Dear Colleagues,

Several imaging modalities are currently used to improve the accuracy of gynecological examination. In particular, imaging in gynecological tumors has a long-standing history. Since the pioneering works of professor Ian Donald and his colleagues in Glasgow, Scotland performed in mid-1950s obstetrical and gynecological ultrasound imaging has been extensively used in both clinical and research settings. Later developments in the fields of computed tomography, MRI and PET alone or PET combined with CT or MRI have enabled the diagnostic use of these new imaging modalities in women with various gynecological tumors. Currently, all these methods of imaging have their known advantages and disadvantages which in many instances remain subject to expert’s debate. Although various tumor molecular markers including modern “liquid biopsies” that may be assessed in blood and urine are still popular, all these modalities are by now far from producing a clear solution for preoperative diagnosis and/or risk of malignancy assessment. This is why constant broadening of scientific interest in the modern methods of gynecological imaging is visible in the current medical literature. Apparently, an improved mutual understanding between specialists is extremely important for a high quality and consistent imaging services to be delivered to women with gynecological tumors.

One such outstanding example of international scientific cooperation and multicenter research network in the field of adnexal masses diagnosis is the IOTA group (www.iotagroup.org) which was founded in 1999 in Leuven, Belgium. In 2000, IOTA published a consensus statement on terms, definitions and measurements to describe the sonographic features of adnexal masses and these criteria are now widely used among sonographers in Europe. The group is multidisciplinary and involves gynecologists, radiologists, oncologists – as well as physicists and biologists. These scientists believe that good communication between all included specialists is how ideas can be turned into improvements of care for patients with adnexal masses. IOTA developed the “Simple Rules” and several other mathematical models based on logistic regression, which are very easy to use in clinical practice to estimate the risk of malignancy. All models were prospectively and externally validated and proved to have very good performances, close to that of subjective assessment of an expert sonographer. Moreover, these models keep to be performing well by users with different levels of ultrasound experience in various gynecological units around the world. Currently there are over 50 clinical units contributing to IOTA studies, nearly every continent is represented and until 2019, 4 biannual congresses were held, with the most recent one attracting over 300 scientists from across the world. As a result of this broadening interest both ultrasound and MRI based research related to ovarian tumors was presented.

Despite known limitations in terms of biological specificity the currently used imaging methods have gained increasing popularity. To a large extent, this is driven by the growing number of gynecological cancers but also by the well-recognized need for novel prognostic biomarkers that could be used not only to find early cancers but also to better predict future risk and understand the underlying molecular mechanisms. One such good example of the constant development of modern imaging technique is MRI-guided High Intensity Focused Ultrasound (MRI-HIFU) used for the non-invasive ablation of pathological tissue in several body organs, including liver, kidney and uterus. In particular, uterine fibroids in women represent a major health problem because not all patients would like to be operated and some are not suitable for curative treatment with surgery. Improvements in MRI-HIFU could increase the possibility to locally deposit thermal energy in a non-invasive way in uterine fibroids. This in turn may open a new path towards novel therapeutic strategies with improved reliability and reduced associated trauma, leading to a better efficacy, reduced hospitalization and costs.

In view of the presented facts improvement in predictive power of currently used imaging techniques in gynecological tumors appears to be one possible avenue to achieve significant progress in clinical knowledge. Apart from identifying fields where consensus already exists, this process might serve to find new research priorities by highlighting areas where experts are currently unable to agree on existing recommendations. The aim of this Special issue is to explore and collect the ongoing research activities and clinical application of modern imaging techniques like ultrasound, computed tomography and MRI used for gynecological tumors diagnosis. It is hoped that this mechanism will ultimately cause an alignment of the methods for measuring gynecological tumors features in order to indicate new imaging biomarkers and to create the necessary conditions for a more efficient international scientific cooperation.

Prof. Artur Czekierdowski
Guest Editor

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• Imaging in gynecology
• Female genital tract
• Gynecological cancers
• Uterine fibroids
• Ultrasonography
• Computed Tomography
• Magnetic Resonance Imaging