Research

13 pages, 2488 KiB

Open AccessArticle

Performance of MRI for Detection of ≥pT1b Disease in Local Staging of Endometrial Cancer

by Leonie Van Vynckt, Philippe Tummers, Hannelore Denys, Menekse Göker, Sigi Hendrickx, Eline Naert, Rawand Salihi, Koen Van de Vijver, Gabriëlle H. van Ramshorst, Donatienne Van Weehaeghe, Katrien Vandecasteele, Geert M. Villeirs and Pieter J. L. De Visschere

Cancers 2024, 16(6), 1142; https://doi.org/10.3390/cancers16061142 - 13 Mar 2024

Viewed by 643

Abstract

Magnetic resonance imaging (MRI) can be used for the preoperative local staging of endometrial cancer (EC). The presence of ≥pT1b disease (i.e., tumor invasion in ≥50% of the myometrium, into the cervical stroma or spread outside the uterus) has important prognostic value and [...] Read more.

Magnetic resonance imaging (MRI) can be used for the preoperative local staging of endometrial cancer (EC). The presence of ≥pT1b disease (i.e., tumor invasion in ≥50% of the myometrium, into the cervical stroma or spread outside the uterus) has important prognostic value and implications for the decision to perform lymphadenectomy. The purpose of this study was to assess the performance of MRI for the detection of ≥pT1b disease and to evaluate whether tumor size measured via MRI was predictive for ≥pT1b disease, independent of imaging signs of deep invasion. MRI T-staging and tumor diameter and volume were correlated with histopathology of the hysterectomy specimen in 126 patients. MRI had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 70.0%, 83.3%, 79.2%, 75.3% and 77.0%, respectively, for the detection of ≥pT1b disease. A tumor diameter of ≥40 mm and volume of ≥20 mL measured via MRI were predictive for ≥pT1b disease at rates of 78.3% and 87.1%, respectively. An EC size of at least 5 mm upon MRI was predictive for ≥pT1b disease in more than 50% of cases. Our results support the use of MRI in the preoperative staging of EC and suggest including size criteria in EC staging guidelines. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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13 pages, 10815 KiB

Open AccessArticle

Prediction of the Risk of Malignancy of Adnexal Masses during Pregnancy Comparing Subjective Assessment and Non-Contrast MRI Score (NCMS) in Radiologists with Different Expertise

by Camilla Panico, Silvia Bottazzi, Luca Russo, Giacomo Avesani, Veronica Celli, Luca D’Erme, Alessia Cipriani, Floriana Mascilini, Anna Fagotti, Giovanni Scambia, Evis Sala and Benedetta Gui

Cancers 2023, 15(21), 5138; https://doi.org/10.3390/cancers15215138 - 25 Oct 2023

Viewed by 837

Abstract

Ovarian cancer represents 7% of all cancers in pregnant women. Characterising an ovarian mass during pregnancy is essential to avoid unnecessary treatment and, if treatment is required, to plan it accordingly. Although ultrasonography (US) is the first-line modality to characterise adnexal masses, MRI [...] Read more.

Ovarian cancer represents 7% of all cancers in pregnant women. Characterising an ovarian mass during pregnancy is essential to avoid unnecessary treatment and, if treatment is required, to plan it accordingly. Although ultrasonography (US) is the first-line modality to characterise adnexal masses, MRI is indicated when adnexal masses are indeterminate at the US examination. An MRI risk stratification system has been proposed to assign a malignancy probability based on the adnexal lesion’s MRI, but features of the scoring system require the administration of intravenous gadolinium-based contrast agents, a method that might have a limited use in pregnant women. The non-contrast MRI score (NCMS) has been used and evaluated in non-pregnant women to characterise adnexal masses indeterminate at the US examination. Therefore, we evaluated the diagnostic accuracy of the NCMS in pregnant women, analysing 20 cases referred to our specialised institution. We also evaluated the diagnostic agreement between two radiologists with different expertise. The two readers classified ovarian masses as benign or malignant using both subjective assessment (SA), based on the interpretive evaluation of imaging findings derived from personal experience, and the NCMS, which includes five categories where 4 and 5 indicate a high probability of a malignant mass. The expert radiologist correctly classified 90% of the diagnoses, using both SA and the NCMS, relying on a sensitivity of 85.7% and a specificity of 92.3%, with a false positive rate of 7.7% and a false negative rate of 14.3%. The non-expert radiologist correctly identified patients at a lower rate, especially using the SA. The analysis of the inter-observer agreement showed a K = 0.47 (95% CI: 0.48–0.94) for the SA (agreement in 71.4% of cases) and a K = 0.8 (95% CI: 0.77–1.00) for the NCMS (agreement in 90% of cases). Although in pregnant patients, non-contrast MRI is used, our results support the use of a quantitative score, i.e., the NCMS, as an accurate tool. This procedure may help less experienced radiologists to reduce the rate of false negatives or positives, especially in centres not specialised in gynaecological imaging, making the MRI interpretation easier and more accurate for radiologists who are not experts in the field, either. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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15 pages, 2481 KiB

Open AccessArticle

Standardization of Body Composition Status in Patients with Advanced Urothelial Tumors: The Role of a CT-Based AI-Powered Software for the Assessment of Sarcopenia and Patient Outcome Correlation

by Antonella Borrelli, Martina Pecoraro, Francesco Del Giudice, Leonardo Cristofani, Emanuele Messina, Ailin Dehghanpour, Nicholas Landini, Michela Roberto, Stefano Perotti, Maurizio Muscaritoli, Daniele Santini, Carlo Catalano and Valeria Panebianco

Cancers 2023, 15(11), 2968; https://doi.org/10.3390/cancers15112968 - 29 May 2023

Viewed by 1604

Abstract

Background: Sarcopenia is a well know prognostic factor in oncology, influencing patients’ quality of life and survival. We aimed to investigate the role of sarcopenia, assessed by a Computed Tomography (CT)-based artificial intelligence (AI)-powered-software, as a predictor of objective clinical benefit in advanced [...] Read more.

Background: Sarcopenia is a well know prognostic factor in oncology, influencing patients’ quality of life and survival. We aimed to investigate the role of sarcopenia, assessed by a Computed Tomography (CT)-based artificial intelligence (AI)-powered-software, as a predictor of objective clinical benefit in advanced urothelial tumors and its correlations with oncological outcomes. Methods: We retrospectively searched patients with advanced urothelial tumors, treated with systemic platinum-based chemotherapy and an available total body CT, performed before and after therapy. An AI-powered software was applied to CT to obtain the Skeletal Muscle Index (SMI-L3), derived from the area of the psoas, long spine, and abdominal muscles, at the level of L3 on CT axial images. Logistic and Cox-regression modeling was implemented to explore the association of sarcopenic status and anthropometric features to the clinical benefit rate and survival endpoints. Results: 97 patients were included, 66 with bladder cancer and 31 with upper-tract urothelial carcinoma. Clinical benefit outcomes showed a linear positive association with all the observed body composition variables variations. The chances of not experiencing disease progression were positively associated with ∆_SMI-L3, ∆_psoas, and ∆_long spine muscle when they ranged from ~10–20% up to ~45–55%. Greater survival chances were matched by patients achieving a wider ∆_SMI-L3, ∆_abdominal and ∆_long spine muscle. Conclusions: A CT-based AI-powered software body composition and sarcopenia analysis provide prognostic assessments for objective clinical benefits and oncological outcomes. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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Review

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21 pages, 4609 KiB

Open AccessReview

Imaging of Peritoneal Carcinomatosis in Advanced Ovarian Cancer: CT, MRI, Radiomic Features and Resectability Criteria

by Valentina Miceli, Marco Gennarini, Federica Tomao, Angelica Cupertino, Dario Lombardo, Innocenza Palaia, Federica Curti, Sandrine Riccardi, Roberta Ninkova, Francesca Maccioni, Paolo Ricci, Carlo Catalano, Stefania Maria Rita Rizzo and Lucia Manganaro

Cancers 2023, 15(24), 5827; https://doi.org/10.3390/cancers15245827 - 13 Dec 2023

Cited by 1 | Viewed by 1120

Abstract

PC represents the most striking picture of the loco-regional spread of ovarian cancer, configuring stage III. In the last few years, many papers have evaluated the role of imaging and therapeutic management in patients with ovarian cancer and PC. This paper summed up [...] Read more.

PC represents the most striking picture of the loco-regional spread of ovarian cancer, configuring stage III. In the last few years, many papers have evaluated the role of imaging and therapeutic management in patients with ovarian cancer and PC. This paper summed up the literature on traditional approaches to the imaging of peritoneal carcinomatosis in advanced ovarian cancer, presenting classification systems, most frequent patterns, routes of spread and sites that are difficult to identify. The role of imaging in diagnosis was investigated, with particular attention to the reported sensitivity and specificity data—computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)—and to the peritoneal cancer index (PCI). In addition, we explored the therapeutic possibilities and radiomics applications that can impact management of patients with ovarian cancer. Careful staging is mandatory, and patient selection is one of the most important factors influencing complete cytoreduction (CCR) outcome: an accurate pre-operative imaging may allow selection of patients that may benefit most from primary cytoreductive surgery. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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39 pages, 26869 KiB

Open AccessReview

Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice

by Carlotta Pozza, Marta Tenuta, Franz Sesti, Michele Bertolotto, Dean Y. Huang, Paul S. Sidhu, Mario Maggi, Andrea M. Isidori and Francesco Lotti

Cancers 2023, 15(22), 5332; https://doi.org/10.3390/cancers15225332 - 08 Nov 2023

Viewed by 1492

Abstract

Background: Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign [...] Read more.

Background: Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs. Methods: An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs. Results: A practical mp-US “identity card” and iconographic characterization of several benign and malignant TLs is provided herein. Conclusions: The mp-US characterization of TL reported herein can be useful in daily clinical practice. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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20 pages, 9821 KiB

Open AccessReview

An Update on the Role of MRI in Treatment Stratification of Patients with Cervical Cancer

by Amreen Shakur, Janice Yu Ji Lee and Sue Freeman

Cancers 2023, 15(20), 5105; https://doi.org/10.3390/cancers15205105 - 23 Oct 2023

Cited by 1 | Viewed by 2713

Abstract

Cervical cancer is the fourth most common cancer in women worldwide and the most common gynaecological malignancy. The FIGO staging system is the most commonly utilised classification system for cervical cancer worldwide. Prior to the most recent update in the FIGO staging in [...] Read more.

Cervical cancer is the fourth most common cancer in women worldwide and the most common gynaecological malignancy. The FIGO staging system is the most commonly utilised classification system for cervical cancer worldwide. Prior to the most recent update in the FIGO staging in 2018, the staging was dependent upon clinical assessment alone. Concordance between the surgical and clinical FIGO staging decreases rapidly as the tumour becomes more advanced. MRI now plays a central role in patients diagnosed with cervical cancer and enables accurate staging, which is essential to determining the most appropriate treatment. MRI is the best imaging option for the assessment of tumour size, location, and parametrial and sidewall invasion. Notably, the presence of parametrial invasion precludes surgical options, and the patient will be triaged to chemoradiotherapy. As imaging is intrinsic to the new 2018 FIGO staging system, nodal metastases have been included within the classification as stage IIIC disease. The presence of lymph node metastases within the pelvis or abdomen is associated with a poorer prognosis, which previously could not be included in the staging classification as these could not be reliably detected on clinical examination. MRI findings corresponding to the 2018 revised FIGO staging of cervical cancers and their impact on treatment selection will be described. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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28 pages, 14553 KiB

Open AccessReview

Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI

by Charis Bourgioti, Marianna Konidari and Lia Angela Moulopoulos

Cancers 2023, 15(7), 2106; https://doi.org/10.3390/cancers15072106 - 31 Mar 2023

Cited by 2 | Viewed by 4228

Abstract

Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and [...] Read more.

Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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Other

Jump to: Research, Review

39 pages, 7051 KiB

Open AccessSystematic Review

Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis

by Athina C. Tsili, George Alexiou, Martha Tzoumpa, Timoleon Siempis and Maria I. Argyropoulou

Cancers 2024, 16(8), 1467; https://doi.org/10.3390/cancers16081467 - 11 Apr 2024

Viewed by 397

Abstract

This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC). A comprehensive search was performed for articles published from 2000 to February 2023. [...] Read more.

This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC). A comprehensive search was performed for articles published from 2000 to February 2023. The inclusion criteria were the following: diagnosis/suspicion of PMs in patients with ovarian/fallopian/primary peritoneal cancer; initial staging or suspicion of recurrence; MDCT, MRI and/or FDG PET/CT performed for the detection of PMs; population of at least 10 patients; surgical results, histopathologic analysis, and/or radiologic follow-up, used as reference standard; and per-patient and per-region data and data for calculating sensitivity and specificity reported. In total, 33 studies were assessed, including 487 women with OC and PMs. On a per-patient basis, MRI (p = 0.03) and FDG PET/CT (p < 0.01) had higher sensitivity compared to MDCT. MRI and PET/CT had comparable sensitivities (p = 0.84). On a per-lesion analysis, no differences in sensitivity estimates were noted between MDCT and MRI (p = 0.25), MDCT and FDG PET/CT (p = 0.68), and MRI and FDG PET/CT (p = 0.35). Based on our results, FDG PET/CT and MRI are the preferred imaging modalities for the detection of PMs in OC. However, the value of FDG PET/CT and MRI compared to MDCT needs to be determined. Future research to address the limitations of the existing studies and the need for standardization and to explore the cost-effectiveness of the three imaging modalities is required. Full article

(This article belongs to the Special Issue Updates on Imaging of Common Urogenital Neoplasms)

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