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Leng Y, Wang X, Zheng T, Peng F, Xiong L, Wang Y, Gong L. Development and validation of radiomics nomogram for metastatic status of epithelial ovarian cancer. Sci Rep 2024; 14:12456. [PMID: 38816463 PMCID: PMC11139946 DOI: 10.1038/s41598-024-63369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/28/2024] [Indexed: 06/01/2024] Open
Abstract
To develop and validate an enhanced CT-based radiomics nomogram for evaluating preoperative metastasis risk of epithelial ovarian cancer (EOC). One hundred and nine patients with histologically confirmed EOC were retrospectively enrolled. The volume of interest (VOI) was delineated in preoperative enhanced CT images, and 851 radiomics features were extracted. The radiomics features were selected by the least absolute shrinkage and selection operator (LASSO), and the rad-score was calculated using the formula of the radiomics label. A clinical model, radiomics model, and combined model were constructed using the logistic regression classification algorithm. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were used to evaluate the diagnostic performance of the models. Seventy-five patients (68.8%) were histologically confirmed to have metastasis. Eleven optimal radiomics features were retained by the LASSO algorithm to develop the radiomic model. The combined model for evaluating metastasis of EOC achieved area under the curve (AUC) values of 0.929 (95% CI 0.8593-0.9996) in the training cohort and 0.909 (95% CI 0.7921-1.0000) in the test cohort. To facilitate clinical use, a radiomic nomogram was built by combining the clinical characteristics with rad-score. The DCA indicated that the nomogram had the most significant net benefit when the threshold probability exceeded 15%, surpassing the benefits of both the treat-all and treat-none strategies. Compared with clinical model and radiomics model, the radiomics nomogram has the best diagnostic performance in evaluating EOC metastasis. The nomogram is a useful and convenient tool for clinical doctors to develop personalized treatment plans for EOC patients.
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Affiliation(s)
- Yinping Leng
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi, China
| | - Xiwen Wang
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi, China
| | - Tian Zheng
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi, China
| | - Fei Peng
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi, China
| | - Liangxia Xiong
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, 200072, Shanghai, China
| | - Lianggeng Gong
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi, China.
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Nomani A, Yousefi S, Sargsyan D, Hatefi A. A quantitative MRI-based approach to estimate the permeation and retention of nanomedicines in tumors. J Control Release 2024; 368:728-739. [PMID: 38493951 DOI: 10.1016/j.jconrel.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
Despite the potential of the enhanced permeability and retention (EPR) effect in tumor passive targeting, many nanotherapeutics have failed to produce meaningful clinical outcomes due to the variable and challenging nature of the tumor microenvironment (TME) and EPR effect. This EPR variability across tumors and inconsistent translation of nanomedicines from preclinical to clinical settings necessitates a reliable method to assess its presence in individual tumors. This study aimed to develop a reliable and non-invasive approach to estimate the EPR effect in tumors using a clinically compatible quantitative magnetic resonance imaging (qMRI) technique combined with a nano-sized MRI contrast agent. A quantitative MR imaging was developed using a dynamic contrast-enhanced (DCE) MRI protocol. Then, the permeability and retention of the nano-sized MRI contrast agent were evaluated in three different ovarian xenograft tumor models. Results showed significant differences in EPR effects among the tumor models, with tumor growth influencing the calculated parameters of permeability (Ktrans) and retention (Ve) based on Tofts pharmacokinetic (PK) modeling. Our data indicate that the developed quantitative DCE-MRI method, combined with the Tofts PK modeling, provides a robust and non-invasive approach to screen tumors for their responsiveness to nanotherapeutics. These results imply that the developed qMRI method can be beneficial for personalized cancer treatments by ensuring that nanotherapeutics are administered only to patients with tumors showing sufficient EPR levels.
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Affiliation(s)
- Alireza Nomani
- Department of Pharmaceutics, Rutgers University, Piscataway, NJ 08854, USA.
| | - Siavash Yousefi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Davit Sargsyan
- Department of Pharmaceutics, Rutgers University, Piscataway, NJ 08854, USA
| | - Arash Hatefi
- Department of Pharmaceutics, Rutgers University, Piscataway, NJ 08854, USA; Cancer Pharmacology Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA.
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Leng Y, Kan A, Wang X, Li X, Xiao X, Wang Y, Liu L, Gong L. Contrast-enhanced CT radiomics for preoperative prediction of stage in epithelial ovarian cancer: a multicenter study. BMC Cancer 2024; 24:307. [PMID: 38448945 PMCID: PMC10916071 DOI: 10.1186/s12885-024-12037-8] [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: 08/14/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Preoperative prediction of International Federation of Gynecology and Obstetrics (FIGO) stage in patients with epithelial ovarian cancer (EOC) is crucial for determining appropriate treatment strategy. This study aimed to explore the value of contrast-enhanced CT (CECT) radiomics in predicting preoperative FIGO staging of EOC, and to validate the stability of the model through an independent external dataset. METHODS A total of 201 EOC patients from three centers, divided into a training cohort (n = 106), internal (n = 46) and external (n = 49) validation cohorts. The least absolute shrinkage and selection operator (LASSO) regression algorithm was used for screening radiomics features. Five machine learning algorithms, namely logistic regression, support vector machine, random forest, light gradient boosting machine (LightGBM), and decision tree, were utilized in developing the radiomics model. The optimal performing algorithm was selected to establish the radiomics model, clinical model, and the combined model. The diagnostic performances of the models were evaluated through receiver operating characteristic analysis, and the comparison of the area under curves (AUCs) were conducted using the Delong test or F-test. RESULTS Seven optimal radiomics features were retained by the LASSO algorithm. The five radiomics models demonstrate that the LightGBM model exhibits notable prediction efficiency and robustness, as evidenced by AUCs of 0.83 in the training cohort, 0.80 in the internal validation cohort, and 0.68 in the external validation cohort. The multivariate logistic regression analysis indicated that carcinoma antigen 125 and tumor location were identified as independent predictors for the FIGO staging of EOC. The combined model exhibited best diagnostic efficiency, with AUCs of 0.95 in the training cohort, 0.83 in the internal validation cohort, and 0.79 in the external validation cohort. The F-test indicated that the combined model exhibited a significantly superior AUC value compared to the radiomics model in the training cohort (P < 0.001). CONCLUSIONS The combined model integrating clinical characteristics and radiomics features shows potential as a non-invasive adjunctive diagnostic modality for preoperative evaluation of the FIGO staging status of EOC, thereby facilitating clinical decision-making and enhancing patient outcomes.
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Affiliation(s)
- Yinping Leng
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Ao Kan
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Xiwen Wang
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Xiaofen Li
- Department of Radiology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Xuan Xiao
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Lan Liu
- Department of Radiology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China.
| | - Lianggeng Gong
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China.
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Dabi Y, Rockall A, Razakamanantsoa L, Guerra A, Fournier LS, Fotopoulou C, Touboul C, Thomassin-Naggara I. O-RADS MRI scoring system has the potential to reduce the frequency of avoidable adnexal surgery. Eur J Obstet Gynecol Reprod Biol 2024; 294:135-142. [PMID: 38237312 DOI: 10.1016/j.ejogrb.2024.01.016] [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: 07/05/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To assess the potential impact of the O-RADS MRI score on the decision-making process for the management of adnexal masses. METHODS EURAD database (prospective, European observational, multicenter study) was queried to identify asymptomatic women without history of infertility included between March 1st and March 31st 2018, with available surgical pathology or clinical findings at 2-year clinical follow-up. Blinded to final diagnosis, we stratified patients into five categories according to the O-RADS MRI score (absent i.e. non adnexal, benign, probably benign, indeterminate, probably malignant). Prospective management was compared to theoretical management according to the score established as following: those with presumed benign masses (scored O-RADS MRI 2 or 3) (follow-up recommended) and those with presumed malignant masses (scored O-RADS MRI 4 or 5) (surgery recommended). RESULTS The accuracy of the score for assessing the origin of the mass was of 97.2 % (564/580, CI95% 0.96-0.98) and was of 92.0 % (484/526) for categorizing lesions with a negative predictive value of 98.1 % (415/423, CI95% 0.96-0.99). Theoretical management using the score would have spared surgery in 229 patients (87.1 %, 229/263) with benign lesions and malignancy would have been missed in 6 borderline and 2 invasive cases. In patients with a presumed benign mass using O-RADS MRI score, recommending surgery for lesions >= 100 mm would miss only 4/77 (4.8 %) malignant adnexal tumors instead of 8 (50 % decrease). CONCLUSION The use of O-RADS MRI scoring system could drastically reduce the number of asymptomatic patients undergoing avoidable surgery.
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Affiliation(s)
- Yohann Dabi
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service de gynécologie et obstétrique, Hôpital Tenon, France.
| | - Andrea Rockall
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom; Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
| | - Léo Razakamanantsoa
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS) - Hôpital Tenon, France
| | | | - Laure S Fournier
- Assistance Publique des Hopitaux de Paris, Service de radiologie, Hôpital Européeen Georges Pompidou, France
| | - Christina Fotopoulou
- Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
| | - Cyril Touboul
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service de gynécologie et obstétrique, Hôpital Tenon, France
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS) - Hôpital Tenon, France
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Dabi Y, Rockall A, Sadowski E, Touboul C, Razakamanantsoa L, Thomassin-Naggara I. O-RADS MRI to classify adnexal tumors: from clinical problem to daily use. Insights Imaging 2024; 15:29. [PMID: 38289563 PMCID: PMC10828223 DOI: 10.1186/s13244-023-01598-0] [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: 09/03/2023] [Accepted: 11/25/2023] [Indexed: 02/02/2024] Open
Abstract
Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. This finding led to the conclusion that ultrasonography was insufficient to accurately assess adnexal masses and that a standardized MRI criteria could improve these patients' management. The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. The different steps were the following: (1) preliminary work to formalize the issue, (2) physiopathological analysis and finding dynamic parameters relevant to increase MRI performances, (3) construction and internal validation of a score to predict the nature of the lesion, (4) external multicentric validation (the EURAD study) of the score named O-RADS MRI, and (5) communication and education work to spread its use and inclusion in guidelines. Future steps will include studies at patients' levels and a cost-efficiency analysis. Critical relevance statement We present translating radiological research into a clinical application based on a step-by-step structured and systematic approach methodology to validate MR imaging for the characterization of adnexal mass with the ultimate step of incorporation in the latest worldwide guidelines of the O-RADS MRI reporting system that allows to distinguish benign from malignant ovarian masses with a sensitivity and specificity higher than 90%. Key points • The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography.• The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management.• The first developing score named ADNEX MR Score was constructed using multiple easily assessed criteria on MRI to classify indeterminate adnexal lesions following ultrasonography.• The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.
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Affiliation(s)
- Yohann Dabi
- APHP, Sorbonne Université, Hôpital Tenon, Service de Gynecologie Et Obstétrique, 75020, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Andrea Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Cyril Touboul
- APHP, Sorbonne Université, Hôpital Tenon, Service de Gynecologie Et Obstétrique, 75020, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Leo Razakamanantsoa
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
- APHP, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France
| | - Isabelle Thomassin-Naggara
- Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France.
- APHP, Sorbonne Université, Hôpital Tenon, Service de Radiologie, 58 Avenue Gambetta, 75020, Paris, France.
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Suarez-Weiss KE, Sadowski EA, Zhang M, Burk KS, Tran VT, Shinagare AB. Practical Tips for Reporting Adnexal Lesions Using O-RADS MRI. Radiographics 2023; 43:e220142. [PMID: 37319025 DOI: 10.1148/rg.220142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI risk stratification system provides a standardized lexicon and evidence-based risk score for evaluation of adnexal lesions. The goals of the lexicon and risk score are to improve report quality and communication between radiologists and clinicians, reduce variability in the reporting language, and optimize management of adnexal lesions. The O-RADS MRI risk score is based on the presence or absence of specific imaging features, including the lipid content, enhancing solid tissue, number of loculi, and fluid type. The probability of malignancy ranges from less than 0.5% when there are benign features to approximately 90% when there is solid tissue with a high-risk time-intensity curve. This information can aid in optimizing management of patients with adnexal lesions. The authors present an algorithmic approach to the O-RADS MRI risk stratification system and highlight key teaching points and common pitfalls. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Krista E Suarez-Weiss
- From the Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115 (K.E.S.W., K.S.B., A.B.S.); Department of Radiology, University of Wisconsin Health University Hospital, Madison, Wis (E.A.S.); and Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada (M.Z., V.T.T.)
| | - Elizabeth A Sadowski
- From the Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115 (K.E.S.W., K.S.B., A.B.S.); Department of Radiology, University of Wisconsin Health University Hospital, Madison, Wis (E.A.S.); and Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada (M.Z., V.T.T.)
| | - Michelle Zhang
- From the Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115 (K.E.S.W., K.S.B., A.B.S.); Department of Radiology, University of Wisconsin Health University Hospital, Madison, Wis (E.A.S.); and Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada (M.Z., V.T.T.)
| | - Kristine S Burk
- From the Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115 (K.E.S.W., K.S.B., A.B.S.); Department of Radiology, University of Wisconsin Health University Hospital, Madison, Wis (E.A.S.); and Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada (M.Z., V.T.T.)
| | - Vi T Tran
- From the Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115 (K.E.S.W., K.S.B., A.B.S.); Department of Radiology, University of Wisconsin Health University Hospital, Madison, Wis (E.A.S.); and Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada (M.Z., V.T.T.)
| | - Atul B Shinagare
- From the Department of Radiology, Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115 (K.E.S.W., K.S.B., A.B.S.); Department of Radiology, University of Wisconsin Health University Hospital, Madison, Wis (E.A.S.); and Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada (M.Z., V.T.T.)
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Manganaro L, Ciulla S, Celli V, Ercolani G, Ninkova R, Miceli V, Cozzi A, Rizzo SM, Thomassin-Naggara I, Catalano C. Impact of DWI and ADC values in Ovarian-Adnexal Reporting and Data System (O-RADS) MRI score. LA RADIOLOGIA MEDICA 2023; 128:565-577. [PMID: 37097348 PMCID: PMC10181975 DOI: 10.1007/s11547-023-01628-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/27/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Introduce DWI and quantitative ADC evaluation in O-RADS MRI system and observe how diagnostic performance changes. Assess its validity and reproducibility between readers with different experience in female pelvic imaging. Finally, evaluate any correlation between ADC value and histotype in malignant lesions. MATERIALS AND METHODS In total, 173 patients with 213 indeterminate adnexal masses (AMs) on ultrasound were subjected to MRI examination, from which 140 patients with 172 AMs were included in the final analysis. Standardised MRI sequences were used, including DWI and DCE sequences. Two readers, blinded to histopathological data, retrospectively classified AMs according to the O-RADS MRI scoring system. A quantitative analysis method was applied by placing a ROI on the ADC maps obtained from single-exponential DWI sequences. AMs considered benign (O-RADS MRI score 2) were excluded from the ADC analysis. RESULTS Excellent inter-reader agreement was found in the classification of lesions according to the O-RADS MRI score (K = 0.936; 95% CI). Two ROC curves were created to determine the optimal cut-off value for the ADC variable between O-RADS MRI categories 3-4 and 4-5, respectively, 1.411 × 10-3 mm2/sec and 0.849 × 10-3 mm2/sec. Based on these ADC values, 3/45 and 22/62 AMs were upgraded, respectively, to score 4 and 5, while 4/62 AMs were downgraded to score 3. ADC values correlated significantly with the ovarian carcinoma histotype (p value < 0.001). CONCLUSION Our study demonstrates the prognostic potential of DWI and ADC values in the O-RADS MRI classification for better radiological standardisation and characterisation of AMs.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberta Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valentina Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Piazza Malan 2, 20097, San Donato Milanese, Italy
| | - Stefania Maria Rizzo
- Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Via Buffi 13, 6900, Lugano, Switzerland
- Service of Radiology, Imaging Institute of Southern Switzerland, Clinica Di Radiologia EOC, 6900, Lugano, Switzerland
| | - Isabelle Thomassin-Naggara
- Service de Radiologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Elshetry ASF, Hamed EM, Frere RAF, Zaid NA. Impact of Adding Mean Apparent Diffusion Coefficient (ADCmean) Measurements to O-RADS MRI Scoring For Adnexal Lesions Characterization: A Combined O-RADS MRI/ADCmean Approach. Acad Radiol 2023; 30:300-311. [PMID: 36085271 DOI: 10.1016/j.acra.2022.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES Evaluate the impact of adding mean apparent diffusion coefficient (ADCmean) measurements to the Ovarian-Adnexal Imaging Reporting and Data System MRI (O-RADS MRI) scoring for adnexal lesion characterization using a combined O-RADS MRI/ADCmean reading approach. MATERIALS AND METHODS This prospective study included 90 women who underwent pelvic MRI for adnexal lesions diagnosis and characterization. Two readers scored the adnexal lesions using the O-RADS MRI scoring independently and in consensus. A third reader calculated ADCmean measurements. The final diagnoses were determined by histo-pathology (n = 77) or follow-up imaging (n = 13). Areas under the curves (AUCs) and diagnostic performance metrics were calculated for the O-RADS MRI scoring, ADCmean, and combined O-RADS MRI/ADCmean thresholds. P-value <0.05 was significant. RESULTS 116 adnexal lesions (71 benign, 45 malignant) were analyzed. The optimal thresholds to predict malignant adnexal lesions were O-RADS MRI score >3 and ADCmean value ≤1.08 × 10-3 mm2/s (AUC 0.926 and 0.823; sensitivity 97.7% and 95.5%; specificity 87.3% and 68%; positive predictive value (PPV) 83% and 66.2%; positive likelihood ratio (PLR) 7.7 and 3.08, respectively). Compared to the O-RADS MRI scoring, a combined threshold of O-RADS MRI >3/ADCmean ≤1.08 × 10-3 mm2/s, yielded a reduction of false positives, a significant increase in the specificity (97.1%, p = 0.005), PPV (95.4%, p = 0.002), and PLR (33.1, p <0.0001), and non-significant change in the AUC (0.953, p = 0.252), and sensitivity (93.3%, p = 0.467). CONCLUSION The diagnostic performance of O-RADS MRI scoring to characterize adnexal lesions could be improved by adding the ADCmean values through reducing false positives, increasing specificity, and maintaining good sensitivity.
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Affiliation(s)
| | - Enas Mahmoud Hamed
- Radio-diagnosis department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Nesma Adel Zaid
- Radio-diagnosis department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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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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10
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Lin R, Hung YY, Cheng J, Suh-Burgmann E. Accuracy of Magnetic Resonance Imaging for Identifying Ovarian Cancer in a Community-Based Setting. WOMEN'S HEALTH REPORTS 2022; 3:43-48. [PMID: 35136876 PMCID: PMC8812505 DOI: 10.1089/whr.2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/12/2022]
Abstract
Introduction: Many ovarian or adnexal masses have an indeterminate appearance on ultrasound that can raise concerns about cancer. Although magnetic resonance imaging (MRI) has been reported to reliably distinguish between benign and malignant masses, studies evaluating the accuracy of MRI in community-based practice settings are lacking. Methods: Women who underwent MRI to further evaluate an ultrasound-detected adnexal mass in 2016–2017 within a large community-based health system were identified. MRI reports were classified as favoring malignancy, benign disease, or indeterminate, blinded to pathological outcome. With a minimum of 2 years of follow-up, all ovarian cancers and borderline tumors were identified, and the accuracy of MRI assessment was determined. Results: Among 338 women who had MRI to evaluate an adnexal mass, 144 (42.6%) subsequently underwent surgery. MRI favored malignancy in 7 (4.9%) cases, benign disease in 89 (62.2%) cases, and was indeterminate in 48 (33.6%) cases. Of the seven cases in which MRI favored malignancy, two cancers and five benign tumors were found. An additional 10 cases of cancer or borderline tumor were found among women who had MRI reports that were read as indeterminate (n = 6) or that favored benign disease (n = 4). The sensitivity, specificity, positive predictive value, and negative predictive value of an MRI favoring malignancy were 16.7%, 96.2%, 28.5%, and 92.7%, respectively. Discussion: In a large community-based setting, an MRI favoring malignancy was more likely to be associated with benign disease than cancer and identified only 16.7% of true malignant cases. The findings suggest that the ability of MRI to differentiate between benign and malignant adnexal masses in community-based practice settings is currently limited.
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Affiliation(s)
- Ruby Lin
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, California, USA
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Julia Cheng
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Elizabeth Suh-Burgmann
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Gynecologic Oncology, The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
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11
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Aslan S, Tosun SA. Diagnostic accuracy and validity of the O-RADS MRI score based on a simplified MRI protocol: a single tertiary center retrospective study. Acta Radiol 2021; 64:377-386. [PMID: 34839677 DOI: 10.1177/02841851211060413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Adnexal masses (AM) are a common gynecological problem. It is important to use a reliable imaging method in the differentiation of benign and malignant AMs. PURPOSE To assess the accuracy and validity of the O-RADS magnetic resonance imaging (MRI) score for characterizing AM using a simplified MRI protocol. MATERIAL AND METHODS The study population comprised 332 women who underwent MRI due to the detection of indeterminate AM on ultrasonography between January 2018 and June 2020. An experienced radiologist calculated the O-RADS MRI score into five categories, using an MRI protocol with a simplified dynamic study. Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >24 months of follow-up. RESULTS Of 237 AMs, 28 (11.9%) were malignant. The malignancy rates of AMs with scores of 1, 2, 3, 4, and 5 were 0% (0/12), 0% (0/111), 1.2% (1/77), 50% (10/20), and 100% (17/17), respectively. The O-RADS MRI score showed 96.3% sensitivity, 95.2% specificity, and 95.3% accuracy in malignancy prediction. The AUC for the differentiation of benign and malignant masses were 0.983. False positivity rate was high in cases with an O-RADS MRI score of 4 (50%). CONCLUSION The O-RADS MRI score, based on a simplified MRI protocol, has high accuracy and validity in distinguishing benign from malignant sonographically indeterminate AMs. Its use in clinical practice can classify the malignancy risks of masses and prevent unnecessary surgery in benign lesions.
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Affiliation(s)
- Serdar Aslan
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Sebnem Alanya Tosun
- Department of Obstetrics and Gynecology, Giresun University Faculty of Medicine, Giresun, Turkey
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12
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Indirect comparison of the diagnostic performance of 18F-FDG PET/CT and MRI in differentiating benign and malignant ovarian or adnexal tumors: a systematic review and meta-analysis. BMC Cancer 2021; 21:1080. [PMID: 34615498 PMCID: PMC8495994 DOI: 10.1186/s12885-021-08815-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/27/2021] [Indexed: 01/23/2023] Open
Abstract
Objective To compare the value of fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI) in differentiating benign and malignant ovarian or adnexal tumors. Materials and methods English articles reporting on the diagnostic performance of MRI or 18F-FDG PET/CT in identifying benign and malignant ovarian or adnexal tumors published in PubMed and Embase between January 2000 and January 2021 were included in the meta-analysis. Two authors independently extracted the data. If the data presented in the study report could be used to construct a 2 × 2 contingency table comparing 18F-FDG PET/CT and MRI, the studies were selected for the analysis. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the included studies. Forest plots were generated according to the sensitivity and specificity of 18F-FDG PET/CT and MRI. Results A total of 27 articles, including 1118F-FDG PET/CT studies and 17 MRI studies on the differentiation of benign and malignant ovarian or adnexal tumors, were included in this meta-analysis. The pooled sensitivity and specificity for 18F-FDG PET/CT in differentiating benign and malignant ovarian or adnexal tumors were 0.94 (95% CI, 0.87–0.97) and 0.86 (95% CI, 0.79–0.91), respectively, and the pooled sensitivity and specificity for MRI were 0.92 (95% CI: 0.89–0.95) and 0.85 (95% CI: 0.79–0.89), respectively. Conclusion While MRI and 18F-FDG PET/CT both showed to have high and similar diagnostic performance in the differential diagnosis of benign and malignant ovarian or adnexal tumors, MRI, a promising non-radiation imaging technology, may be a more suitable choice for patients with ovarian or accessory tumors. Nonetheless, prospective studies directly comparing MRI and 18F-FDG PET/CT diagnostic performance in the differentiation of benign and malignant ovarian or adnexal tumors are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08815-3.
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13
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Otani S, Kido A, Himoto Y, Sakata A, Otani T, Kuwahara R, Moribata Y, Nishio N, Yajima R, Nakao K, Kurata Y, Minamiguchi S, Mandai M, Nakamoto Y. Diagnostic Value of DCE-MRI for Differentiating Malignant Adnexal Masses Compared with Contrast-enhanced-T1WI. Magn Reson Med Sci 2021; 21:599-607. [PMID: 34483226 DOI: 10.2463/mrms.mp.2021-0003] [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] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the diagnostic performance of dynamic contrast-enhanced-MR (DCE-MR) and delayed contrast-enhanced (CE)-MRI added to unenhanced MRI, including diffusion weighted image (DWI) for differentiating malignant adnexal tumors, conducting a retrospective blinded image interpretation study. METHODS Data of 80 patients suspected of having adnexal tumors by ultrasonography between April 2008 and August 2018 were used for the study. All patients had undergone preoperative MRI and surgical resection at our institution. Four radiologists (two specialized in gynecological radiology and two non-specialized) were enrolled for blinded review of the MR images. A 3-point scale was used: 0 = benign, 1 = indeterminate, and 2 = malignant. Three imaging sets were reviewed: Set A, unenhanced MRI including DWI; Set B, Set A and delayed CE-T1WI; and Set C, Set A and DCE-MRI. Imaging criteria for benign and malignant tumors were given in earlier reports. The diagnostic performance of the three imaging sets of the four readers was calculated. Their areas under the curve (AUCs) were compared using the DeLong method. RESULTS Accuracies of Set B were 81%-88%. Those of Set C were 81%-85%. The AUCs of Set B were 0.83 and 0.89. Those of Set C were 0.81-0.86. For two readers, Set A showed lower accuracy and AUC than Set B/Set C (less than 0.80), although those were equivalent in other readers. No significant difference in AUCs was found among the three sequence sets. Intrareader agreement was moderate to almost perfect in Sets A and B, and substantial to almost perfect in Set C. CONCLUSION DCE-MR showed no superiority for differentiating malignant adnexal tumors from benign tumors compared to delayed CE-T1WI with conventional MR and DWI.
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Affiliation(s)
- Satoshi Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Tomoaki Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Ryo Kuwahara
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Naoko Nishio
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Ryo Yajima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Kyoko Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
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14
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Wei M, Bo F, Cao H, Zhou W, Shan W, Bai G. Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging for malignant ovarian tumors: a systematic review and meta-analysis. Acta Radiol 2021; 62:966-978. [PMID: 32741199 DOI: 10.1177/0284185120944916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Accurate preoperative diagnosis of malignant ovarian tumors (MOTs) is particularly important for selecting the optimal treatment strategy and avoiding overtreatment. PURPOSE To evaluate the diagnostic efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for MOTs. MATERIAL AND METHODS A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science databases to find relevant original articles up to October 2019. The included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Studies on the diagnosis of MOTs with quantitative or semi-quantitative DCE-MRI were analyzed separately. The bivariate random-effects model was used to assess the diagnostic authenticity. Meta-regression analyses were performed to analyze the potential heterogeneity. RESULTS For semi-quantitative DCE-MRI, the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic curves (AUC) were 85% (95% confidence interval [CI] 0.75-0.92), 85% (95% CI 0.77-0.91), 5.8 (95% CI 3.8-8.8), 0.17 (95% CI 0.10-0.30), 33 (95% CI 18-61), and 0.92 (95% CI 0.89-0.94), respectively. For quantitative DCE-MRI, the pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 88% (95% CI 0.65-0.96), 93% (95% CI 0.78-0.98), 12.3 (95% CI 3.4-43.9), 0.13 (95% CI 0.04-0.45), 91 (95% CI 10-857), and 0.96 (95% CI 0.94-0.98), respectively. CONCLUSION DCE-MRI has great diagnostic value for MOTs. Semi-quantitative DCE-MRI may be a relatively mature approach; however, quantitative DCE-MRI appears to be more promising than semi-quantitative DCE-MRI.
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Affiliation(s)
- Mingxiang Wei
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Fan Bo
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Hui Cao
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wei Zhou
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wenli Shan
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Genji Bai
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
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15
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Hottat NA, Van Pachterbeke C, Vanden Houte K, Denolin V, Jani JC, Cannie MM. Magnetic resonance scoring system for assessment of adnexal masses: added value of diffusion-weighted imaging including apparent diffusion coefficient map. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:478-487. [PMID: 32438461 DOI: 10.1002/uog.22090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To validate prospectively the ADNEX magnetic resonance (MR) scoring system to assess adnexal masses and to evaluate a new, modified ADNEX MR scoring system that incorporates diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping. METHODS Between January 2015 and September 2018, 323 consecutive women with adnexal masses diagnosed on transvaginal ultrasound (TVS) underwent standardized MR imaging (MRI) including diffusion and dynamic contrast-enhanced sequences. Of these, 131 underwent subsequent surgery. For interpretation of the MRI examinations, we applied the five-category ADNEX MR scoring system, along with a modified scoring system including DWI with ADC mapping. For both scoring systems, a score was given for all adnexal masses. Histological diagnosis was considered as the gold standard and lesions were classified as benign or malignant. The difference between the predictive values for diagnosing malignancy of the classical and modified scoring systems was assessed on the basis of the areas under the receiver-operating-characteristics (AUC) curves. The sensitivity and specificity for diagnosing malignancy of each score were also calculated. RESULTS Among the 131 women with adnexal mass(es) diagnosed on TVS who underwent MRI and subsequent surgery, the surgery revealed 161 adnexal masses in 126 women; five women had no mass. Histological examination confirmed 161 adnexal masses, of which all had been detected on MRI: 32 malignant tumors, 15 borderline tumors, which were classified as part of the malignant group (n = 47), and 114 benign lesions. The AUC for prediction of a malignant lesion was 0.938 (95% CI, 0.902-0.975) using the classical ADNEX MR scoring system and 0.974 (95% CI, 0.953-0.996) using the modified scoring system. Pairwise comparison of these AUCs revealed a significant difference (P = 0.0032). The sensitivity and specificity for diagnosing malignancy with an ADNEX MR score of 4 or more were 95.5% and 86.6%, respectively, using the classic scoring system, and 95.7% and 93.3%, respectively, using the modified scoring system. CONCLUSION DWI with ADC mapping could be integrated into the ADNEX MR scoring system to improve specificity, thereby potentially optimizing clinical management by avoiding unnecessary surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N A Hottat
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Van Pachterbeke
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - K Vanden Houte
- Department of Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - V Denolin
- Siemens Healthineers, Beersel, Belgium
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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16
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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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ACR Appropriateness Criteria ® Clinically Suspected Adnexal Mass, No Acute Symptoms. J Am Coll Radiol 2020; 16:S77-S93. [PMID: 31054761 DOI: 10.1016/j.jacr.2019.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 01/30/2023]
Abstract
There are approximately 9.1 pelvic surgeries performed for every histologically confirmed adnexal malignancy in the United States, compared to 2.3 surgeries per malignancy (in oncology centers) and 5.9 surgeries per malignancy (in other centers) in Europe. An important prognostic factor in the long-term survival in patients with ovarian malignancy is the initial management by a gynecological oncologist. With high accuracy of imaging for adnexal mass characterization and consequent appropriate triage to subspecialty referral, the better use of gynecologic oncology can improve treatment outcomes. Ultrasound, including transabdominal, transvaginal, and duplex ultrasound, combined with MRI with contrast can diagnose adnexal masses as benign with specific features (ie, functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, hydrosalpinx, peritoneal inclusion cyst, Tarlov cyst), malignant, or indeterminate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Basha MAA, Abdelrahman HM, Metwally MI, Alayouty NA, Mohey N, Zaitoun MMA, Almassry HN, Yousef HY, El Sammak AA, Aly SA, Algazzar HY, Farag MAEAM, Mosallam W, Abo Shanab WS, Ibrahim SA, Mohamed EA, Mohamed AEM, Afifi AHM, Harb OA, Azmy TM. Validity and Reproducibility of the ADNEX MR Scoring System in the Diagnosis of Sonographically Indeterminate Adnexal Masses. J Magn Reson Imaging 2020; 53:292-304. [PMID: 32715577 DOI: 10.1002/jmri.27285] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The diagnosis of sonographically indeterminate adnexal masses (AM) signifies a major challenge in clinical practice. Early detection and characterization have increased the need for accurate imaging evaluation before treatment. PURPOSE To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM. STUDY TYPE A prospective multicenter study. POPULATION In all, 531 women (mean age, 44 ± 11.2 years; range, 21-79 years) with 572 sonographically indeterminate AM. FIELD STRENGTH/SEQUENCE 1.5T/precontrast T1 -weighted imaging (WI) fast spin echo (FSE) (in-phase and out-of-phase, with and without fat suppression); T2 -WI FSE; diffusion-WI single-shot echo planner with b-values of 0 and 1000 s/mm2 ; and dynamic contrast-enhanced perfusion T1 -WI liver acquisition with volume acceleration (LAVA). ASSESSMENT All MRI examinations were evaluated by three radiologists, and the AM were categorized into five scores based on the ADNEX MR Scoring system. Score 1: no AM; 2: benign AM; 3: probably benign AM; 4: indeterminate AM; 5: probably malignant AM. Histopathology and imaging follow-up were used as the standard references for evaluating the validity of the ADNEX MR Scoring system for detecting ovarian malignancy. STATISTICAL TESTS Four-fold table test, kappa statistics (κ), and receiver operating characteristic (ROC) curve. RESULTS In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (κ = 0.861). DATA CONCLUSION The current study supports the high validity and reproducibility of the ADNEX MR Scoring system for the diagnosis of sonographically indeterminate AM. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
| | - Hossam M Abdelrahman
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Maha Ibrahime Metwally
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Ali Alayouty
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nesreen Mohey
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hosam Nabil Almassry
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El Sammak
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radio-Diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | | | - Walid Mosallam
- Department of Radio-Diagnosis, Faculty of Human Medicine, Suez Canal University, Ismailia, Egypt
| | - Waleed S Abo Shanab
- Department of Radio-Diagnosis, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Safaa A Ibrahim
- Department of Obstetrics & Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ekramy A Mohamed
- Department of Obstetrics & Gynecology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Abd El Motaleb Mohamed
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ola A Harb
- Department of Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Taghreed M Azmy
- Department of Radio-Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Mokry T, Mlynarska-Bujny A, Kuder TA, Hasse FC, Hog R, Wallwiener M, Dinkic C, Brucker J, Sinn P, Gnirs R, Kauczor HU, Schlemmer HP, Rom J, Bickelhaupt S. Ultra-High- b-Value Kurtosis Imaging for Noninvasive Tissue Characterization of Ovarian Lesions. Radiology 2020; 296:358-369. [PMID: 32544033 DOI: 10.1148/radiol.2020191700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background MRI with contrast material enhancement is the imaging modality of choice to evaluate sonographically indeterminate adnexal masses. The role of diffusion-weighted MRI, however, remains controversial. Purpose To evaluate the diagnostic performance of ultra-high-b-value diffusion kurtosis MRI in discriminating benign and malignant ovarian lesions. Materials and Methods This prospective cohort study evaluated consecutive women with sonographically indeterminate adnexal masses between November 2016 and December 2018. MRI at 3.0 T was performed, including diffusion-weighted MRI (b values of 0-2000 sec/mm2). Lesions were segmented on b of 1500 sec/mm2 by two readers in consensus and an additional independent reader by using full-lesion segmentations on a single transversal slice. Apparent diffusion coefficient (ADC) calculation and kurtosis fitting were performed. Differences in ADC, kurtosis-derived ADC (Dapp), and apparent kurtosis coefficient (Kapp) between malignant and benign lesions were assessed by using a logistic mixed model. Area under the receiver operating characteristic curve (AUC) for ADC, Dapp, and Kapp to discriminate malignant from benign lesions was calculated, as was specificity at a sensitivity level of 100%. Results from two independent reads were compared. Histopathologic analysis served as the reference standard. Results A total of 79 ovarian lesions in 58 women (mean age ± standard deviation, 48 years ± 14) were evaluated. Sixty-two (78%) lesions showed benign and 17 (22%) lesions showed malignant histologic findings. ADC and Dapp were lower and Kapp was higher in malignant lesions: median ADC, Dapp, and Kapp were 0.74 µm2/msec (range, 0.52-1.44 µm2/msec), 0.98 µm2/msec (range, 0.63-2.12 µm2/msec), and 1.01 (range, 0.69-1.30) for malignant lesions, and 1.13 µm2/msec (range, 0.35-2.63 µm2/msec), 1.45 µm2/msec (range, 0.44-3.34 µm2/msec), and 0.65 (range, 0.44-1.43) for benign lesions (P values of .01, .02, < .001, respectively). AUC for Kapp of 0.85 (95% confidence interval: 0.77, 0.94) was higher than was AUC from ADC of 0.78 (95% confidence interval: 0.67, 0.89; P = .047). Conclusion Diffusion-weighted MRI by using quantitative kurtosis variables is superior to apparent diffusion coefficient values in discriminating benign and malignant ovarian lesions and might be of future help in clinical practice, especially in patients with contraindication to contrast media application. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Theresa Mokry
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Anna Mlynarska-Bujny
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Tristan Anselm Kuder
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Felix Christian Hasse
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Robert Hog
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Markus Wallwiener
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Christine Dinkic
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Janina Brucker
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Peter Sinn
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Regula Gnirs
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Hans-Ulrich Kauczor
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Heinz-Peter Schlemmer
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Joachim Rom
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
| | - Sebastian Bickelhaupt
- From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.)
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Qualitative and quantitative comparison of image quality between single-shot echo-planar and interleaved multi-shot echo-planar diffusion-weighted imaging in female pelvis. Eur Radiol 2019; 30:1876-1884. [PMID: 31822971 PMCID: PMC7062860 DOI: 10.1007/s00330-019-06491-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/20/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To qualitatively and quantitatively compare the image quality between single-shot echo-planar (SS-EPI) and multi-shot echo-planar (IMS-EPI) diffusion-weighted imaging (DWI) in female pelvis METHODS: This was a prospective study involving 80 females who underwent 3.0T pelvic magnetic resonance imaging (MRI). SS-EPI and IMS-EPI DWI were acquired with 3 b values (0, 400, 800 s/mm2). Two independent reviewers assessed the overall image quality, artifacts, sharpness, and lesion conspicuity based on a 5-point Likert scale. Regions of interest (ROI) were placed on the endometrium and the gluteus muscles to quantify the signal intensities and apparent diffusion coefficient (ADC). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and geometric distortion were quantified on both sequences. Inter-rater agreement was assessed using κ statistics and Kendall test. Qualitative scores were compared using Wilcoxon signed-rank test and quantitative parameters were compared with paired t test and Bland-Altman analysis. RESULTS IMS-EPI demonstrated better image quality than SS-EPI for all aspects evaluated (SS-EPI vs. IMS-EPI: overall quality 3.04 vs. 4.17, artifacts 3.09 vs. 3.99, sharpness 2.40 vs. 4.32, lesion conspicuity 3.20 vs. 4.25; p < 0.001). Good agreement and correlation were observed between two reviewers (SS-EPI κ 0.699, r 0.742; IMS-EPI κ 0.702, r 0.789). IMS-EPI showed lower geometric distortion, SNR, and CNR than SS-EPI (p < 0.050). There was no significant difference in the mean ADC between the two sequences. CONCLUSION IMS-EPI showed better image quality with lower geometric distortion without affecting the quantification of ADC, though the SNR and CNR decreased due to post-processing limitations. KEY POINTS • IMS-EPI showed better image quality than SS-EPI. • IMS-EPI showed lower geometric distortion without affecting ADC compared with SS-EPI. • The SNR and CNR of IMS-EPI decreased due to post-processing limitations.
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Ibrahim RSM, Maher MAELO, Abdalaziz S, Amer S, Shafie D, Hamed ST. Functional MRI in the pre-operative assessment of GI-RADS 3, 4, and 5 ovarian masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Characterization of an ovarian lesion is a diagnostic challenge. A correct preoperative assessment is of great importance so as to arrange adequate therapeutic procedures. The aim of the current study is to evaluate the diagnostic performance of functional MRI in differentiation between malignant, borderline, and benign ovarian masses.
Results
This study included 56 adnexal lesions. Bilateral synchronous ovarian lesions are detected in 16 cases. Postoperative histologically proved to be benign in 17 (30%), borderline (low potential malignancy) in 12 (22%), and malignant in 27 (48%). The overall diagnostic performance of conventional MRI in the diagnosis of adenexal lesion was a sensitivity of 74%, specificity of 47%, positive predictive value (PPV) of 76%, negative predictive value (NPV) of 44%, and an accuracy of 66%. Functional pelvic MRI examination showed an increase in overall diagnostic performance compared to conventional values with the highest sensitivity of 90% and NPV of 67% using DWI, and the highest specificity of 88%, PPV of 94%, and an accuracy of 82% using DCE MRI.
Conclusion
Functional MRI in conjugation with conventional MRI plays a key role in the ovarian lesion detection, characterization, and staging. Functional MRI is currently being evaluated as possible predictive and prognostic biomarkers in ovarian lesions.
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Jayasankaran SC, Chelakkot PG, Prabhakaran P, Sekhar R. Role of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Ovarian Tumours. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mansour SM, Gomma MMM, Shafik PN. Proton MR spectroscopy and the detection of malignancy in ovarian masses. Br J Radiol 2019; 92:20190134. [PMID: 31287729 DOI: 10.1259/bjr.20190134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the impact of MR spectroscopy (MRS) on the detection of malignancy in ovarian masses. METHODS This prospective work included 230 females that had 245 adnexal/ovarian masses. Tumours were spotted by preliminary pelvic ultrasound. Masses assessed by MRI, multi- or single-voxel spectroscopy. Patients' spectra were assessed for peaks of lactate (Lac, 1.31 ppm), lipid (Lip, 1.33 ppm), N-acetyl aspartate (2.0 ppm), acetone (A, 2.05 ppm), choline (Cho, 3.23 ppm) and creatinine (Cr, 3.4 ppm) and the mean values of the (Cho/Cr) ratios were performed by a semi-quantitative approach. The operative pathology served as the standard of reference. RESULTS Cho peak twofold higher than the average noise level was detected in 72% of the malignant and only 5.4% of the benign masses with an accuracy of 83%. Adding lactate to the choline enhanced the accuracy to 93%. The mean Cho/Cr ratios of the malignant ovarian masses (2.8) were significantly higher than that of the benign ones (1.2) . We used a receiver operating characteristic curve to determine the best cut-off value (1.7) for the mean Cho/Cr ratio to discriminate malignancy with sensitivity: 81.2%, specificity: 93.3 %, positive-predictive value: 92.9 %, negative-predictive value: 82.4% and accuracy: 87.1%. CONCLUSION The simultaneous presence of choline and lactate peaks in MRS examination of the ovarian masses minimizes the overlap between benign and malignant categories. N-acetyl aspartate and acetone are the metabolites for diagnosing complex cystic masses as benign teratoma, endomterioma and tubo- ovarian abscess. ADVANCES IN KNOWLEDGE MRS is a non-contrast based and fast MR sequence that gives an idea about tissue components could be used to improve the sensitivity and the accuracy of detecting malignancy in ovarian masses.
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Affiliation(s)
- Sahar Mahmoud Mansour
- 1Department of Radiology (Women's imaging unit), Kasr ElAiny Hospital - Faculty of Medicine - Cairo University, Cairo, Egypt
| | | | - Peter Nashaat Shafik
- 2Department of Radiology, National Cancer Institute- Faculty of Medicine - Cairo University, Cairo, Egypt
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Kim SH. Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging. Yeungnam Univ J Med 2019; 36:231-240. [PMID: 31620638 PMCID: PMC6784647 DOI: 10.12701/yujm.2019.00234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023] Open
Abstract
Background We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas. Methods Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), Ktrans (vessel permeability), and Ve (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences. Results There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, Ktrans, and Ve values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively. Conclusion Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.
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Affiliation(s)
- See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
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Malek M, Oghabian Z, Tabibian E, Rahmani M, Miratashi Yazdi SN, Oghabian MA, Parviz S. Comparison of Qualitative (Time Intensity Curve Analysis), Semi-Quantitative, and Quantitative Multi-Phase 3T DCEMRI Parameters as Predictors of Malignancy in Adnexal. Asian Pac J Cancer Prev 2019; 20:1603-1611. [PMID: 31244278 PMCID: PMC7021620 DOI: 10.31557/apjcp.2019.20.6.1603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Indexed: 01/08/2023] Open
Abstract
Objective: The present study aimed to compare the qualitative (time intensity curve analysis), the semi-quantitative and the quantitative multiphase 3T dynamic contrast-enhanced (DCE) MRI parameters as predictors of malignancy in adnexal masses. Materials and Methods: In this prospective study, women with an adnexal mass who were scheduled for surgical resection or were followed for more than one year period to confirm the benignity of their lesions, underwent multiphase 3T DCE-MRI. The qualitative (time intensity curve), semi-quantitative (SImax, SIrel, WIR) and quantitative (Ktrans, Kep, Vb) analyses were performed on DCE-MRI sequences and their predictive values were compared. Results: A total of 17 benign and 14 malignant lesions were included. According to the qualitative analysis, none of the lesions with Type I time intensity curves (TIC) were malignant and none of the masses with Type III TICs were benign. The accuracy of the quantitative parameters in detection of malignancy was found to be higher than that of semi-quantitative variables, particularly when calculated for a small ROI within the high signal area of the mass (sROI) rather than the largest ROI including the whole mass (lROI), and when inter-MRI variations were omitted using ratios. The Kep(tumor)/Kep(myometrium) ratio measured from sROI was the best parameter for differentiating a malignant lesion with a sensitivity of 100% and a specificity of 92.3%. Conclusion: We concluded that a Type I TIC confirms a benign lesion, and a type III TIC confirms the malignancy and further evaluation is not recommended for these lesions. So complementary quantitative analysis is only recommended for adnexal masses with type II TICs.
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Affiliation(s)
- Mehrooz Malek
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Zeynab Oghabian
- Neuroimaging and Analysis Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Tabibian
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Rahmani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Nooshin Miratashi Yazdi
- Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Oghabian
- Neuroimaging and Analysis Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Parviz
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
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External validation of ADNEX MR SCORING system: a single-centre retrospective study. Clin Radiol 2018; 74:131-139. [PMID: 30514585 DOI: 10.1016/j.crad.2018.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/31/2018] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the accuracy of the ADNEX MR SCORING system for characterising adnexal masses. MATERIALS AND METHODS An institutional review board approved this retrospective study. The study population comprised 663 women who underwent magnetic resonance imaging (MRI) from January 2007 to December 2014 to characterise 778 adnexal masses that were indeterminate under ultrasonography (590 benign and 188 malignant). Two radiologists independently reviewed the MRI images. The masses were scored from 1 to 5 according to the ADNEX MR SCORING system. The diagnostic performance of the system was evaluated by receiver operating characteristic (ROC) analysis. Masses scored 4 or greater were considered malignant (including tumours of borderline malignancy or low malignant potential). RESULTS The malignancy rates of masses with scores of 2, 3, 4 and 5 were 1.9% (8/419), 12.8% (19/149), 62.6% (57/91) and 87.4% (104/119) for reader 1 and 2.1% (9/424), 13.6% (20/147), 67.6% (71/105) and 86.3% (88/102) for reader 2, respectively. The areas under the ROC curves for the differentiation of benign and malignant masses were 0.929 and 0.923, respectively; the sensitivity, specificity and accuracy of diagnosis were 85.6% (161/188), 91.7% (541/590), and 90.2% (702/778) for reader 1 and 84.6% (159/188), 91.9% (542/590), and 90.1% (701/778) for reader 2, respectively. Tumours of borderline malignancy or low malignant potential had a higher rate of misclassification (46.1%) than other malignant tumours (6-7.4%). CONCLUSION The ADNEX MR SCORING system was highly accurate in differentiating benign and malignant adnexal masses, although it may be less accurate for tumours of borderline malignancy or low malignant potential.
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The utility of magnetic resonance imaging in the diagnosis and management of pediatric benign ovarian lesions. J Pediatr Surg 2018; 53:2013-2018. [PMID: 29433795 DOI: 10.1016/j.jpedsurg.2017.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The utility of magnetic resonance imaging (MRI) in the diagnosis and management of pediatric ovarian lesions has not been well defined. METHODS A retrospective review of all girls who underwent MRI evaluation of ovarian masses during the period 2009-2015 was performed. The accuracy of MRI was evaluated by comparing results with surgical findings, pathology reports, and subsequent imaging. The influence of the MRI on the treatment plan was specifically explored. RESULTS Eighteen girls, 12-17years of age, underwent 27 MRIs, subsequent to ultrasound identification of ovarian lesions. Of 9 neoplastic lesions diagnosed on MRI, 8 (89%) were confirmed by surgical and pathological findings. Of 18 functional lesions, 17 (94.4%) were confirmed pathologically or by resolution on subsequent imaging. Twenty MRI exams (74%) directly influenced the treatment plan, by leading to appropriate operative intervention in 9 and appropriate observation in 11. The extent of ovarian resection was guided by MRI findings in 8 of 9 (89%) neoplastic lesions. For characterizing lesions as neoplastic, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI were 89%, 94%, 94%, 89%, and 93% respectively. CONCLUSIONS MRI can differentiate functional from neoplastic pediatric ovarian masses, and guide ovarian resection in appropriate cases. LEVEL OF STUDY II.
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Fan H, Wang TT, Ren G, Fu HL, Wu XR, Chu CT, Li WH. Characterization of tubo-ovarian abscess mimicking adnexal masses: Comparison between contrast-enhanced CT, 18F-FDG PET/CT and MRI. Taiwan J Obstet Gynecol 2018; 57:40-46. [PMID: 29458901 DOI: 10.1016/j.tjog.2017.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 02/08/2023] Open
Abstract
0BJECTIVE: We compared the diagnostic accuracy of contrast-enhanced computed tomography (CT), fluorine 18-labeled-fludeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and conventional magnetic resonance imaging (MRI) without and with diffusion-weighted imaging (DWI) for characterization of tubo-ovarian abscesses (TOAs) that mimic adnexal tumors. MATERIALS AND METHODS We evaluated (retrospectively) 43 patients who underwent contrast-enhanced CT, PET/CT, conventional MRI without and with DWI, and who were found to have TOAs and complex adnexal tumors. All images were evaluated independently by four radiologists using a two-point grading system. Results of contrast-enhanced CT, PET/CT, MRI without DWI, and MRI with DWI were compared for each patient using receiver operating characteristic curves. Sensitivity, specificity, and positive predictive value (PPV) were calculated and compared using the chi-square test. RESULTS Sensitivity of MRI with DWI (95%) was significantly higher than that of contrast-enhanced CT (78.6%), PET/CT (86.7%) and MRI without DWI (87.5%). Specificities of these modalities were not significantly different. The PPV of MRI with DWI (100%) was significantly higher than that of the other three modalities (CT, 72.4%; PET/CT 78.5%; MRI without DWI, 81.5%). Overall accuracy of MRI with DWI was significantly higher than that of the other three modalities (CT, 74.4%; PET/CT, 81.4%; MRI without DWI, 83.7%). CONCLUSION MRI with DWI shows high accuracy for characterization of complex ovarian lesions, and is the most useful method for differentiation of TOAs from ovarian tumors.
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Affiliation(s)
- Hua Fan
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Ting-Ting Wang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Gang Ren
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Hong-Liang Fu
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Xiang-Ru Wu
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Cai-Ting Chu
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Wen-Hua Li
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China.
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Ahmed SA, Ahmed El Taieb H. Variations in radiological features between primary and secondary ovarian malignancies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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The diagnostic potential of diffusion weighted and dynamic contrast enhanced MR imaging in the characterization of complex ovarian lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Nishio N, Kido A, Kataoka M, Kuwahara R, Nakao K, Kurata Y, Matsumura N, Mandai M, Togashi K. Longitudinal changes in magnetic resonance imaging of malignant and borderline tumors associated with ovarian endometriotic cyst comparing with endometriotic cysts without arising malignancy. Eur J Radiol 2018; 105:175-181. [DOI: 10.1016/j.ejrad.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
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Lam CZ, Chavhan GB. Magnetic resonance imaging of pediatric adnexal masses and mimics. Pediatr Radiol 2018; 48:1291-1306. [PMID: 30078037 DOI: 10.1007/s00247-018-4073-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/07/2017] [Accepted: 01/03/2018] [Indexed: 01/09/2023]
Abstract
Evaluation of adnexal masses in children and adolescents relies on imaging for appropriate diagnosis and management. Pelvic MRI is indicated and adds value for all adnexal masses when surgery is considered or when ultrasound findings are indeterminate. Specifically, features on MR imaging can help distinguish between benign and malignant lesions, which not only influences the decision between surgery and conservative treatment, but also the type of surgery to be performed, including potential use of fertility-sparing approaches with minimally invasive techniques. Larger size, younger age, presentation with precocious puberty or virilization, restricted diffusion in a solid mass, and rapid and strong enhancement of solid components are all features concerning for malignancy. In addition, distinctive MR imaging features of adnexal masses, combined with clinical and laboratory biomarkers, might suggest a specific histological diagnosis.
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Affiliation(s)
- Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
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Improving women's health in low-income and middle-income countries. Part II: the needs of diagnostic imaging. Nucl Med Commun 2018; 38:1024-1028. [PMID: 28953209 PMCID: PMC5704652 DOI: 10.1097/mnm.0000000000000752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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An H, Lee E, Chiu K, Chang C. The emerging roles of functional imaging in ovarian cancer with peritoneal carcinomatosis. Clin Radiol 2018; 73:597-609. [DOI: 10.1016/j.crad.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/09/2018] [Indexed: 12/22/2022]
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Zhang H, Zhang H, Gu S, Zhang Y, Liu X, Zhang G. MR findings of primary ovarian granulosa cell tumor with focus on the differentiation with other ovarian sex cord-stromal tumors. J Ovarian Res 2018; 11:46. [PMID: 29871662 PMCID: PMC5989475 DOI: 10.1186/s13048-018-0416-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 05/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To describe magnetic resonance imaging (MRI) features of ovarian granulosa cell tumors (OGCTs) and compare with other sex cord-stromal tumors (OSCs) in ovary. METHODS MR findings of 18 patients with surgically confirmed ovarian granulosa cell tumor were retrospectively reviewed by two radiologists with consensus reading. All MR examinations were prospectively performed within one month. Clinical and imaging characteristics of OGCTs were evaluated and compared with OSCs (control group). RESULTS In 18 patients, 20 ovarian granulosa cell tumors were detected on MRI. Sixteen tumors appeared as solid or mostly solid mass (16/20), while 4 tumors as cystic mass. Pathological pelvic fluid was detected in 1 OGCT (1/18) and 11 OSCs (11/34) (p = 0.031).On T2 weighted imaging (T2WI), most of OGCTs displayed hyperintense signal and mixed signal (19/20); on T1 weighted imaging (T1WI), 11 OGCTs (11/20) displayed similar signal as on T2WI imaging. The lesion signal between OGCT and OSC differed significantly on both T1WI (p = 0.017) and T2WI (p = 0.002). Tumoral bleeding was detected in 6 OGCTs on MRI. On diffusion weighted imaging (DWI) images, OGCTs mostly appeared as high signal (16/20). Average apparent diffusion coefficient (ADC) value derived from DWI images in the OGCT group (0.84 ± 0.26× 10- 3 mm2/s was less than the control group (1.22 ± 0.47 × 10- 3 mm2/s) with statistical difference (p = 0.002). CONCLUSIONS MRI could provide important information in OGCT diagnosis. ADC value might be useful in differentiating OGCT from OSC.
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Affiliation(s)
- He Zhang
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Hongyu Zhang
- 0000 0004 1757 9055grid.452354.1Department of Ultrasound, Daqing Oilfield General Hospital, Daqing, Heilongjiang Province 163001 People’s Republic of China
| | - Shouxin Gu
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Yanyu Zhang
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Xuefen Liu
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Guofu Zhang
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
- 0000 0001 0125 2443grid.8547.eInstitute of functional and molecular medical imaging, Fudan University, Shanghai, 200040 People’s Republic of China
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A systematic approach to adnexal masses discovered on ultrasound: the ADNEx MR scoring system. Abdom Radiol (NY) 2018; 43:679-695. [PMID: 28900696 DOI: 10.1007/s00261-017-1272-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Adnexal lesions are a common occurrence in radiology practice and imaging plays a crucial role in triaging women appropriately. Current trends toward early detection and characterization have increased the need for accurate imaging assessment of adnexal lesions prior to treatment. Ultrasound is the first-line imaging modality for assessing adnexal lesions; however, approximately 20% of lesions are incompletely characterized after ultrasound evaluation. Secondary assessment with MR imaging using the ADNEx MR Scoring System has been demonstrated as highly accurate in the characterization of adnexal lesions and in excluding ovarian cancer. This review will address the role of MR imaging in further assessment of adnexal lesions discovered on US, and the utility of the ADNEx MR Scoring System.
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Sadowski EA, Paroder V, Patel-Lippmann K, Robbins JB, Barroilhet L, Maddox E, McMahon T, Sampene E, Wasnik AP, Blaty AD, Maturen KE. Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer. Radiology 2018; 287:1041-1049. [PMID: 29480762 DOI: 10.1148/radiol.2018172271] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the prevalence of indeterminate adnexal cysts in women presenting to academic medical centers for pelvic ultrasonography (US), determine the incidence of malignancy, and identify cyst and patient characteristics that are predictive of malignancy. Materials and Methods A multicenter study of US-detected adnexal cysts with appropriate follow-up (surgical pathologic examination, imaging and/or clinical examination) was conducted from January 2008 to June 2012. Indeterminate cysts were classified as category 1 (typical benign appearing cysts >5 cm) or category 2 (cysts with avascular solid components) on the basis of a combination of definitions in the existing literature. The incidence of neoplasms and malignant tumors was calculated. Patient and cyst characteristics associated with neoplasm and malignant tumors were evaluated with the χ2 test or Fisher exact test for categorical variables and the t test for continuous variables. A backward stepwise logistic regression model was performed for two outcomes: (a) the presence of any neoplasm (benign or malignant) and (b) the presence of a malignant tumor. Results There were 1637 women with an adnexal cyst at US; 391 (mean age = 41.8 years ± 13.5.1; range = 17-91 years) had an indeterminate adnexal cyst at US. The prevalence of indeterminate adnexal cysts was 23.9% (391 of 1637; 95% confidence interval [CI]: 0.22, 0.26). Three hundred three indeterminate cysts in 280 women (mean age = 42.9 years ± 14.1; range = 17-88 years) had adequate follow-up. The incidence of ovarian neoplasms (benign and malignant) was 24.8% (75 of 303 cysts; 95% CI: 0.20, 0.30), and the incidence of malignant tumors was 3.6% (11 of 303 cysts; 95% CI: 0.02, 0.06). The proportion of ovarian neoplasms differed between category 1 and category 2 cysts (17.5% [25 of 143 cysts; 95% CI: 0.12, 0.25] vs 31.3% [50 of 160 cysts; 95% CI: 0.24, 0.39], respectively; P = .001). The proportion of malignant tumors differed between categories 1 and 2 cysts (0% [0 of 143 cysts] vs 6.9% [11 of 160 cysts; 95% CI: 0.03, 0.12]; P < .001). The presence of an avascular nodular component was a significant predictor of malignancy at stepwise logistic regression analysis (odds ratio = 2.83; P ≤ .0001; 95% CI: 1.69, 4.70). Conclusion The presence of an avascular nodular component was the most significant predictor of the presence of malignancy in indeterminate adnexal cysts. The risk of malignancy is higher with category 2 cysts than with category 1 cysts. © RSNA, 2018.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Viktoriya Paroder
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Krupa Patel-Lippmann
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Jessica B Robbins
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Lisa Barroilhet
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Elizabeth Maddox
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Timothy McMahon
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Emmanuel Sampene
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Ashish P Wasnik
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Alexander D Blaty
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
| | - Katherine E Maturen
- From the Departments of Radiology (E.A.S., J.B.R., E.M.), Obstetrics and Gynecology (E.A.S., L.B.), and Biostatistics and Medical Informatics (E.S.), University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/372, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (V.P., T.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology (A.P.W., A.D.B., K.E.M.) and Department of Obstetrics and Gynecology (K.E.M.), University of Michigan Health System, Ann Arbor, Mich
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Cappabianca S, Iaselli F, Reginelli A, D'Andrea A, Urraro F, Grassi R, Rotondo A. Value of Diffusion-Weighted Magnetic Resonance Imaging in the Characterization of Complex Adnexal Masses. TUMORI JOURNAL 2018; 99:210-7. [DOI: 10.1177/030089161309900215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aims and background The aim of the study was to define the role of diffusion-weighted imaging in the characterization of adnexal complex masses, with particular regard to the distinction between benign and malignant lesions. Conflicting results on this topic have emerged from studies in the last decade, with a consequent substantial limitation to the use of this relatively novel technique in clinical practice. Methods and study design Magnetic resonance imaging examinations performed on 91 patients with ovarian masses (56 benign, 35 malignant) were retrospectively evaluated by two observers unaware of the final histopathological diagnosis. Diffusion-weighted sequences with b values of 0, 500 and 1000 were performed in all cases, and apparent diffusion coefficient maps were automatically generated. The signals of both the cystic and solid components of the ovarian masses were evaluated on T2-weighted and diffusion-weighted images acquired with a b value of 1000. Apparent diffusion coefficient values were measured in all cases. Results With regard to the solid components, hypointensity on both the T2-weighted and diffusion-weighted images has proved to be a reliable indicator of benignancy. In contrast, hyperintensity on both sequences was suggestive of malignancy. Signal intensity of the cystic components and apparent diffusion coefficient values of both components have not proven useful in characterization of the masses. Conclusions Only the definition of the signal intensities on diffusion-weighted images obtained with the use of high b values on the solid component of a complex adnexal mass is useful to characterize an ovarian mass as benign or malignant.
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Affiliation(s)
- Salvatore Cappabianca
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Francesco Iaselli
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Alfonso Reginelli
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Alfredo D'Andrea
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Fabrizio Urraro
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Roberto Grassi
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
| | - Antonio Rotondo
- Dipartimento di Internistica Clinica e Sperimentale “F Magrassi, A Lanzara”, Unità di Radiologia, Radioterapia e Medicina Nucleare, Seconda Università di Napoli, Naples, Italy
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The role of dynamic contrast enhanced MR imaging in the assessment of inconclusive ovarian masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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40
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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41
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Park SB. Functional MR imaging in gynecologic malignancies: current status and future perspectives. Abdom Radiol (NY) 2016; 41:2509-2523. [PMID: 27743019 DOI: 10.1007/s00261-016-0924-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Using functional MR imaging techniques, we can approach the functional assessment of gynecologic malignancies. Among them, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MR imaging (DCE-MRI) are two important techniques. This article provides an overview of functional MR imaging techniques, focusing DWI and DCE-MRI on clinical application in gynecologic malignancies. Functional MR imaging techniques play an important role in detection, characterization, staging, treatment response, and outcome prediction, as well as providing conventional morphologic imaging. Familiarity with the characteristics and imaging features of functional MR imaging in gynecologic malignancies will facilitate prompt and accurate diagnosis and treatment.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea.
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Mahajan A, Sable NP, Popat PB, Bhargava P, Gangadhar K, Thakur MH, Arya S. Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management. Semin Ultrasound CT MR 2016; 38:231-268. [PMID: 28705370 DOI: 10.1053/j.sult.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Nilesh P Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Palak B Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
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Khalil RM, El-Dieb LR. Sonographic and MRI features of ovarian torsion. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Dynamic-contrast enhanced (DCE) and diffusion-weighted (DW) MR imaging are invaluable in the detection, staging, and characterization of uterine and ovarian malignancies, for monitoring treatment response, and for identifying disease recurrence. When used as adjuncts to morphologic T2-weighted (T2-W) MR imaging, these techniques improve accuracy of disease detection and staging. DW-MR imaging is preferred because of its ease of implementation and lack of need for an extrinsic contrast agent. MR spectroscopy is difficult to implement in the clinical workflow and lacks both sensitivity and specificity. If used quantitatively in multicenter clinical trials, standardization of DCE- and DW-MR imaging techniques and rigorous quality assurance is mandatory.
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Affiliation(s)
- Nandita M deSouza
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
| | - Andrea Rockall
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, DuCane Road, London W12 0HS, UK; Department of Radiology, Imperial College, South Kensington, London SW7 2AZ, UK
| | - Susan Freeman
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
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Revisiting the role of MRI in gynecological emergencies – An institutional experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Xu Y, Yang J, Zhang Z, Zhang G. MRI for discriminating metastatic ovarian tumors from primary epithelial ovarian cancers. J Ovarian Res 2015; 8:61. [PMID: 26310488 PMCID: PMC4551762 DOI: 10.1186/s13048-015-0188-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/25/2015] [Indexed: 01/30/2023] Open
Abstract
AIMS To find specific magnetic resonance imaging (MRI) features to differentiate metastatic ovarian tumors from primary epithelial ovarian cancers. METHODS Eleven cases with metastatic ovarian tumors and 26 cases with primary malignant epithelial ovarian cancers were retrospectively studied. All features such as patient characteristics, MRI findings and biomarkers were evaluated. The differences including laterality, configuration, uniformity of locules, diffusion weighted imaging (DWI) signal of solid components and enhancement of solid portions between metastatic ovarian tumors and primary epithelial ovarian cancers were compared by Fisher's exact test. Median age of patients, the maximum diameter of lesions and biomarkers were compared by the Mann-Whitney test. RESULTS Patients with metastatic ovarian tumors were younger than patients with primary epithelial ovarian cancers in the median age (P = 0.015). Patients with bilateral tumors in metastatic ovarian tumors were more than those of primary epithelial ovarian cancers (P = 0.032). The maximum diameter of lesions in metastatic ovarian tumors was smaller than that of primary epithelial ovarian cancers (P = 0.005). The locules in metastatic ovarian tumors were more uniform than those of primary epithelial ovarian cancers (P = 0.024). The enhancement of solid portions in metastatic ovarian tumors showed more moderate than that of primary epithelial ovarian cancers (P = 0.037). There was no statistically significant difference between the two groups in configuration, DWI signal of solid components and ascites. Biomarkers such as CA125 and human epididymis protein 4 (HE4) in metastatic ovarian tumors showed less elevated than that of primary epithelial ovarian cancers. CONCLUSIONS Significant differences between metastatic ovarian tumors and primary epithelial ovarian cancers were found in the median age of patients, laterality, the maximum diameter of lesions, uniformity of locules, enhancement patterns of solid portions and biomarkers. Metastatic ovarian tumors usually presented in the younger patients, smaller-sized, more bilateral lesions, more uniform of locules, more moderate enhancement of solid portions, and less elevated levels of CA125 and HE4 than those of primary epithelial ovarian cancers.
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Affiliation(s)
- Yanhong Xu
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Jia Yang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Zaixian Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Guixiang Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China.
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Added Value of Assessing Adnexal Masses with Advanced MRI Techniques. BIOMED RESEARCH INTERNATIONAL 2015; 2015:785206. [PMID: 26413542 PMCID: PMC4564594 DOI: 10.1155/2015/785206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/23/2014] [Accepted: 12/07/2014] [Indexed: 12/16/2022]
Abstract
This review will present the added value of perfusion and diffusion MR sequences to characterize adnexal masses. These two functional MR techniques are readily available in routine clinical practice. We will describe the acquisition parameters and a method of analysis to optimize their added value compared with conventional images. We will then propose a model of interpretation that combines the anatomical and morphological information from conventional MRI sequences with the functional information provided by perfusion and diffusion weighted sequences.
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Mansour SM, Saraya S, El-Faissal Y. Semi-quantitative contrast-enhanced MR analysis of indeterminate ovarian tumours: when to say malignancy? Br J Radiol 2015; 88:20150099. [PMID: 26083260 DOI: 10.1259/bjr.20150099] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the ability of dynamic post-contrast sequence to specify indeterminate ovarian masses with inconclusive MR features of malignancy. Since management is dramatically different, special focus on the ability to differentiate borderline from invasive malignancy was considered. METHODS 150 ovarian masses were detected by pelvic ultrasound in 124 patients. Masses had been considered for dynamic post-contrast MRI. We expressed the kinetic parameters (i.e. enhancement amplitude, time peak of maximal uptake and maximal slope) in the form of maximum relative enhancement percentage (MRE%), time of maximal peak of contrast uptake (Tmax) and slope enhancement ratio (SER) curves. Histological findings were the gold standard of reference. RESULTS Malignant ovarian masses showed higher MRE% than benign and borderline masses (p < 0.001). Tmax was shorter for malignant than benign (p < 0.01) and borderline (p < 0.001) ovarian masses. SER curves were the most suggestive of malignancy with a specificity and accuracy of 85.7% and 84.7%, respectively. CONCLUSION Dynamic contrast-enhanced MRI could be a specific sequence to differentiate ovarian masses with indeterminate MR morphology with a special discrimination for low potential from invasive ovarian malignancy. ADVANCES IN KNOWLEDGE The study evaluated the diagnostic performance of the individual parameters of dynamic post-contrast MR sequence in evaluating ovarian masses. Management divert between benign, borderline and invasive malignant masses; our work presented a cut-off value for the peak of contrast uptake of 120%, which helped in the differentiation between benign and malignant tumours; the SER curves with Type III (early washout) pattern that was indicative of invasive malignancy was more specific than borderline malignancy.
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Affiliation(s)
- S M Mansour
- 1 Radiology Department (Women's Imaging Unit), Faculty of Medicine, Cairo University, Kasr El Aini Hospital, Cairo, Egypt
| | - S Saraya
- 2 Radiology Department, Faculty of Medicine, Cairo University, Egypt
| | - Y El-Faissal
- 3 Obstetrics and Gynaecology Department, Faculty of Medicine, Cairo University, Egypt
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Jalaguier-Coudray A, Jacquemier J, Villard-Mahjoub R, Delarbre B, Thomassin-Piana J. Pourquoi la macroscopie est-elle essentielle pour comprendre et analyser les tumeurs ovariennes ? IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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