Pattern Recognition or Adnexal MR Scoring System: Which Is More Accurate in Evaluating Adnexal Lesions?

PURPOSE: This study aims to compare the accuracy of the ADNEX MR scoring system and pattern recognition system to evaluate adnexal lesions indeterminate on the US exam. METHODS: In this cross-sectional retrospective study, pelvic DCE-MRI of 245 patients with 340 adnexal masses was studied based on the ADNEX MR scoring system and pattern recognition system. RESULTS: ADNEX MR scoring system with a sensitivity of 96.6% and specificity of 91% has an accuracy of 92.9%. The pattern recognition system's sensitivity, specificity, and accuracy are 95.8%, 93.3%, and 94.7%, respectively. PPV and NPV for the ADNEX MR scoring system were 85.1 and 98.1, respectively. PPV and NPV for the pattern recognition system were 89.7% and 97.7%, respectively. The area under the ROC curve for the ADNEX MR scoring system and pattern recognition system is 0.938 (95% CI, 0.909-0.967) and 0.950 (95% CI, 0.922-0.977). Pairwise comparison of these AUCs showed no significant difference (p = 0.052). CONCLUSION: The pattern recognition system is less sensitive than the ADNEX MR scoring system, yet more specific.

Prediction of lymphovascular space invasion in cervical carcinoma using diffusion kurtosis imaging.

BACKGROUND: This study aimed to investigate the potential relationship between diffusion kurtosis imaging (DKI)- derived parameters and lymphovascular space invasion (LVSI) in patients with cervical carcinoma. PATIENTS AND METHODS: This prospective study included 30 patients with cervical carcinoma. The patients underwent MRI, diffusion-weighted imaging (DWI), and DKI prior to surgery. The surgical pathology results were accepted as the reference standard for determining the LVSI status. The DKI-derived parameters, including mean diffusivity (MD) and mean kurtosis (MK), were measured. The apparent diffusion coefficient (ADC) value was also assessed. RESULTS: The MD value of LVSI positive cervical carcinomas was significantly lower than LVSI negative carcinomas (p-value = 0.01). MK value was significantly higher in LVSI positive tumors (p-value = 0.01). However, the ADC value did not show a significant difference between LVSI positive and LVSI negative tumors (p-value = 0.2). MD and MK parameters showed similar diagnostic accuracy in identifying the LVSI status, with the area under the curve of 0.77 and 0.78, respectively. CONCLUSION: In this study, DKI-derived parameters were associated with the LVSI status in cervical carcinomas. Further studies with larger sample size are required to confirm these results.

Identification and Subtyping of Cryptosporidium parvum and Cryptosporidium hominis in Cancer Patients, Isfahan Province, Central Iran.

Background: Cryptosporidium spp. are protozoan parasites that cause diarrhea in humans and animals. Subtyping data about Cryptosporidium spp. in Isfahan, Iran is limited; therefore, we aimed to study the prevalence rate of Cryptosporidium spp. in cancer patients, associated risk factors, and subtypes of Cryptosporidium spp. Methods: Fecal samples were collected from 187 cancer patients from the Oncology Department of Seyed-al-Shohada Hospital, Isfahan University of Medical Sciences during 2014-2020 and screened for Cryptosporidium spp. using microscopical techniques. Nested PCR amplifying 18S rRNA gene was used to detect Cryptosporidium spp. in samples, followed by subtyping using nested PCR amplifying gp60 sequences. Results: Overall, the rate of infection with Cryptosporidium spp. was 4.3% (n=8). Five samples out of eight samples were identified as Cryptosporidium spp. using a nested PCR for the 18S rRNA gene, two subtypes of C. parvum named IIaA18G3R1 (n = 2) and IIaA17G2R1 (n = 2), and one subtype of C. hominis named IbA6G3 were identified by sequencing of the gp60. The IbA6G3 subtype has rarely been detected in other investigations. Conclusion: This is the first survey on the subtyping of Cryptosporidium spp. in this region. The results of the present survey show both zoonotic and anthroponotic transmission routes in the region.

The importance of correct radiological diagnosis in (adenoma malignum): a case report.

Minimal deviation adenocarcinoma (MDA) of the cervix otherwise known as adenoma malignum is a rare variation of cervical adenocarcinoma. Radiological evaluation plays a great role to ensure an early diagnosis. Here, we report a 48-year-old woman who was presented with a mucoid vaginal discharge 10 years after a supracervical hysterectomy. Despite normal biopsy and cytology, magnetic resonance imaging showed a large cervix and multiple cervical cysts that considered adenoma malignum as a differential diagnosis. She underwent surgery and the pathology confirmed the adenoma malignum. In conclusion, radiologists, as well as gynecologists, and also pathologists may consider MDA among the differential diagnosis in patients with a vaginal discharge and multicysts in the cervix even after hysterectomy despite normal cytology and biopsy.

Accurate Estimation of Breast Tumor Size: A Comparison Between Ultrasonography, Mammography, Magnetic Resonance Imaging, and Associated Contributing Factors.

OBJECTIVE: This study aimed to provide further evidence on the accuracy of tumor size estimates and influencing factors. MATERIALS AND METHODS: In this cross-sectional study, patients with a biopsy-proven diagnosis of breast cancer referred to our hospital to obtain a preoperative magnetic resonance imaging (MRI) between 2015 and 2016 were included. Data from 76 breast cancer patients with 84 lesions were collected. All participants underwent ultrasonography and MRI, and their mammograms (MGMs) were reevaluated for tumor size estimation. Measurements by the three imaging modalities were compared with the pathologically determined tumor size to assess their accuracy. Influencing factors such as surgical management, molecular and histopathological subtypes, and Breast Imaging Reporting and Data System enhancement types in MRI were also assessed. RESULTS: The rates of concordance with the gold standard were 64.3%, 76.2%, and 82.1% for MGM, ultrasound (US), and MRI measurements, respectively. Therefore, the highest concordance rate was observed in MRI-based estimates. Among the discordant cases, US and MGM underestimation were more prevalent (70%); nevertheless, MRI showed significant overestimation (80%). Tumor size estimates in patients whose MRIs presented with either non-mass enhancement [p=0.030; odds ratio (OR)=17.2; 95% confidence interval (CI): 1.3-225.9] or mass lesion with non-mass enhancement (p=0.001; OR=51.0; 95% CI: 5.0-518.4) were more likely to be discordant with pathological measurements compared with those in cases with only mass lesion on their MRIs. CONCLUSION: MRI was more accurate than either US or MGM in estimating breast tumor size but had the highest overestimation rate. Therefore, caution should be practiced in interpreting data obtained from subjects whose MRIs present with non-mass enhancement or mass lesion with non-mass enhancement.

A Practical, Clinical User-Friendly Format for Breast Ultrasound Report.

OBJECTIVE: Breast ultrasound (BUS) is often performed as an adjunct to mammography in breast cancer screening or for evaluating breast lesions. Our aim was to design a practical and user-friendly format for BUS that could include the details of the Breast Imaging Reporting and Data System. MATERIALS AND METHODS: As a team of radiologists and surgeons trained in the management of breast diseases, we gathered and carried out the project in four phases-literature search and collection of present report formats, summarizing key points and preparing the first draft, seeking expert opinion and preparing the final format, and pilot testing-followed by a survey was answered by the research team's radiologists and surgeons. RESULTS: It produced a list of items to be stated in the BUS report, the final BUS report format, and the pilot format guide. Then, the radiologists used the format in three active ultrasound units in university-affiliated centers, and reports were referred to the surgeons. At the end of the project, the survey showed a high degree of ease of use, clarity, conciseness, comprehensiveness, and well-classified structure of the report format; but radiologists believed that the new organization took more time. CONCLUSION: We propose our design as a user-friendly and practical format for BUS reports. It should be used for a longer time and by various ultrasound centers in order to ascertain its benefits.

A Diagnostic Algorithm using Multi-parametric MRI to Differentiate Benign from Malignant Myometrial Tumors: Machine-Learning Method.

This study aimed to develop a diagnostic algorithm for preoperative differentiating uterine sarcoma from leiomyoma through a supervised machine-learning method using multi-parametric MRI. A total of 65 participants with 105 myometrial tumors were included: 84 benign and 21 malignant lesions (belonged to 51 and 14 patients, respectively; based on their postoperative tissue diagnosis). Multi-parametric MRI including T1-, T2-, and diffusion-weighted (DW) sequences with ADC-map, contrast-enhanced images, as well as MR spectroscopy (MRS), was performed for each lesion. Thirteen singular MRI features were extracted from the mentioned sequences. Various combination sets of selective features were fed into a machine classifier (coarse decision-tree) to predict malignant or benign tumors. The accuracy metrics of either singular or combinational models were assessed. Eventually, two diagnostic algorithms, a simple decision-tree and a complex one were proposed using the most accurate models. Our final simple decision-tree obtained accuracy = 96.2%, sensitivity = 100% and specificity = 95%; while the complex tree yielded accuracy, sensitivity and specificity of 100%. To summarise, the complex diagnostic algorithm, compared to the simple one, can differentiate tumors with equal sensitivity, but a higher specificity and accuracy. However, it needs some further time-consuming modalities and difficult imaging calculations. Trading-off costs and benefits in appropriate situations must be determinative.

Parity and Incidence of Thyroid Autoimmunity: A Population-Based Tehran Thyroid Study.

Introduction: Autoimmune thyroid disease is the most common autoimmune disorder. Evidence regarding causes of the high prevalence and incidence of thyroid autoimmunity in women, and especially women of reproductive age, is still inconclusive and previous studies have suggested genetic, environmental, and existential factors to play a role in its pathogenesis. In this study, we aimed to investigate the effect of parity and other reproductive factors on the incidence of thyroid autoimmunity within the framework of the Tehran Thyroid Study (TTS). Materials and Methods: This study was conducted within the framework of the TTS and 1999 nonpregnant euthyroid thyroid peroxidase antibody (TPOAb) negative women were followed up for an average of 8.3 years. A pooled logistic regression model was used to assess the association (odds ratio) between time-dependent covariates parity, menopause, and abortion, and incidence of TPOAb positivity. Results: The total incidence rate of TPOAb positivity was 8.65 [7.35-10.18] per 1000 person-years. We found no significant association between changes in the number of parity and risk of developing TPOAb using multiple pooled logistic models both as crude effect and after adjustment for age, body mass index, and smoking. Similarly, there was no association between changes of parity, menopause, and abortion status, and incidence of TPOAb positivity. Conclusions: Parity does not seem to have an independent role in triggering thyroid autoimmunity, but vast immunological and physiological changes during pregnancy may act as a precipitating factor in the context of other genetic and environmental modifiers.

Cavum velum interpositum cysts in normal and anomalous fetuses in second trimester of pregnancy: Comparison of its size and prevalence.

OBJECTIVE: Cavum veli interpositi (CVI) is a potential space below the splenium of corpus callosum and sometimes presents as a cyst. MATERIALS AND METHODS: In this prospective cross-sectional study, 360 fetuses with normal second trimester scan and 152 s trimester fetuses with structural abnormalities were included. RESULTS: The CVI cysts were more common in fetuses with brain anomaly compared to normal fetuses and fetuses with extra-central nervous system (CNS) anomalies (23% vs 18.3% and 18% respectively; p value < 0.01). The mean size of cysts in normal fetuses, fetuses with extra-CNS anomalies and fetuses with brain abnormalities was 4.6 mm, 5.8 mm and 9.2 mm respectively. There was a significant difference between cysts size in normal fetuses and fetuses with brain anomalies (p value < 0.01) and the cut-point was 7.1 mm. CONCLUSION: The prevalence of CVI cysts is more in fetuses with brain anomaly. Fetuses with a cyst size >7.1 mm need a more detailed brain examination.

Serum ferritin levels and irregular use of iron chelators predict liver iron load in patients with major beta thalassemia: a cross-sectional study.

AIM: To determine whether serum ferritin, liver transaminases, and regularity and type of iron chelation protocol can be used to predict liver iron load as assessed by T2* magnetic resonance imaging (MRI) in patients with beta thalassemia major (TM). METHODS: This cross-sectional study, conducted from March 1, 2014 to March 1, 2015, involved 90 patients with beta TM on regular packed red blood cell transfusion. Liver and cardiac iron load were evaluated with T2* MRI. Compliance with iron-chelating agents, deferoxamine or deferasirox, and regularity of their use, as well as serum ferritin and liver transaminase levels were assessed. RESULTS: Patients with high serum ferritin were 2.068 times (95% confidence interval 1.26-3.37) more likely to have higher liver or cardiac iron load. High serum aspartate aminotransferases and irregular use of iron chelating agents, but not their type, predicted higher cardiac iron load. In a multiple regression model, serum ferritin level was the only significant predictor of liver and myocardial iron load. CONCLUSIONS: Higher serum ferritin strongly predicted the severity of cardiac and liver iron load. Irregular use of chelator drugs was associated with a higher risk of cardiac and liver iron load, regardless of the type of chelating agent.

Comparison of Qualitative (Time Intensity Curve Analysis), Semi-Quantitative, and Quantitative Multi-Phase 3T DCEMRI Parameters as Predictors of Malignancy in Adnexal.

Objective: The present study aimed to compare the qualitative (time intensity curve analysis), the semi-quantitative and the quantitative multiphase 3T dynamic contrast-enhanced (DCE) MRI parameters as predictors of malignancy in adnexal masses. Materials and Methods: In this prospective study, women with an adnexal mass who were scheduled for surgical resection or were followed for more than one year period to confirm the benignity of their lesions, underwent multiphase 3T DCE-MRI. The qualitative (time intensity curve), semi-quantitative (SImax, SIrel, WIR) and quantitative (Ktrans, Kep, Vb) analyses were performed on DCE-MRI sequences and their predictive values were compared. Results: A total of 17 benign and 14 malignant lesions were included. According to the qualitative analysis, none of the lesions with Type I time intensity curves (TIC) were malignant and none of the masses with Type III TICs were benign. The accuracy of the quantitative parameters in detection of malignancy was found to be higher than that of semi-quantitative variables, particularly when calculated for a small ROI within the high signal area of the mass (sROI) rather than the largest ROI including the whole mass (lROI), and when inter-MRI variations were omitted using ratios. The Kep(tumor)/Kep(myometrium) ratio measured from sROI was the best parameter for differentiating a malignant lesion with a sensitivity of 100% and a specificity of 92.3%. Conclusion: We concluded that a Type I TIC confirms a benign lesion, and a type III TIC confirms the malignancy and further evaluation is not recommended for these lesions. So complementary quantitative analysis is only recommended for adnexal masses with type II TICs.

Investigating the diagnostic value of quantitative parameters based on T2-weighted and contrast-enhanced MRI with psoas muscle and outer myometrium as internal references for differentiating uterine sarcomas from leiomyomas at 3T MRI.

BACKGROUND: Post-hysterectomy histopathological examination is currently the main diagnostic tool for differentiating uterine sarcomas from leiomyomas. This study aimed to investigate the diagnostic accuracy of preoperative quantitative metrics based on T2-weighted sequences and contrast-enhanced MRI (CE-MRI) for distinguishing uterine sarcomas from leiomyomas. MATERIALS AND METHODS: The institutional review board approved the study. Sixty-five women confirmed to have a total of 105 lesions participated. Routine pelvic MRI sequences, T2 map and CE-MRI images were performed preoperatively using a 3 T MR scanner. Six quantitative metrics-T2 mapping parameter, T2 scaled ratio, tumor myometrium contrast ratio on T2, tumor psoas contrast ratio on T2, tumor myometrium contrast-enhanced ratio, and tumor psoas contrast-enhanced ratio-were extracted from the acquired image sets. Chi-square test was used to compare the percentage of malignant lesions with the central necrosis to the corresponding percentage for the benign masses. Using the area under receiver operating characteristic (AUC) curve, the performance of different metrics for distinguishing uterine sarcomas from leiomyomas was measured. Moreover, for each metric, we extracted the optimal cut-off value. The values of sensitivity, specificity, negative predictive value, and positive predictive value were calculted for the classifiers based on different metrics. RESULTS: The average age, average lesion size, and proportion of premenopausal women in benign and malignant groups were comparable in our dataset. The signal intensity of uterine sarcomas at T2-weighted sequences was significantly higher than that of leiomyomas (p < 0.001), while intensity at T1-weighted sequences exhibited no significant difference between the two masses (p = 0.201). Our data also suggested that a central necrosis was ten times more common among malignant lesions compared to benign ones (p < 0.001). Among different metrics, T2 mapping parameter achieved the highest AUC value and accuracy in differentiating two groups. Three measures-T2 scaled ratio, tumor myometrium contrast ratio on T2, and tumor myometrium contrast-enhanced ratio-achieved a sensitivity of 100%, therefore none of the malignant lesions would have been missed if these metrics had been adopted in patient management. CONCLUSIONS: The findings suggested that the evaluated metrics could be useful in the preoperative assessment of myometrial masses to differentiate uterine sarcomas from leiomyomas. The proposed framework has major implications for improving current practice in the management of myometrial masses.

Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study.

BACKGROUND: Intra-abdominal adhesion is one of the most important complications of abdominopelvic surgery. It increases morbidity and mortality for patients. Although laparoscopy is the gold standard of adhesion diagnosis, it can cause visceral damage during the operation. Therefore, surgeons prefer to use non-invasive methods for planning the operation. We designed this study to evaluate transabdominal ultrasonography ( TAU) accuracy for diagnosing Intra-abdominal Adhesions. MATERIAL & METHODS: This double-blinded cohort study was conducted on 47 patients with previous laparotomy who undergo another surgery. Spontaneous visceral slide (SVS) and induced visceral slide (IVS) were measured during TAU. RESULTS: The mean age and BMI of 47 patients were 43.21±10.3 and 27.545±5.76. The majority of the patients were female (76%). Mean SVS and IVS in patients with intra-abdominal adhesion were 8.73±1.60 and 44.84±11.60. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TAU in intra-abdominal diagnosis were 83.33%, 51.72%, 51.72%, 83.33%, 63.83%. CONCLUSIONS: Although TAU is an appropriate method for detecting the intra-abdominal adhesion, it isn't good enough for diagnosing free adhesion area. We recommended further researches with greater sample size and other non-invasive techniques.

Endometrial Metastasis from Ductal Breast Carcinoma: A Case Report with Literature Review.

BACKGROUND There are few reports of breast cancer cases with uterine metastases; among them, myometrium is more frequently involved than endometrium. The majority of breast cancer metastases to endometrium are lobular type, and there have been only 5 reported cases of ductal type since 1984. Here, we describe a new case of invasive ductal carcinoma with metastases to endometrium and isolated presentation of abnormal uterine bleeding, in addition to reviewing the existing literature on other similar cases. CASE REPORT The patient was a 51-year-old Persian woman with no remarkable past medical or family history of cancer, who presented with a 6-month complaint of menorrhagia to our gynecology clinic. Diagnostic studies including trans-vaginal ultrasonography, pathological examination of endometrial curettage specimen, immunohistochemistry findings, and X-plane and magnetic resonance mammography, and breast core-needle biopsy revealed invasive ductal breast carcinoma as the origin of the endometrial metastasis. CONCLUSIONS Abnormal uterine bleeding in a premenopausal patient should alert clinicians to the possibility of secondary as well as primary neoplasms. It is necessary to differentiate a metastatic tumor from a primary one, since the treatment and prognosis are completely different.

Sentinel lymph node in cervical cancer.

Background: Cervical cancer is the second most common type of cancer among women. Effective screening programs can help cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has been widely studied and clinically used for many types of cancer. Methods: Two techniques exist for detecting sentinel node in cervical cancer, which are Blue dye and gamma probe with radioactive isotope (99mTc). Moreover, lymphoscintigraphy has many advantages over the stain method. Detecting the sentinel node is performed via laparoscopy or laparotomy; former method is better and more accurate. Results: Various researchers have focused on this method and its positive results; its superiority against full lymphadenectomy has been declared in previous studies. Moreover, the role of sentinel lymph nodes biopsy in cervical cancer is still being extensively studied. Sentinel lymph nodes (SLN) method has a higher accuracy level to detect metastasis. Conclusion: Hence, it can be considered as a more appropriate alternative for pelvic lymph node dissection (PLND), which is a standard technique. Altering the method to a standard clinical method needs in-depth researches and studies.

Differentiation of benign from malignant adnexal masses by functional 3 tesla MRI techniques: diffusion-weighted imaging and time-intensity curves of dynamic contrast-enhanced MRI.

BACKGROUND: The aim of this study was to evaluate and compare the accuracy of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) value, and time-intensity curve (TIC) type analysis derived from dynamic contrast-enhanced MR imaging (DCE-MRI) in differentiating benign from malignant adnexal masses. MATERIALS AND METHODS: 47 patients with 56 adnexal masses (27 malignant and 29 benign) underwent DWI and DCE-MRI examinations, prior to surgery. DWI signal intensity, mean ADC value, and TIC type were determined for all the masses. RESULTS: High signal intensity on DWI and type 3 TIC were helpful in differentiating benign from malignant adnexal masses (p<0.001). The mean ADC value was significantly lower in malignant adnexal masses (p<0.001). An ADC value<1.20?10-3 mm2/s may be the optimal cutoff for differentiating between benign and malignant tumors. The negative predictive value for low signal intensity on DWI, and type 1 TIC were 100%. The pairwise comparison among the receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) of TIC was significantly larger than the AUCs of DWI and ADC (p<0.001 for comparison of TIC and DWI, p<0.02 for comparison of TIC and ADC value). CONCLUSIONS: DWI, ADC value and TIC type derived from DCE-MRI are all sensitive and relatively specific methods for differentiating benign from malignant adnexal masses. By comparing these functional MR techniques, TIC was found to be more accurate than DWI and ADC.

Ultrasonography and computed tomography for management of adnexal masses in Iranian patients with suspected ovarian cancer: results of a prospective study.

BACKGROUND: To determine and compare the accuracy of sonographic and computerized tomography (CT) scan assessments in distinguishing between benign and malignant adnexal masses in an under-studied population of Iranian patients. METHODS: Transabdominal sonography (TAS) and CT reports of 75 women with adnexal masses (34 malignant, and 41 benign) who were consecutive operated patients at a tertiary gynecology cancer center (Tehran, Iran) were examined. The sonography examinations were operated by a radiologist experienced in the gynecologic oncology field. Biomarkers were determined in blood samples. For CT and TAS, to classify masses as malignant or benign, receiver operating curves (ROC) were assessed and the areas under the curves were compared. RESULTS: For TAS the sensitivity, specificity, positive predictive value and negative predictive value were 91%, 68%, 71% and 90%, respectively. For CT scans the results were 85%, 56 %, 62% and 83%, respectively. The AUC of sonography assessment to diagnose malignancy was significantly higher than that of CT scan (0.8 vs.0.71; p<0.05). CONCLUSION: Transabdominal sonography proved to be a sensitive method for preoperative detection and staging of suspected ovarian cancer. Biomarkers and CT scan imaging add no additional findings for pre-operative characterization of ovarian masses.

Pathologic significance of the "dural tail sign".

OBJECTIVE: The exact nature of the "dural tail sign" (thickening of the dura adjacent to the tumour in contrast enhanced T1-MRI imaging) is still not clearly established. In this study we tried to verify the histological appearance of the "dural tail sign" and probable correlation between different MRI findings and dural tail histology. MATERIAL AND METHODS: In this study, 129 patients with intracranial lesions underwent MRI imaging with 1.5T scanner. The "dural tail sign" was defined using Goldsher et al. criteria. Size and pattern of enhancement of the tumour and adjacent dura was noted in MRI and in the pathologic samples, dural tail and the dura beneath the tumour was assessed. RESULTS: In 30 cases, "dural tail sign" was evident on MRI, dural tail noted in 17 of these cases in histological samples (12 meningiomas, 3 pituitary adenomas and 2 schwannomas). All of them had vessel dilatation, 6 showed tumoural invasion, 4 demonstrated intravascular growth of the lesion and 1 showed inflammation of the dura. CONCLUSION: In our study MRI findings failed to predict tumoural invasion of the dural tail in histologic samples and because of frequent presence of tumour nests in it, the dura matter should be resected as widely as possible.