Adnexal masses: development and preliminary validation of an MR imaging scoring system.

PURPOSE: To construct and undertake preliminary validation of a magnetic resonance (MR) imaging scoring system designed for use in pelvic MR imaging performed for characterization of adnexal masses that were indeterminate at ultrasonography (US). MATERIALS AND METHODS: The institutional ethics committee approved this retrospective study and granted a waiver of informed consent. The study population comprised 394 women who underwent MR imaging between January 1, 2008, and October 30, 2010, for characterization of 497 adnexal masses that were seen at US. Then, masses were chronologically divided into a training set (329 masses) and a validating set (168 masses). Two radiologists who were blinded to the clinical findings retrospectively evaluated MR imaging criteria for characterization of adnexal masses. In the training set, the positive likelihood ratio (PLR) of malignancy and κ values were calculated for each criterion. The reference standard was surgical pathologic findings or findings at imaging follow-up of at least 1 year. On the basis of the PLR and multivariate analysis, a five-category MR scoring system called the ADNEX MR SCORING system was created and was subsequently tested by six readers with the validating set. RESULTS: There was almost perfect agreement (κ > 0.80) for each MR imaging feature except for grouped septa (κ = 0.558) and thickened regular septa (κ = 0.555). The classification was accurate in both the training set (area under the receiver operating characteristic [ROC] curve [AUC] = 0.981 for reader 1 and 0.961 for reader 2) and the validating set (AUC = 0.964 for reader 1 and 0.943 for reader 2). ROC curve analysis demonstrated that the optimal cutoff point was an ADNEX MR score of 3; an ADNEX MR score of 4 or higher was associated with malignancy with a sensitivity of 93.5% (58 of 62) and a specificity of 96.6% (258 of 267). CONCLUSION: In this study, a reproducible and accurate MR imaging scoring system that has the potential to improve patient care was developed and tested. Multicenter prospective validation of the score is warranted. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121161/-/DC1.

Quantitative dynamic contrast-enhanced MR imaging analysis of complex adnexal masses: a preliminary study.

OBJECTIVE: To evaluate the ability of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate malignant from benign adnexal tumours. METHODS: Fifty-six women with 38 malignant and 18 benign tumours underwent MR imaging before surgery for complex adnexal masses. Microvascular parameters were extracted from high temporal resolution DCE-MRI series, using a pharmacokinetic model in the solid tissue of adnexal tumours. These parameters were tissue blood flow (F(T)), blood volume fraction (Vb), permeability-surface area product (PS), interstitial volume fraction (Ve), lag time (Dt) and area under the enhancing curve (rAUC). Area under the receiver operating curve (AUROC) was calculated as a descriptive tool to assess the overall discrimination of parameters. RESULTS: Malignant tumours displayed higher F(T), Vb, rAUC and lower Ve than benign tumours (P < 0.0001, P = 0.0006, P = 0.04 and P = 0.0002, respectively). F(T) was the most relevant factor for discriminating malignant from benign tumours (AUROC = 0.86). Primary ovarian invasive tumours displayed higher F(T) and shorter Dt than borderline tumours. Malignant adnexal tumours with associated peritoneal carcinomatosis at surgery displayed a shorter Dt than those without peritoneal carcinomatosis at surgery (P = 0.01). CONCLUSION: Quantitative DCE-MRI is a feasible and accurate technique to differentiate malignant from benign adnexal tumours and could potentially help oncologists with management decisions. KEY POINTS: Quantitative DCE MR imaging allows accurate differentiation between malignant and benign tumours. Quantitative DCE MRI may help predict peritoneal carcinomatosis associated with ovarian tumors. Quantitative DCE MRI helps distinguish between invasive and borderline primary ovarian tumours.

Rectal ulcer: Due to ketoprofen, argon plasma coagulation and prostatic brachytherapy.

Prostatic brachytherapy with permanent seed implants is a recent and safe radiation therapy technique associated with radiation-induced digestive disease. Argon plasma coagulation procedure is a validated modality in the management of haemorrhagic radiation proctitis, which is known to occasionally induce chronic rectal ulcers. We report here an original case report of an acute painful rectal ulcer as a consequence of the combination of short-term therapy with non-steroidal anti-inflammatory drugs therapy, prostatic brachytherapy with malposition of seed implants and argon plasma coagulation procedure in a patient with haemorrhagic radiation proctitis. The description of this clinical observation is essential to recommend the discontinuation of non-steroidal anti-inflammatory drugs therapy and the control of the position of seed implants in case of prostatic brachytherapy before argon plasma coagulation for radiation-induced proctitis.