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Malek M, Moayeri M, Akhavan S, Hasani SS, Nili F, Mahboubi-Fooladi Z. Advanced MRI prediction model for anatomical site identification in uterine carcinoma: enhancing diagnostic accuracy. Clin Radiol 2025; 84:106852. [PMID: 40069974 DOI: 10.1016/j.crad.2025.106852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 12/16/2024] [Accepted: 02/11/2025] [Indexed: 04/20/2025]
Abstract
AIM The uterine carcinoma is the most commonly diagnosed malignancy in the female pelvis. Accurate identification of tumour origin is crucial for determining appropriate treatment approaches. This study aims to develop a prediction model using multiple MRI parameters to accurately diagnose uterine cancer with an indistinctive origin and those involving both the endometrium and cervix prior to treatment. MATERIAL AND METHODS This prospective cohort study included patients who were newly diagnosed with uterine carcinoma who underwent MRI and were considered for hysterectomy within 6 months after MRI. RESULTS A total of 78 patients with uterine carcinoma were enrolled. Certain imaging features were found to be consistent with cervical carcinoma, included parametrial, vaginal, stromal invasion, and peripheral rim enhancement. Cervical cancer appeared hyperintense compared to the myometrium unlike endometrial cancer. DISCUSSION The study found that certain morphologic features were reliable indicators for detecting cervical carcinoma.
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Affiliation(s)
- M Malek
- Muskoskletal Imaging Research Research Center (MIRC)Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - M Moayeri
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - S Akhavan
- Department of Obstetrics and Gynecology, Vali-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S S Hasani
- Department of Oncologic Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - F Nili
- Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Z Mahboubi-Fooladi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Shinagare AB, Burk KS, Kilcoyne A, Akin EA, Chuang L, Hindman NM, Huang C, Rauch GM, Small W, Stein EB, Venkatesan AM, Kang SK. ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Invasive Cancer of the Cervix: 2023 Update. J Am Coll Radiol 2024; 21:S249-S267. [PMID: 38823948 DOI: 10.1016/j.jacr.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Cervical cancer is a common gynecological malignancy worldwide. Cervical cancer is staged based on the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was revised in 2018 to incorporate radiologic and pathologic data. Imaging plays an important role in pretreatment assessment including initial staging and treatment response assessment of cervical cancer. Accurate determination of tumor size, local extension, and nodal and distant metastases is important for treatment selection and for prognostication. Although local recurrence can be diagnosed by physical examination, imaging plays a critical role in detection and follow-up of local and distant recurrence and subsequent treatment selection. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Kristine S Burk
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | - Aoife Kilcoyne
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | - Linus Chuang
- University of Vermont Larner College of Medicine Danbury Hospital, Burlington, Vermont; Gynecologic oncology expert
| | | | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Erica B Stein
- University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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Menendez-Santos M, Gonzalez-Baerga C, Taher D, Waters R, Virarkar M, Bhosale P. Endometrial Cancer: 2023 Revised FIGO Staging System and the Role of Imaging. Cancers (Basel) 2024; 16:1869. [PMID: 38791948 PMCID: PMC11119523 DOI: 10.3390/cancers16101869] [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: 03/25/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
The FIGO endometrial cancer staging system recently released updated guidance based on clinical evidence gathered after the previous version was published in 2009. Different imaging modalities are beneficial across various stages of endometrial cancer (EC) management. Additionally, ongoing research studies are aimed at improving imaging in EC. Gynecological cancer is a crucial element in the practice of a body radiologist. With a new staging system in place, it is important to address the role of radiology in the EC diagnostic pathway. This article is a comprehensive review of the changes made to the FIGO endometrial cancer staging system and the impact of imaging in the staging of this disease.
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Affiliation(s)
- Manuel Menendez-Santos
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA; (C.G.-B.); (M.V.)
| | - Carlos Gonzalez-Baerga
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA; (C.G.-B.); (M.V.)
| | - Daoud Taher
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.T.); (R.W.); (P.B.)
| | - Rebecca Waters
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.T.); (R.W.); (P.B.)
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA; (C.G.-B.); (M.V.)
| | - Priya Bhosale
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.T.); (R.W.); (P.B.)
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Fang Y, Wang K, Xiao M, Cheng J, Lin Z, Qiang J, Li Y. Multiparametric MRI-based radiomics nomogram for identifying cervix-corpus junction cervical adenocarcinoma from endometrioid adenocarcinoma. Abdom Radiol (NY) 2024; 49:1557-1568. [PMID: 38441631 DOI: 10.1007/s00261-024-04214-x] [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: 11/03/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To developed a magnetic resonance imaging (MRI) radiomics nomogram to identify adenocarcinoma at the cervix-corpus junction originating from the endometrium or cervix in order to better guide clinical treatment. METHODS Between February 2011 and September 2021, the clinicopathological data and MRI in 143 patients with histopathologically confirmed cervical adenocarcinoma (CAC, n = 86) and endometrioid adenocarcinoma (EAC, n = 57) were retrospectively analyzed at the cervix-corpus junction. Radiomics features were extracted from fat-suppressed T2-weighted imaging (FS-T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, and delayed phase contrast-enhanced T1-weighted imaging (CE-T1WI) sequences. A radiomics nomogram was developed integrating radscore with independent clinical risk factors. The area under the curve (AUC) was used to evaluate the diagnostic efficacy of the radscore, nomogram and two different experienced radiologists in differentiating CAC from EAC at the cervix-corpus junction, and Delong test was applied to compare the differences of their diagnostic performance. RESULTS In the training cohort, the AUC was 0.93 for radscore; 0.97 for radiomics nomograms; 0.85 and 0.86 for radiologists 1 and 2, respectively. Delong test showed that the differential efficacy of nomogram was significant better than those of radiologists in the training cohort (both P < 0.05). CONCLUSIONS The nomogram based on radscore and clinical risk factors could better differentiate CAC from EAC at the cervix-corpus junction than radiologists, and preoperatively and non-invasively identify the origin of adenocarcinoma at the cervix-corpus junction, which facilitates clinicians to make individualized treatment decision.
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Affiliation(s)
- Yuhan Fang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
| | - Keying Wang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Meiling Xiao
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jiejun Cheng
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
| | - Zijing Lin
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China.
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
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Long L, Liu M, Deng X, Cao M, Zhang J, Lan X, Zhang J. 3D multifrequency magnetic resonance elastography in distinguishing endometrial and cervical adenocarcinoma. Magn Reson Imaging 2023; 102:62-68. [PMID: 37146780 DOI: 10.1016/j.mri.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To prospectively evaluate the value of tomoelastography in determining the underlying origins of uterine adenocarcinoma. METHODS This prospective work was approved by our institutional review board, and all patients provided informed consent. 64 patients with histopathologically confirmed adenocarcinomas originated either from the cervix (CAC: cervical adenocarcinoma) or endometrium (EAC: endometrial adenocarcinoma) underwent MRI and tomoelastography examination on a 3.0 T MR scanner. To biomechanically characterize the adenocarcinoma, two MRE-derived parameters maps were provided in the tomoelastography, namely shear wave speed (c, m/s) and loss angle (φ, radian), which represented the stiffness and fluidity, respectively. The MRE-derived parameters were compared by using a two-tailed independent-sample t-test or Mann-Whitney U test. Five morphologic features were also analyzed by using the χ2 test. Logistic regression analysis was used to develop diagnosis models. Delong test was used to compare the receiver operating characteristic curves whith different diagnostic models and evaluate the diagnostic efficiency. RESULTS CAC were significantly stiffer and behaved more fluid like than EAC (c: 2.58 ± 0.62 m/s vs.2.17 ± 0.72 m/s, p = 0.029, φ, 0.97 ± 0.19 rad vs.0.73 ± 0.26 rad, p < 0.0001). The diagnostic performance for distinguishing CAC from EAC was similar for c (AUC = 0.71) and for φ (AUC = 0.75). For distinguishing CAC from EAC, the AUC of tumor location was the higher than c and φ (AUC = 0.80). A cmobined model consisting of tumor location, c, and φ achieved the best diagnostic performance, with an AUC of 0.88 (77.27% sensitivity and 85.71% specificity). CONCLUSIONS CAC and EAC displayed their unique biomechanical features. 3D multifrequency MRE provided added value to the conventional morphologic features in distinguishing the two types of diseases.
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Affiliation(s)
- Ling Long
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Meiling Liu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Xijia Deng
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Meimei Cao
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Jing Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, PR China.
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Gui B, Lupinelli M, Russo L, Miccò M, Avesani G, Panico C, Di Paola V, Rodolfino E, Autorino R, Ferrandina G, Fanfani F, Scambia G, Manfredi R. MRI in uterine cancers with uncertain origin: Endometrial or cervical? Radiological point of view with review of the literature. Eur J Radiol 2022; 153:110357. [DOI: 10.1016/j.ejrad.2022.110357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/24/2022] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
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Jain P, Aggarwal A, Ghasi RG, Malik A, Misra RN, Garg K. Role of MRI in diagnosing the primary site of origin in indeterminate cases of uterocervical carcinomas: a systematic review and meta-analysis. Br J Radiol 2022; 95:20210428. [PMID: 34623892 PMCID: PMC8722231 DOI: 10.1259/bjr.20210428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To perform a literature review assessing role of MRI in predicting origin of indeterminate uterocervical carcinomas with emphasis on sequences and imaging parameters. METHODS Electronic literature search of PubMed was performed from its inception until May 2020 and PICO model used for study selection; population was female patients with known/clinical suspicion of uterocervical cancer, intervention was MRI, comparison was by histopathology and outcome was differentiation between primary endometrial and cervical cancers. RESULTS Eight out of nine reviewed articles reinforced role of MRI in uterocervical primary determination. T2 and Dynamic contrast were the most popular sequences determining tumor location, morphology, enhancement, and invasion patterns. Role of DWI and MR spectroscopy has been evaluated by even fewer studies with significant differences found in both apparent diffusion coefficient values and metabolite spectra. The four studies eligible for meta-analysis showed a pooled sensitivity of 88.4% (95% confidence interval 70.6 to 96.1%) and a pooled specificity of 39.5% (95% confidence interval 4.2 to 90.6%). CONCLUSIONS MRI plays a pivotal role in uterocervical primary determination with both conventional and newer sequences assessing important morphometric and functional parameters. Socioeconomic impact of both primaries, different management guidelines and paucity of existing studies warrants further research. Prospective multicenter trials will help bridge this gap. Meanwhile, individual patient database meta-analysis can help corroborate existing data. ADVANCES IN KNOWLEDGE MRI with its classical and functional sequences helps in differentiation of the uterine 'cancer gray zone' which is imperative as both primary endometrial and cervical tumors have different management protocols.
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Affiliation(s)
- Pooja Jain
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Ankita Aggarwal
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Rohini Gupta Ghasi
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Amita Malik
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Ritu Nair Misra
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Silva C, Carneiro C, Cunha TM. Role of Imaging in the Management of High-Risk Endometrial Cancer. Cureus 2021; 13:e19286. [PMID: 34900469 PMCID: PMC8648287 DOI: 10.7759/cureus.19286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
Endometrial cancer (EC) is the second most frequent gynecological malignancy worldwide with an overall favorable prognosis. However, there is a subgroup of patients with a higher rate of recurrence and worse prognosis who benefit from a specific pre- and post-treatment radiological evaluation that allows the adjustment of the therapeutic attitude towards the biology of the tumor. The main factors that determine high-risk disease are non-endometrioid tumor histology, histopathological grade 3, lymphovascular space invasion (LVSI), myometrial invasion ≥50%, and cervical stroma involvement. Radiological evaluation helps identify high-risk cases prior to surgical staging and is an important tool both in pre-treatment and in case of clinical recurrence suspicion. As for imaging techniques, both transvaginal ultrasound and MRI can assess local tumor extent while CT and positron emission tomography/CT (PET/CT) help assess lymph nodes and distant metastases. The central purpose of this article is to review the specific factors that determine high-risk endometrial cancer, and the main specificities in the pre-treatment and follow-up evaluation according to the most recent international guidelines.
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Gala FB, Gala KB, Gala BM. Magnetic Resonance Imaging of Uterine Cervix: A Pictorial Essay. Indian J Radiol Imaging 2021; 31:454-467. [PMID: 34556931 PMCID: PMC8448214 DOI: 10.1055/s-0041-1734377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Uterine cervix is the lower constricted part of uterus which is best evaluated by magnetic resonance imaging (MRI) due to its higher soft tissue and contrast resolution. The cervical cancer is a common gynecological cancer causing much morbidity and mortality especially in developing countries. Cervical carcinomas mainly occurs in reproductive age group with prognosis mainly depending on the extent of disease at the time of diagnosis, hence it is important to identify these cancerous lesions early and stage them accurately for optimal treatment. In this article, we will review the following: (1) the normal MRI anatomy of uterine cervix; (2) MRI protocol and techniques in evaluation of cervical lesions; (3) imaging of spectrum of various congenital abnormalities and pathologies affecting uterine cervix which ranges from congenital abnormalities to various benign lesions of cervix like nabothian cysts, tunnel cysts, cervicitis, cervical fibroid, and, lastly, endometriosis which usually coexists with adenomyosis; the malignant lesions include carcinoma cervix, adenoma malignum or direct extension from carcinoma endometrium or from carcinoma of vagina; (4) Accurately stage carcinoma of cervix using FIGO classification (2018); and (5) posttreatment evaluation of cervical cancers. MRI is the most reliable imaging modality in evaluation of various cervical lesions, identification of cervical tumors, staging of the cervical malignancy, and stratifying patients for surgery and radiation therapy. It also plays an important role in detection of local disease recurrence.
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Affiliation(s)
- Foram B Gala
- Department of Radiology, Lifescan Imaging Centre, Mumbai, Maharashtra, India.,Department of Radiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Kunal B Gala
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat M Gala
- Department of Radiology, Lifescan Imaging Centre, Mumbai, Maharashtra, India
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Feasibility of intravoxel incoherent motion diffusion-weighted imaging in distinguishing adenocarcinoma originated from uterine corpus or cervix. Abdom Radiol (NY) 2021; 46:732-744. [PMID: 32671441 DOI: 10.1007/s00261-020-02586-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To prospectively assess the incremental value of intravoxel incoherent motion (IVIM) DWI in determining whether the adenocarcinoma originated from the uterine corpus or cervix. METHODS Eighty consecutive uterine adenocarcinomas from the cervix or endometrium confirmed by histopathology underwent IVIM DWI acquisition on a 3.0T MR scanner before treatment. Five morphologic features were analyzed using Fisher exact test; IVIM DWI-derived parameters, including apparent diffusion coefficient (ADC), true coefficient diffusivity (D), perfusion-related diffusivity (D*), and perfusion fraction (f) were compared using two-sample independent t-test or Mann-Whitney U test. Logistic regression analysis was used to develop different diagnosis model. The ROCs of these variables and diagnostic models were compared to evaluate the diagnostic efficiency. RESULTS Among single morphologic features, tumor location yielded the highest AUC of 0.891 in distinguishing endometrial adenocarcinoma (EAC) from cervical adenocarcinoma (CAC). Among single IVIM DWI-derived parameters, f values showed the best diagnostic performance (AUC: 0.837) at the optimal cut-off value of 0.261. Additionally, the combined diagnostic model, which consisted of tumor location, ADC and f showed the largest AUC of 0.967 with the highest sensitivity of 88.14%, highest specificity of 100.00%, and highest accuracy of 91.25%. CONCLUSION IVIM DWI-derived parameters add additional diagnostic value to conventional morphologic features. A combined diagnosis model is a promising imaging tool for predicting the origin of uterine adenocarcinoma, further contributing to therapeutic decision-making.
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Gulati P, Agarwal A, Gulati V. Cervical Malignancies: Status of MRI. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lin M, Zhang Q, Song Y, Yu X, Ouyang H, Xie L, Shang Y. Differentiation of endometrial adenocarcinoma from adenocarcinoma of cervix using kinetic parameters derived from DCE-MRI. Eur J Radiol 2020; 130:109190. [PMID: 32745897 DOI: 10.1016/j.ejrad.2020.109190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This prospective study aimed to investigate the value of kinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiating uterine endometrioid adenocarcinoma (EAC) from adenocarcinoma of cervix (AdC). METHODS Seventy-five newly diagnosed patients with distinctive pathology underwent DCE-MRI. Observers independently calculated the tumor diameters and DCE-MRI parameters using both population and individual-based arterial input function (AIF). Inter-observer consistency was evaluated, and a comparative analysis between EAC (n = 47) and AdC (n = 28) was performed. Regression analysis was used to select parameters that best distinguished EAC from AdC, and to generate predictive models. Receiver operating characteristic curve (ROC) was applied to calculate the diagnostic efficiency of single parameter and the predictive models. RESULTS Inter-observer consistency was excellent (intra-class correlation [ICC] = 0.902-0.981), especially when calculated via population AIF with relatively higher ICC and smaller SD on Bland-Altman plot. Tumor diameters were not correlated with tumor types. All the DCE-MRI parameters were lower in EAC compared to AdC, except Kep by population AIF and TTP by both sets of AIFs. The statistical parameters were Ve, Maxslop, and Maxconc by population AIF, and Maxslop and Ktrans by individual AIF included in the predictive models, respectively. The two predictive models with combined parameters showed improved diagnostic efficiency in differentiating these two diseases compared with a single parameter. CONCLUSION DCE-MRI can quantitatively evaluate the perfusion difference between EAC and AdC, thus improving the identification of uterine adenocarcinoma with uncertain biopsy pathology.
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Affiliation(s)
- Meng Lin
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, PR China
| | - Qi Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, PR China
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, PR China
| | - Xiaoduo Yu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, PR China.
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, PR China
| | - Lizhi Xie
- MR Research China, GE Healthcare, No.1 Yongchang North Road, Beijing Economic-Technological Development Area, Beijing, 100176, PR China
| | - Yuqing Shang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, CT06510, USA
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Steiner A, Alban G, Cheng T, Kapur T, Bay C, McLaughlin PY, King M, Tempany C, Lee LJ. Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy. Abdom Radiol (NY) 2020; 45:1122-1131. [PMID: 32112139 PMCID: PMC7643338 DOI: 10.1007/s00261-020-02453-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose To evaluate MRI characteristics in vaginal recurrence of endometrial cancer (EC) including tumor volume shrinkage during salvage radiotherapy, and to identify imaging features associated with survival. Methods Patients with vaginal recurrence of EC treated with external beam radiotherapy (EBRT) followed by brachytherapy (BT), and with available pelvic MRI at two time points: baseline and/or before BT were retrospectively identified from 2004 to 2017. MRI features including recurrence location and tissue characteristics on T2- and T1-weighted images were evaluated at baseline only. Tumor volumes were measured both at baseline and pre-BT. Survival rates and associations were evaluated by Cox regression and Fisher’s exact test, respectively. Results Sixty-two patients with 36 baseline and 50 pre-BT pelvic MRIs were included (24/62 with both MRIs). Vaginal recurrence of EC was most commonly located in the vaginal apex (27/36, 75%). Tumors with a post-contrast enhancing peripheral rim or low T2 signal rim at baseline showed longer recurrence-free survival (RFS) (HR 0.2, 95% CI 0.1–0.9, P < 0.05 adjusted for histology; HR 0.2, 95% CI 0.1–0.8, P < 0.05, respectively). The median tumor shrinkage at pre-BT was 69% (range 1–99%). Neither absolute tumor volumes nor volume regression at pre-BT were associated with RFS. Lymphovascular space invasion (LVSI) at hysterectomy and adjuvant RT were associated with recurrence involving the distal vagina (both P < 0.05). Conclusion Vaginal recurrences with rim enhancement at baseline MRI predicted improved RFS, while tumor volume shrinkage at pre-BT did not. Distal vaginal recurrence was more common in patients with LVSI and adjuvant RT at EC diagnosis.
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Affiliation(s)
- Aida Steiner
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, L1-050, Boston, MA, 02115, USA.
- Department of Radiology, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
| | - Gabriela Alban
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Teresa Cheng
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, L1-050, Boston, MA, 02115, USA
| | - Camden Bay
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, L1-050, Boston, MA, 02115, USA
| | - Pierre-Yves McLaughlin
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Martin King
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, L1-050, Boston, MA, 02115, USA
| | - Larissa J Lee
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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14
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Otero-García MM, Mesa-Álvarez A, Nikolic O, Blanco-Lobato P, Basta-Nikolic M, de Llano-Ortega RM, Paredes-Velázquez L, Nikolic N, Szewczyk-Bieda M. Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers. Insights Imaging 2019; 10:19. [PMID: 30758678 PMCID: PMC6375059 DOI: 10.1186/s13244-019-0696-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis.
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Affiliation(s)
- María Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain.
| | - Alicia Mesa-Álvarez
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Olivera Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Patricia Blanco-Lobato
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Marijana Basta-Nikolic
- Clinical Centre of Vojvodina, Centre of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | | | - Laura Paredes-Velázquez
- Department of Radiology, Hospital Universitario de Vigo , Carretera Clara Campoamor 341, 36312, Vigo, Spain
| | - Nikola Nikolic
- Centre of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Magda Szewczyk-Bieda
- Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee, UK
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15
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Lin G, Lin YC, Wu RC, Yang LY, Lu HY, Tsai SY, Huang YT, Huang YL, Lu KY, Ng KK, Yen TC, Chao A, Lai CH, Hong JH. Developing and validating a multivariable prediction model to improve the diagnostic accuracy in determination of cervical versus endometrial origin of uterine adenocarcinomas: A prospective MR study combining diffusion-weighted imaging and spectroscopy. J Magn Reson Imaging 2017; 47:1654-1666. [PMID: 29178414 DOI: 10.1002/jmri.25899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/31/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A triage test to assist clinical decision-making on choosing primary chemoradiation for cervical carcinomas or primary surgery for endometrial carcinomas is important. PURPOSE OR HYPOTHESIS To develop and validate a multiparametric prediction model based on MR imaging and spectroscopy in distinguishing adenocarcinomas of uterine cervical or endometrial origin. STUDY TYPE Prospective diagnostic accuracy study. POPULATION Eighty-seven women: 25 cervical and 62 endometrial adenocarcinomas divided into training (n = 43; cervical/endometrial adenocarcinomas = 11/32) and validation (n = 44; 14/30) datasets. FIELD STRENGTH/SEQUENCE The 3T diffusion-weighted (DW) MR imaging and MR spectroscopy. ASSESSMENT Morphology, volumetric DW MR imaging and spectroscopy (MDS) scoring system with total points 0-5, based on presence of the following MR features assessed independently by two radiologists: (a) epicenter at the cervix, (b) rim enhancement, (c) disrupted cervical stromal integrity, (d) mean volumetric apparent diffusion coefficient values (ADCmean) higher than 0.98 × 10-3 mm2 /s, (e) fatty acyl δ 1.3 ppm more than 161.92 mM. Histopathology as gold standard. STATISTICAL TESTS Logistic regression and receiver operator characteristic (ROC) curves analysis. RESULTS For both the training and validation datasets, the MDS score achieved an accuracy of 93.0% and 84.1%, significantly higher than that of morphology (88.4% and 79.5%), ADC value (74.4% and 68.2%), and spectroscopy (81.4% and 68.2%; P < 0.05 for all). The performances of the scoring were superior to the morphology in the training dataset (areas under the receiver operating characteristics curve [AUC] = 0.95 vs. 0.89; P = 0.046), but not in the validation dataset (AUC = 0.90 vs. 0.85; P = 0.289). DATA CONCLUSION MDS score has potentials to improve distinguishing adenocarcinomas of cervical or endometrial origin, and warrants large-scale studies for further validation. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1654-1666.
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Affiliation(s)
- Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at LinkouGuishan, Taoyuan, Taiwan.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at LinkouGuishan, Taoyuan, Taiwan.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan.,Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Hsin-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at LinkouGuishan, Taoyuan, Taiwan.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Shang-Yueh Tsai
- Graduate Institute of Applied Physics, National Chengchi University, Taipei, Taiwan
| | - Yu-Ting Huang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at LinkouGuishan, Taoyuan, Taiwan
| | - Kuan-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at LinkouGuishan, Taoyuan, Taiwan.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Koon-Kwan Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan.,Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan.,Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Ji-Hong Hong
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Guishan, Taoyuan, Taiwan
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16
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Lin CN, Liao YS, Chen WC, Wang YS, Lee LW. Use of Myometrium as an Internal Reference for Endometrial and Cervical Cancer on Multiphase Contrast-Enhanced MRI. PLoS One 2016; 11:e0157820. [PMID: 27326456 PMCID: PMC4915709 DOI: 10.1371/journal.pone.0157820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/06/2016] [Indexed: 12/11/2022] Open
Abstract
Background Myometrial smooth muscle is normally within the field of view for the gynecological imaging. This study aimed to investigate the use of normal myometrium as an internal reference for endometrial and cervical cancer during multiphase contrast-enhanced magnetic resonance imaging (MCE-MRI) and to explore whether this information regarding tumor enhancement relative to the myometrium could be used to discriminate between endometrial and cervical cancer. Methods MRI images, before and after contrast enhancement, were analyzed in newly diagnosed cervical (n = 18) and endometrial cancer (n = 19) patients. Signal intensities (SIs) from tumor tissue and non-neoplastic myometrium were measured using imaging software. Results The relative signal for cervical cancer was approximately 30% higher than that of endometrial cancer after contrast administration. The area under receiver operating characteristic curve for SI, relative signal enhancement, and tumor to myometrium contrast ratio (as used to discriminate between cervical cancer and endometrial cancer) was 0.7807, 0.7456 and 0.7895, respectively. There was no difference in SI of the normal myometrium between endometrial and cervical cancer patients prior to and after contrast administration. Using non-tumorous myometrium as an internal reference, the tumor to myometrium contrast ratio was significantly higher in tumor tissue from cervical cancer compared with that from endometrial cancer at 25 s post contrast enhancement (p = 0.0016), with an optimal sensitivity of 72.22% and specificity of 84.21%. Conclusion With SI normalized to baseline or normal myometrium, tumor tissue from cervical cancer patients showed significant hyperintensity compared with that of tumor tissue from endometrial cancer patients after contrast enhancement, yielding acceptable performance. The use of the myometrium as an internal reference may provide an alternative method to analyze MCE-MRI data.
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Affiliation(s)
- Chia-Ni Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-San Liao
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Chemistry and Biochemistry, National Chung Cheng University, Chiayi, Taiwan
| | - Wen-Chang Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yue-Sheng Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Wen Lee
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
- * E-mail:
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17
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Meissnitzer M, Forstner R. MRI of endometrium cancer - how we do it. Cancer Imaging 2016; 16:11. [PMID: 27157039 PMCID: PMC4860771 DOI: 10.1186/s40644-016-0069-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/27/2016] [Indexed: 12/16/2022] Open
Abstract
Endometrial cancer is the most common malignancy of the female pelvis. New concepts in endometrial cancer treatment emphasize the value of MRI as a major predictor of lymph node metastasis and tumour recurrence. MRI findings aid in triaging patients for a more tailored therapeutic regimen.This review discusses the value of MRI in the preoperative assessment of endometrial cancer and provides a practical approach how to image and report endometrial cancer. Practical tips are provided how to increase the diagnostic accuracy in staging of endometrial cancer and how to avoid pitfalls.
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Affiliation(s)
- Matthias Meissnitzer
- Department of Radiology, Landeskliniken Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Rosemarie Forstner
- Department of Radiology, Landeskliniken Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
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18
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Bourgioti C, Chatoupis K, Moulopoulos LA. Current imaging strategies for the evaluation of uterine cervical cancer. World J Radiol 2016; 8:342-354. [PMID: 27158421 PMCID: PMC4840192 DOI: 10.4329/wjr.v8.i4.342] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/15/2016] [Accepted: 01/31/2016] [Indexed: 02/06/2023] Open
Abstract
Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.
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