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OBJECTIVES: To develop an innovative magnetic resonance imaging (MRI)-based PUMCH (Peking Union Medical College Hospital) classification system aimed at standardising the diagnosis of congenital cervical malformations (CCMs) by identifying their distinctive MRI features. METHODS: Seventy-nine consecutive patients with CCM underwent pre-treatment pelvic MRI; three experienced gynaecological radiologists retrospectively analysed these images. Qualitative assessments included Rock et al's classification; PUMCH classification; haematometra; cervical signal features; ovarian endometriosis; haematosalpinx; and uterine, vaginal, urinary, and musculoskeletal malformations. Quantitative assessments involved the uterine volume, sagittal cervical length, and maximum ovarian cross-sectional area. The surgical treatment types were also recorded. Statistical methods were used to incorporate differences in clinical features and surgical methods into our classification. RESULTS: Morphologically, CCMs were categorised into three types: type I (53%) was characterised by the presence of a cervix with visible cervical canals; type II (23%) featured an existing cervix with concealed cervical canals; and type III (24%) indicated cervical aplasia, which involves a blind end in the lower part of the uterine corpus. Haematometra was significantly more prevalent in patients with type I CCM than in those with type II (p < 0.001). There were three cervical signal patterns: no signal (27%), no evident layer differentiation (21%), and multi-layer differentiation with haematocele (52%). Most patients (94%) had complete vaginal atresia. Type I CCM patients had a higher likelihood of regaining normal uterovaginal anatomy compared to types II and III. CONCLUSIONS: Our proposed PUMCH classification system has a high potential for enhancing the efficiency of clinical diagnosis among patients with CCM. CRITICAL RELEVANCE STATEMENT: The proposed new PUMCH classification promised to elevate the conventional diagnostic trajectory for congenital cervical malformations, offering a valuable framework to refine the selection and planning of surgical interventions, thereby enhancing overall clinical efficacy. KEY POINTS: Effective classification of congenital cervical malformations is desirable to optimise the diagnostic process. We presented a PUMCH classification of congenital cervical malformations using pelvic MRI. The new classification significantly aids clinical triage for congenital cervical malformations.
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PURPOSE: We aimed to systematically assess the methodological quality and clinical potential application of published magnetic resonance imaging (MRI)-based radiomics studies about endometrial cancer (EC). METHODS: Studies of EC radiomics analyses published between 1 January 2000 and 19 March 2023 were extracted, and their methodological quality was evaluated using the radiomics quality score (RQS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pairwise correlation analyses and separate meta-analyses of studies exploring differential diagnoses and risk prediction were also performed. RESULTS: Forty-five studies involving 3 aims were included. The mean RQS was 13.77 (range: 9-22.5); publication bias was observed in the areas of 'index test' and 'flow and timing'. A high RQS was significantly associated with therapy selection-aimed studies, low QUADAS-2 risk, recent publication year, and high-performance metrics. Raw data from 6 differential diagnosis and 34 risk prediction models were subjected to meta-analysis, revealing diagnostic odds ratios of 23.81 (95% confidence interval [CI] 8.48-66.83) and 18.23 (95% CI 13.68-24.29), respectively. CONCLUSION: The methodological quality of radiomics studies involving patients with EC is unsatisfactory. However, MRI-based radiomics analyses showed promising utility in terms of differential diagnosis and risk prediction.
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Neoplasias Endometriales , Imagen por Resonancia Magnética , Radiómica , Femenino , Humanos , Diagnóstico Diferencial , Neoplasias Endometriales/diagnóstico por imagen , Imagen por Resonancia Magnética/métodosRESUMEN
OBJECTIVES: We aimed to present the state of the art of CT- and MRI-based radiomics in the context of ovarian cancer (OC), with a focus on the methodological quality of these studies and the clinical utility of these proposed radiomics models. METHODS: Original articles investigating radiomics in OC published in PubMed, Embase, Web of Science, and the Cochrane Library between January 1, 2002, and January 6, 2023, were extracted. The methodological quality was evaluated using the radiomics quality score (RQS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pairwise correlation analyses were performed to compare the methodological quality, baseline information, and performance metrics. Additional meta-analyses of studies exploring differential diagnoses and prognostic prediction in patients with OC were performed separately. RESULTS: Fifty-seven studies encompassing 11,693 patients were included. The mean RQS was 30.7% (range - 4 to 22); less than 25% of studies had a high risk of bias and applicability concerns in each domain of QUADAS-2. A high RQS was significantly associated with a low QUADAS-2 risk and recent publication year. Significantly higher performance metrics were observed in studies examining differential diagnosis; 16 such studies as well as 13 exploring prognostic prediction were included in a separate meta-analysis, which revealed diagnostic odds ratios of 25.76 (95% confidence interval (CI) 13.50-49.13) and 12.55 (95% CI 8.38-18.77), respectively. CONCLUSION: Current evidence suggests that the methodological quality of OC-related radiomics studies is unsatisfactory. Radiomics analysis based on CT and MRI showed promising results in terms of differential diagnosis and prognostic prediction. CRITICAL RELEVANCE STATEMENT: Radiomics analysis has potential clinical utility; however, shortcomings persist in existing studies in terms of reproducibility. We suggest that future radiomics studies should be more standardized to better bridge the gap between concepts and clinical applications.
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OBJECTIVE: To develop and validate a model that can preoperatively identify the ovarian clear cell carcinoma (OCCC) subtype in epithelial ovarian cancer (EOC) using CT imaging radiomics and clinical data. MATERIAL AND METHODS: We retrospectively analyzed data from 282 patients with EOC (training set = 225, testing set = 57) who underwent pre-surgery CT examinations. Patients were categorized into OCCC or other EOC subtypes based on postoperative pathology. Seven clinical characteristics (age, cancer antigen [CA]-125, CA-199, endometriosis, venous thromboembolism, hypercalcemia, stage) were collected. Primary tumors were manually delineated on portal venous-phase images, and 1218 radiomic features were extracted. The F-test-based feature selection method and logistic regression algorithm were used to build the radiomic signature, clinical model, and integrated model. To explore the effects of integrated model-assisted diagnosis, five radiologists independently interpreted images in the testing set and reevaluated cases two weeks later with knowledge of the integrated model's output. The diagnostic performances of the predictive models, radiologists, and radiologists aided by the integrated model were evaluated. RESULTS: The integrated model containing the radiomic signature (constructed by four wavelet radiomic features) and three clinical characteristics (CA-125, endometriosis, and hypercalcinemia), showed better diagnostic performance (AUC = 0.863 [0.762-0.964]) than the clinical model (AUC = 0.792 [0.630-0.953], p = 0.295) and the radiomic signature alone (AUC = 0.781 [0.636-0.926], p = 0.185). The diagnostic sensitivities of the radiologists were significantly improved when using the integrated model (p = 0.023-0.041), while the specificities and accuracies were maintained (p = 0.074-1.000). CONCLUSION: Our integrated model shows great potential to facilitate the early identification of the OCCC subtype in EOC, which may enhance subtype-specific therapy and clinical management.
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Endometriosis , Neoplasias Ováricas , Humanos , Femenino , Carcinoma Epitelial de Ovario/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Neoplasias Ováricas/diagnóstico por imagenRESUMEN
OBJECTIVES: To investigate the feasibility of a deep learning-accelerated T2-weighted turbo spin echo (TSE) sequence (T2DL) applied to female pelvic MRI, using standard T2-weighted TSE (T2S) as reference. METHODS: In total, 24 volunteers and 48 consecutive patients with benign uterine diseases were enrolled. Patients in the menstrual phase were excluded. T2S and T2DL sequences in three planes were performed for each participant. Quantitative image evaluation was conducted by calculating the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image geometric distortion was evaluated by measuring the diameters in all three directions of the uterus and lesions. Qualitative image evaluation including overall image quality, artifacts, boundary sharpness of the uterine zonal layers, and lesion conspicuity were assessed by three radiologists using a 5-point Likert scale, with 5 indicating the best quality. Comparative analyses were conducted for the two sequences. RESULTS: T2DL resulted in a 62.7% timing reduction (1:54 min for T2DL and 5:06 min for T2S in axial, sagittal, and coronal imaging, respectively). Compared to T2S, T2DL had significantly higher SNR (p ≤ 0.001) and CNR (p ≤ 0.007), and without geometric distortion (p = 0.925-0.981). Inter-observer agreement regarding qualitative evaluation was excellent (Kendall's W > 0.75). T2DL provided superior image quality (all p < 0.001), boundary sharpness of the uterine zonal layers (all p < 0.001), lesion conspicuity (p = 0.002, p < 0.001, and p = 0.021), and fewer artifacts (all p < 0.001) in sagittal, axial, and coronal imaging. CONCLUSIONS: Compared with standard TSE, deep learning-accelerated T2-weighted TSE is feasible to reduce acquisition time of female pelvic MRI with significant improvement of image quality.
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OBJECTIVE: To evaluate and compare the diagnostic performance of apparent diffusion coefficient (ADC) values and MRI-based radiomics analysis for lymph node metastasis (LNM) detection in patients with cervical cancer (CC). METHODS: We searched relevant databases for studies on ADC values and MRI-based radiomics analysis for LNM detection in CC between January 2001 and December 2021. Methodological quality assessment of risk of bias using Quality Assessment of Diagnostic Accuracy Studies 2 and radiomics quality score (RQS) of the studies was conducted. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated. Diagnostic performance was compared between the two quantitative analyses using a two-sample Z-test. RESULTS: In total, 22 studies including 2314 patients were included. Unclear risk of bias was observed in 4.5-36.4% of the studies. The 8 radiomics studies exhibited a median (interquartile range) RQS of 13.5 (5.5-15.75). The pooled sensitivity, specificity, LR+, LR-, DOR, and AUC of the ADC values vs radiomics analysis were 0.86 vs 0.84, 0.85 vs 0.73, 5.7 vs 3.1, 0.17 vs 0.22, 34 vs 14, and 0.91 vs 0.86, respectively. There was no threshold effect or publication bias, but significant heterogeneity existed among the studies. No significant difference was detected in the diagnostic performance of the two quantitative analyses using the Z-test. CONCLUSION: ADC values are more clinically promising because they are more easily accessible and widely applied, and exhibit a non-statistically significant trend to outperform radiomics analysis.
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Neoplasias del Cuello Uterino , Femenino , Humanos , Metástasis Linfática/diagnóstico por imagen , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/patología , Imagen de Difusión por Resonancia Magnética , Imagen por Resonancia Magnética , Área Bajo la CurvaRESUMEN
Objective To evaluate changes in morphology of the cesarean scar and uterus between one and two years after cesarean section using high-resolution, three dimensional T2-weighted sampling perfection with application optimized contrast using different flip angle evolutions Magnetic Resonance Imaging (3D T2w SPACE MRI). Methods This prospective study was performed to investigate morphological changes in the cesarean scars and uterus from one to two years after cesarean section using high-resolution, 3D T2w SPACE MRI. The healthy volunteers having no childbearing history were recruited as the controls. All data were measured by two experienced radiologists. All data with normal distribution between the one-year and two-year groups were compared using a paired-sample t test or independent t test. Results Finally, 46 women took a pelvic MR examination one year after cesarean section, and a subset of 15 completed the same examination again after two years of cesarean section. Both the uterine length and the anterior wall thickness after two years of cesarean section (5.75 ± 0.46 and 1.45 ± 0.35 cm) were significantly greater than those measured at one year (5.33 ± 0.59 and 1.25 ± 0.27 cm) (t = -2.363 and -2.175, P= 0.033 and 0.048). No significant difference was shown in myometrial thickness two years after cesarean section (1.45 ±0.35 cm) with respect to the control group (1.58 ± 0.21 cm, P= 0.170). Nine women who underwent MRI twice were considered to have scar diverticula one year after cesarean section, and still had diverticula two years after cesarean section. The thickness, height, and width of the uterine scar showed no significant change from one to two years (all P > 0.05). Conclusions 3D T2w SPACE MRI provides overall morphologic details and shows dynamic changes in the scar and the uterus between one and two years after cesarean section. Scar morphology after cesarean section reached relatively stable one year after cesarean section, and uterine morphology was closer to normal two years after cesarean section.
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Cicatriz , Divertículo , Cesárea/efectos adversos , Cicatriz/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Embarazo , Estudios Prospectivos , Útero/diagnóstico por imagenRESUMEN
Ewing's sarcoma in the cervix is characterized by extremely rare occurrence,high degree of malignancy,and rapid progression.The diagnosis of this disease is based on pathology and immunohistochemistry. The main image of the case reported in this paper showed the cervical cyst with solid mass,large volume,and uneven density and signal,and the solid part can be strengthened in enhanced scanning.Because of the rapid growth,the lesion is prone to liquefaction necrosis and bleeding.Since the metastasis occurs early,timely diagnosis is essential.
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Tumores Neuroectodérmicos Periféricos Primitivos , Sarcoma de Ewing , Neoplasias del Cuello Uterino , Cuello del Útero/patología , Femenino , Humanos , Inmunohistoquímica , Tumores Neuroectodérmicos Periféricos Primitivos/patología , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/patologíaRESUMEN
OBJECTIVE: To investigate the clinical characteristics, treatments, and prognostic factors among patients with gestational trophoblastic neoplasia (GTN) exhibiting brain metastases who underwent craniotomy. METHODS: Thirty-five patients with GTN who had brain metastases and subsequently underwent craniotomies between January 1990 and December 2018 at Peking Union Medical College Hospital were identified using the GTN database. Their clinical manifestations, treatments, outcomes, and prognostic factors were retrospectively analyzed. RESULTS: All 35 patients underwent decompressive craniotomy, hematoma removal, and metastatic tumor resection combined with multiagent chemotherapy. Eighty percent (28/35) achieved complete remission, 11.4% (4/35) achieved partial remission, and 8.6% (3/35) had progressive disease. Not counting 2 patients who were lost to follow-up, 81.8% of the patients (27/33) were alive after a median follow-up of 72 months. The 5-year overall survival rate was 80.4%. Univariate analysis revealed that a history of chemotherapy failure (p=0.020) and a >1-week interval between craniotomy and chemotherapy commencement (p=0.027) were adverse risk factors for survival. Multivariate analysis showed that previous chemotherapy failure remained an independent risk factor for poor survival (odds ratio=11.50; 95% confidence interval=1.55-85.15; p=0.017). CONCLUSION: Decompressive craniotomy is a life-saving option if metastatic hemorrhage and intracranial hypertension produce a risk of cerebral hernia in patients with GTN who have brain metastases. Higher survival rates and improved prognoses can be achieved through perioperative multidisciplinary cooperation and timely standard postoperative chemotherapy.
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Neoplasias Encefálicas , Enfermedad Trofoblástica Gestacional , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Craneotomía , Femenino , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Enfermedad Trofoblástica Gestacional/cirugía , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVES: To develop and validate a clinical-radiomics model that incorporates radiomics signatures and pretreatment clinicopathological parameters to identify multimodality therapy candidates among patients with early-stage cervical cancer. METHODS: Between January 2017 and February 2021, 235 patients with IB1-IIA1 cervical cancer who underwent radical hysterectomy were enrolled and divided into training (n = 194, training:validation = 8:2) and testing (n = 41) sets according to surgical time. The radiomics features of each patient were extracted from preoperative sagittal T2-weighted images. Significance testing, Pearson correlation analysis, and Least Absolute Shrinkage and Selection Operator were used to select radiomic features associated with multimodality therapy administration. A clinical-radiomics model incorporating radiomics signature, age, 2018 Federation International of Gynecology and Obstetrics (FIGO) stage, menopausal status, and preoperative biopsy histological type was developed to identify multimodality therapy candidates. A clinical model and a clinical-conventional radiological model were also constructed. A nomogram and decision curve analysis were developed to facilitate clinical application. RESULTS: The clinical-radiomics model showed good predictive performance, with an area under the curve, sensitivity, and specificity in the testing set of 0.885 (95% confidence interval: 0.781-0.989), 78.9%, and 81.8%, respectively. The AUC, sensitivity, and specificity of the clinical model and clinical-conventional radiological model were 0.751 (0.603-0.900), 63.2%, and 63.6%, 0.801 (0.661-0.942), 73.7%, and 68.2%, respectively. A decision curve analysis demonstrated that when the threshold probability was > 20%, the clinical-radiomics model or nomogram may be more advantageous than the treat all or treat-none strategy. CONCLUSIONS: The clinical-radiomics model and nomogram can potentially identify multimodality therapy candidates in patients with early-stage cervical cancer. KEY POINTS: ⢠Pretreatment identification of multimodality therapy candidates among patients with early-stage cervical cancer helped to select the optimal primary treatment and reduce severe complication risk and costs. ⢠The clinical-radiomics model achieved a better prediction performance compared with the clinical model and the clinical-conventional radiological model. ⢠An easy-to-use nomogram exhibited good performance for individual preoperative prediction.
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Neoplasias del Cuello Uterino , Femenino , Humanos , Histerectomía , Imagen por Resonancia Magnética/métodos , Nomogramas , Estudios Retrospectivos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapiaRESUMEN
BACKGROUND: The depth of cervical stromal invasion is one of the important prognostic factors affecting decision-making for early stage cervical cancer (CC). This study aimed to develop and validate a T2-weighted imaging (T2WI)-based radiomics model and explore independent risk factors (factors with statistical significance in both univariate and multivariate analyses) of middle or deep stromal invasion in early stage CC. METHODS: Between March 2017 and March 2021, a total of 234 International Federation of Gynecology and Obstetrics IB1-IIA1 CC patients were enrolled and randomly divided into a training cohort (n = 188) and a validation cohort (n = 46). The radiomics features of each patient were extracted from preoperative sagittal T2WI, and key features were selected. After independent risk factors were identified, a combined model and nomogram incorporating radiomics signature and independent risk factors were developed. Diagnostic accuracy of radiologists was also evaluated. RESULTS: The maximal tumor diameter (MTD) on magnetic resonance imaging was identified as an independent risk factor. In the validation cohort, the radiomics model, MTD, and combined model showed areas under the curve of 0.879, 0.844, and 0.886. The radiomics model and combined model showed the same sensitivity and specificity of 87.9% and 84.6%, which were better than radiologists (sensitivity, senior = 75.7%, junior = 63.6%; specificity, senior = 69.2%, junior = 53.8%) and MTD (sensitivity = 69.7%, specificity = 76.9%). CONCLUSION: MRI-based radiomics analysis outperformed radiologists for the preoperative diagnosis of middle or deep stromal invasion in early stage CC, and the probability can be individually evaluated by a nomogram.
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BACKGROUND: To evaluate 3-dimensional amide proton transfer weighted (APTw) imaging for type I endometrial carcinoma (EC), and investigate correlations of Ki-67 labelling index with APTw and intravoxel incoherent motion (IVIM) imaging. METHODS: 54 consecutive patients suspected of endometrial lesions underwent pelvic APTw and IVIM imaging on a 3 T MR scanner. APTw values and IVIM-derived parameters (Dt, D*, f) were independently measured by two radiologists on 22 postoperative pathological confirmed of type I EC lesions. Results were compared between histological grades and Ki-67 proliferation groups. ROC analysis was performed. Pearson's correlation analysis was performed for APTw values and IVIM-derived parameters with Ki-67 labeling index. RESULTS: APTw values and Dt, D*, f of all type I EC were 2.9 ± 0.1%, 0.677 ± 0.027 × 10-3 mm2/s, 31.801 ± 11.492 × 10-3 mm2/s, 0.179 ± 0.050 with inter-observer ICC 0.996, 0.850, 0.956, 0.995, respectively. APTw values of Ki-67 low-proliferation group (<30%, n = 8) were 2.5 ± 0.2%, significantly lower than the high-proliferation group (>30%, n = 14) with APTw values of 3.1 ± 0.1% (p = 0.016). Area under the curve was 0.768. APTw values of type I EC were moderately positively correlated with Ki-67 labelling index (r = 0.583, p = 0.004). There was no significant difference of Dt (p = 0.843), D* (p = 0.262), f (p = 0.553) between the two groups. No correlation was found between IVIM-derived parameters and Ki-67 labelling index (Dt, p = 0.717; D* p = 0.151; f, p = 0.153). CONCLUSION: 3D TSE APTw imaging is a feasible approach for detecting type I EC. Ki-67 labeling index positively moderately correlates with APTw not with IVIM.
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Amidas/química , Imagen de Difusión por Resonancia Magnética/métodos , Neoplasias Endometriales/diagnóstico por imagen , Neoplasias Endometriales/patología , Imagenología Tridimensional/métodos , Antígeno Ki-67/metabolismo , Protones , Adulto , Anciano , Proliferación Celular , Neoplasias Endometriales/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROCRESUMEN
PURPOSE: To evaluate the utility of three-dimensional (3D) amide proton transfer-weighted (APTw) imaging for differentiation of endometrial adenocarcinoma and uterine benign lesions. PROCEDURES: This prospective study enrolled 22 normal volunteers and 113 patients with suspicious uterine lesions, including endometrial adenocarcinoma, leiomyoma, and adenomyosis. Pelvic APTw MRI was performed on a 3-T MRI scanner with default APTw parameters. Two radiologists blindly evaluated uterine lesion APTw image quality by a 3-point Likert scale and independently measured APTw values on images with excellent to good image quality. Inter-reader agreement was evaluated. The Mann-Whitney U test with Bonferroni correction was used to compare the differences among different types of uterine lesions. A receiver operating characteristic analysis was performed. RESULTS: A total of 111 lesions (33 endometrial adenocarcinoma, 26 leiomyoma, and 52 adenomyosis lesions) from 99 patients revealing a majority of good quality with excellent inter-reader agreement were included for the image quality evaluation. APTw values of endometrial adenocarcinoma were 2.9 ± 0.1 %, significantly higher than those of leiomyoma (1.9 ± 0.1 %), adenomyosis (2.2 ± 0.1 %), and normal uterine myometrium (1.9 ± 0.1 %) (all p < 0.0001). The area under the receiver operating characteristic curve for differentiating endometrial adenocarcinoma from leiomyoma, adenomyosis, and myometrium was 0.87, 0.85, and 0.91, respectively. Feasible threshold APTw values of each group were determined as 2.4 %, 2.7 %, and 2.4 % with a sensitivity of 83.3 %, 76.7 %, and 83.3 % and a specificity of 83.3 %, 81.6 %, and 86.4 %, respectively. CONCLUSIONS: Malignant endometrial adenocarcinoma had significantly higher APTw values than leiomyoma, adenomyosis, and normal uterine myometrium. Our study adds to the growing body of validation on 3D APTw imaging and uterine lesions.
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Adenocarcinoma/diagnóstico por imagen , Neoplasias Endometriales/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Neoplasias Uterinas/diagnóstico por imagen , Adenomiosis/diagnóstico por imagen , Adulto , Anciano , Amidas , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Leiomioma/diagnóstico por imagen , Persona de Mediana Edad , Estudios Prospectivos , Protones , Curva ROCRESUMEN
OBJECTIVES: To comprehensively evaluate the pelvic magnetic resonance imaging (MRI) findings of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and summarize the typical and atypical characteristics. METHODS: A retrospective analysis of 201 consecutive MRKH patients was carried out. Pelvic MRI was reviewed by two experienced gynecological radiologists in consensus. Characteristics including the morphology, signal pattern and volumes of the uterine rudiments, location and volume of the ovaries, and the degree of vaginal dysgenesis were evaluated. Other noted abnormalities were also recorded. RESULTS: Morphologically, the majority (95%) of patients displayed bilateral uterine rudiments combined with a fibrous band. The minority of patients showed no (3.5%) or unilateral (1.5%) uterine rudiments. A total of 385 uterine rudiments were detected which showed four types of signal patterns: one-layer differentiation (325, 84.4%), two-layer differentiation (27, 7%), three-layer differentiation without subsequent alteration (23, 6.0%), and three-layer differentiation with hematometra and/or ipsilateral hematosalpinx (10, 2.6%). The median volumes of these four types of uterine rudiments were 2.6 ml (1.69-3.81 ml), 3.19 ml (2.67-4.51 ml), 6.05 ml (3.37-12.44 ml), and 31.97 ml (19.2-38.7 ml), respectively. The mean ovarian volume was 6.49 ± 3.91 ml. Abnormally located ovaries were detected in 63 (31.3%) patients. The distal vagina was discernable in 25.1% of patients. CONCLUSION: MRKH patients typically display bilateral uterine rudiments combined with a fibrous band and normally located ovaries. The uterine rudiments are generally small with only one-layer differentiation, a subset of which might be large and exhibited other atypical presentations, including two- or three-layer differentiation or even hematometra. Abnormally located ovaries are not rare. KEY POINTS: ⢠Morphologically, MRKH patients typically displayed bilateral uterine rudiments combined with a fibrous band. ⢠Typically, the uterine rudiments (84.4%) were small and displayed only one-layer differentiation. ⢠About 15.6% of rudiments showed atypical characteristics including two- or three-layer differentiation, even complicated with hematometra or hematosalpinx.
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Trastornos del Desarrollo Sexual 46, XX/diagnóstico por imagen , Anomalías Congénitas/diagnóstico por imagen , Imagen por Resonancia Magnética , Conductos Paramesonéfricos/anomalías , Trastornos del Desarrollo Sexual 46, XX/patología , Adolescente , Adulto , Niño , Anomalías Congénitas/patología , Femenino , Humanos , Conductos Paramesonéfricos/diagnóstico por imagen , Conductos Paramesonéfricos/patología , Ovario/diagnóstico por imagen , Ovario/patología , Pelvis/diagnóstico por imagen , Estudios Retrospectivos , Anomalías Urogenitales/diagnóstico por imagen , Anomalías Urogenitales/patología , Útero/anomalías , Útero/diagnóstico por imagen , Útero/patología , Vagina/anomalías , Vagina/diagnóstico por imagen , Vagina/patología , Adulto JovenRESUMEN
PURPOSE: We sought to evaluate the image quality and compare the signal intensity (SI) and apparent diffusion coefficient (ADC) maps of ultra-high b-value (2000â¯s/mm2; B2) images against those of 800â¯s/mm2 b-value (B1) images of diffusion-weighted imaging (DWI) for cervical cancer. METHOD: This study was approved by the institutional review board. Sixty patients diagnosed with cervical cancer by pathology were prospectively included. Female pelvic magnetic resonance imaging was performed using a 3â¯T magnetic resonance scanner; B1 and B2 images were obtained for evaluation. Two radiologists blinded to the scan parameters evaluated the images for signal loss in the background, spatial distortion, image ghosting, confidence in the lesion delineation, and overall image quality using a 5-point scoring system. The scores were compared using a paired Wilcoxon test. SI was measured in the B1 and B2 images for the tumour and normal reference tissues. Additionally, the SI contrast ratios were calculated and compared using the Mann-Whitney U test, the ADC values of tumours and normal tissues were measured, and the maximum tumour diameters were measured from the B1 and B2 images and compared with those from the T2-weighted images, which was the reference standard. RESULTS: The signal loss in the background, confidence of the lesion delineation and overall image quality scores were higher for the B2 images than for the B1 images (all pâ¯<â¯0.001). The contrast ratios of the tumour-to-normal SI were also higher for the B2 images than for the B1 images (pâ¯<â¯0.01). The mean ADC values derived from the B2 images showed better correlations with the tumour differentiation grades than those from the B1 images. The tumour diameters measured from the B2 images experienced less bias than those from the B1 images. CONCLUSIONS: B2 images of DWI are technically feasible to acquire and provide more promising additional information for the delineation of cervical cancer tumours than B1 images of the female pelvis.
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Imagen de Difusión por Resonancia Magnética/métodos , Interpretación de Imagen Asistida por Computador/métodos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Adulto , Anciano , Algoritmos , Cuello del Útero/diagnóstico por imagen , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Adulto JovenRESUMEN
BACKGROUND: Amide proton transfer-weighted (APTw) imaging has shown great potential in the diagnosis of cancer, but has yet not been well studied in cervical cancer. PURPOSE: To evaluate the image quality and clinical feasibility of APTw MRI for cervical cancer. STUDY TYPE: Prospective. POPULATION: In all, 75 patients with cervical lesions and 49 healthy volunteers. FIELD STRENGTH/SEQUENCE: 3.0 T, 3D turbo spin echo (TSE) APTw sequence. ASSESSMENT: Three radiologists, blinded to the clinical data, independently evaluated APTw image quality with a 5-point Likert scale on 64 patients with pathologically confirmed cervical cancer. APT values, calculated based on asymmetry of acquired Z-spectrum with respect to water frequency, using 3D turbo spin echo volume acquisition with B0 correction, were independently measured by two radiologists, twice for each observer, on 52 cervical cancer lesions and 49 normal cervical stroma with a mean region of interest area of 638.6 mm2 and 557.5 mm2 , respectively. STATISTICAL TESTS: Interobserver agreement was evaluated by Kendall's W test. Intra- and interobserver interclass correlation coefficients (ICC) were computed. Student's t-test was used to compare the differences of APT values between cervical cancer and normal cervix; receiver operating characteristic analysis was performed. RESULTS: Most cases revealed good APTw image quality with excellent agreement (Kendall's W = 0.850, P < 0.001). APT values of cervical cancer and normal cervical stroma were 2.745 ± 0.065 and 1.853 ± 0.059, respectively, with a significant difference (P < 0.0001). Intraobserver ICCs were 0.963 and 0.960 for two readers. Interobserver ICC was 0.993. Area under the curve (AUC) for differentiating cervical cancer from normal cervical stroma was 0.927. The feasible threshold value for AUC was determined as 2.221 with sensitivity of 84.62% and specificity of 83.66%. DATA CONCLUSION: 3D TSE APTw MRI is feasible in cervical cancer. Cervical cancer showed significantly higher APT values than normal cervix. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1318-1325.
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Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Adulto , Anciano , Amidas , Cuello del Útero/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Protones , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Objective To retrospectively determine the features of stones and calcifications in hepatobiliary system on virtual nonenhanced (VNE) dual-energy computed tomography (CT), and to evaluate the possibility of VNE images in diagnosis for those lesions.Methods A total of 128 gall stones and calcifications of the liver found in 110 patients were examined with triple phase abdominal CT scan from July 2007 to December 2011, in which true nonenhanced (TNE) phase and arterial phase were performed with single-energy CT (120 kVp) and portal venous phase was performed with dual-energy CT (100 kVp and 140 kVp). VNE images were generated from the portal venous phase dual-energy CT data sets by using commercially VNC software. The mean CT values for the stone, liver, bile and paraspinal muscle, mean lesion density and size in area dimension, contrast-to-noise ratio (CNR) of lesion to the liver or bile, and image noise were assessed and compared between VNE and TNE images. The effective dose and size-specific dose estimate (SSDE) were also calculated.Results The mean CT values of the lesions measured on VNE images declined significantly compared with those measured on TNE images (164.51±102.13 vs. 290.72±197.80 HU, P<0.001), so did the lesion-to-liver CNR (10.80±11.82 vs.18.81±17.06, P<0.001) and the lesion-to-bile CNR (17.24±14.41 vs. 21.32±17.31, P<0.001). There was no significant difference in size of lesions area between VNE and TNE images (0.69±0.88 vs. 0.72±0.85 cm2, P=0.062). Compared to the 128 lesions found in TNE images, VNE images showed the same density in 30 (23.4%) lesions, lighter density in 88 (68.8%) lesions, while failed to show 10 (7.8%) lesions, and showed the same size in 61 (47.7%) lesions and smaller size in 57 (44.5%) lesions. The CT cutoff values of lesion and size were 229.21 HU and 0.15 cm2, respectively. The total effective dose for triple phase scan protocol with TNE images was 19.51±7.03 mSv, and the SSDE was 39.84±11.10 mGy. The effective dose for dual phase scan protocol with VNE images instead of TNE images was 13.29±4.89 mSv, and the SSDE was 27.83±9.99 mGy. Compared with TNE images, the effective dose and SSDE of VNE images were down by 32.05%±3.69 % and 30.63%±2.34 %, respectively.Conclusions Although the CT values and CNR of the lesions decreased in VNE images, the lesions of which attenuation greater than 229.21 HU and size larger than 0.15 cm2 could be detected with good reliability and obvious dose reduction. There was good consistency in the size of stones and calcifications in hepatobiliary system between VNE images and TNE images, which ensured the possibility of the clinical application of VNE images.
Asunto(s)
Tomografía Computarizada por Rayos X , Enfermedades de las Vías Biliares , Calcinosis , Colelitiasis , Medios de Contraste , Humanos , Vena Porta , Dosis de Radiación , Interpretación de Imagen Radiográfica Asistida por Computador , Imagen Radiográfica por Emisión de Doble Fotón , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: To evaluate the feasibility and clinical robustness of zoomed diffusion-weighted echo planar imaging (z-EPI) relative to conventional single-shot EPI (c-EPI) for DWI of the kidneys. MATERIALS AND METHODS: This retrospective study was approved by the institutional research ethics board. 66 patients (median age 58.5 years±13.4, range 23-83 years, 45 men, 21 women) undergoing 3T (Magnetom Skyra(®), Siemens Healthcare, Erlangen, Germany) using a dynamic parallel transmit array (TimTX TrueShape, Siemens Healthcare, Erlangen, Germany) for renal MRI were included in this study. Both c-EPI and z-EPI images were obtained. For z-EPI, a two-dimensional spatially-selective radiofrequency (RF) pulse was applied for echo planar imaging with the FOV reduced by a factor of 3. Two radiologists, blinded to clinical data and scan parameters evaluated the images with respect to their diagnostic confidence, overall preference, overall image quality, delineation of the kidney, spatial distortion, and image blur. Sequences were compared using a paired Wilcoxon test. ADC values for the upper pole, mid-zone, lower pole of the normal kidneys were compared between sequences as well as ADC values for renal lesions, using a paired t-test. RESULTS: With z-EPI, the kidney was significantly better delineated with sharper boundaries, less image blur and distortion, and overall better image quality relative to c-EPI (all p<0.001). The z-EPI technique led to greater diagnostic confidence than c-EPI (p=0.020). z-EPI was preferred to c-EPI in 60 cases (90.9%, 60/66). No statistically significant differences in the ADC values of renal parenchyma or of renal lesions were observed between the two sequences (all p>0.05). CONCLUSION: Image quality, distortion, and susceptibility artifacts might be improved by using z-EPI rather than c-EPI for DWI of the kidney.
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Imagen de Difusión por Resonancia Magnética , Imagen Eco-Planar , Enfermedades Renales/diagnóstico por imagen , Riñón/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Imagen de Difusión por Resonancia Magnética/métodos , Imagen Eco-Planar/métodos , Estudios de Factibilidad , Femenino , Humanos , Riñón/patología , Enfermedades Renales/patología , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVES: We aimed to determine the frequency of isoattenuating insulinomas, to investigate their clinicopathological features and to assess their regional pancreatic perfusion characteristics. METHODS: Institutional review board approval was obtained, and patient informed consent was waived. From July 2010 to June 2014, 170 patients (66 male, 104 female) with endogenous hyperinsulinemic hypoglycemia underwent biphasic contrast-enhanced CT before surgery, and 129 of those patients also received preoperative whole-pancreas CT perfusion. A total of 181 tumours were proved histopathologically after surgery. Enhancement pattern and regional pancreatic perfusion characteristics were analyzed. Clinical features, tumour size and pathological grading were investigated. RESULTS: The frequency of isoattenuating tumours was 24.9 %. Tumour size and WHO grading was not significantly different between isoattenuating and hyperattenuating tumours. Tumour-free regions had identical blood flow (BF) regardless of their location (p = 0.35). Isoattenuating tumour-harbouring regions had lower BF compared with hyperattenuating tumour-harbouring regions; both showed higher BF compared with tumour-free neighbourhood regions (all p < 0.01). For patients with isoattenuating tumours, the overall hospital stay was longer (p < 0.01). CONCLUSIONS: A substantial subset of insulinomas were isoattenuating on biphasic CT. CT perfusion showed higher BF in tumour-harbouring regions compared to tumour-free regions, providing a clue for tumour regionalization. KEY POINTS: ⢠About a quarter of all insulinomas were isoattenuating on biphasic contrast-enhanced CT. ⢠CT perfusion finds tumour-harbouring regions have higher blood-flow compared to tumour-free regions. ⢠CT perfusion provides important information for tumour regionalization, for isoattenuating tumours.
Asunto(s)
Insulinoma/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Insulinoma/irrigación sanguínea , Insulinoma/patología , Insulinoma/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/métodos , Clasificación del Tumor , Neovascularización Patológica/diagnóstico por imagen , Neoplasias Pancreáticas/irrigación sanguínea , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Perfusión , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: To investigate the image quality, radiation dose and diagnostic value of the low-tube-voltage high-pitch dual-source computed tomography (DSCT) with sinogram affirmed iterative reconstruction (SAFIRE) for non-enhanced abdominal and pelvic scans. METHODS: This institutional review board-approved prospective study included 64 patients who gave written informed consent for additional abdominal and pelvic scan with DSCT in the period from November to December 2012. The patients underwent standard non-enhanced CT scans (protocol 1) [tube voltage of 120 kVp/pitch of 0.9/filtered back-projection (FBP) reconstruction] followed by high-pitch non-enhanced CT scans (protocol 2) (100 kVp/3.0/SAFIRE). The total scan time, mean CT number, signal-to-noise ratio (SNR), image quality, lesion detectability and radiation dose were compared between the two protocols. RESULTS: The total scan time of protocol 2 was significantly shorter than that of protocol 1 (1.4±0.1 seconds vs. 7.6±0.6 seconds, P<0.001). There was no significant difference between protocol 1 and protocol 2 in mean CT number of all organs (liver, 55.4±6.3 HU vs. 56.1±6.8 HU, P=0.214; pancreas, 43.6±5.9 HU vs. 43.7±5.8 HU, P=0.785; spleen, 47.9±3.9 HU vs. 49.4±4.3 HU, P=0.128; kidney, 32.2±2.3 HU vs. 33.1±2.3 HU, P=0.367; abdominal aorta, 44.8±5.6 HU vs. 45.0±5.5 HU, P=0.499; psoas muscle, 50.7±4.1 HU vs. 50.3±4.5 HU, P=0.279). SNR on images of protocol 2 was higher than that of protocol 1 (liver, 5.0±1.2 vs. 4.5±1.1, P<0.001; pancreas, 4.0±1.0 vs. 3.6±0.8, P<0.001; spleen, 4.7±1.0 vs. 4.1±0.9, P<0.001; kidney, 3.1±0.6 vs. 2.8±0.6, P<0.001; abdominal aorta, 4.1±1.0 vs. 3.8±1.0, P<0.001; psoas muscle, 4.5±1.1 vs. 4.3±1.2, P=0.012). The overall image noise of protocol 2 was lower than that of protocol 1 (9.8±3.1 HU vs. 11.1±3.0 HU, P<0.001). Image quality of protocol 2 was good but lower than that of protocol 1 (4.1±0.7 vs. 4.6±0.5, P<0.001). Protocol 2 perceived 229 of 234 lesions (97.9%) that were detected in protocol 1 in the abdomen and pelvis. Radiation dose of protocol 2 was lower than that of protocol 1 (4.4±0.4 mSv vs. 7.3±2.4 mSv, P<0.001) and the mean dose reduction was 41.4%. CONCLUSION: The high-pitch DSCT with SAFIRE can shorten scan time and reduce radiation dose while preserving image quality in non-enhanced abdominal and pelvic scans.