncology surgeons, based on the results of our study, this paradigm can now be made to shift back to the arena of Radiology and Radiologists, the imaging experts.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sayantan Patra
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hemal Grover
- Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA
| | - Pratima Mittal
- Department of Gynecology and Obstetrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geetika Khanna
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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