Objective
The aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging guidelines for MR work-up in patients with known or ...suspected uterine leiomyomas.
Methods
Guidelines for imaging uterine leiomyomas were defined based on a survey distributed to all members of the working group, an expert consensus meeting at European Congress of Radiology (ECR) 2017 and a critical review of the literature.
Results
The 25 returned questionnaires as well as the expert consensus meeting have shown reasonable homogeneity of practice among institutions. Expert consensus and literature review lead to an optimized MRI protocol to image uterine leiomyomas. Recommendations include indications for imaging, patient preparation, MR protocols and reporting criteria. The incremental value of functional imaging (DWI, DCE) is highlighted and the role of MR angiography discussed.
Conclusions
MRI offers an outstanding and reproducible map of the size, site and distribution of leiomyomas. A standardised imaging protocol and method of reporting ensures that the salient features are recognised. These imaging guidelines are based on the current practice among expert radiologists in the field of female pelvic imaging and also incorporate essentials of the current published MR literature of uterine leiomyomas.
Key Points
•
MRI allows comprehensive mapping of size and distribution of leiomyomas.
•
Basic MRI comprise T2W and T1W sequences centered to the uterus.
•
Standardized reporting ensures pivotal information on leiomyomas, the uterus and differential diagnosis.
•
MRI aids in differentiation of leiomyomas from other benign and malignant entities, including leiomyosarcoma.
Objectives
To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI.
Methods
...The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as “RECOMMENDED” versus “NOT RECOMMENDED” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts).
Results
Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended.
Conclusions
These consensus recommendations should be used as a guide for endometrial cancer staging with MRI.
Key points
• MRI is recommended for initial staging of endometrial cancer.
• MR imaging protocol should be tailored based on the risk of lymph node metastases.
• Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging.
• The mnemonic “Clinical and MRI Critical TEAM” summarizes key elements of the standardized report.
Background
High‐intensity focused ultrasound (HIFU) emerged as a novel approach for the treatment of localized prostate cancer (PCa). However, prospective studies on HIFU‐related outcomes and ...predictors of treatment failure (TF) remain scarce.
Materials and Methods
We conducted a multinational prospective cohort study among patients undergoing HIFU therapy for localized, low‐ to intermediate‐risk PCa. Follow‐up data on serial prostate specific antigen (PSA), multi‐parametric magnetic resonance imaging (mpMRI), targeted/systematic biopsies, adverse events and functional outcomes were collected. The primary endpoint was TF, defined as histologically confirmed PCa requiring whole‐gland salvage treatment. Uni‐ and multi‐variable adjusted hazard ratios (HRs) were calculated using Cox proportional hazard regression models.
Results
At baseline, mean (standard deviation) age was 64.14 (7.19) years, with the majority of patients showing T‐stage 1 (73.9%) and International Society of Urological Pathology grading system Grade 2 (58.8%). PSA nadir (median, 1.70 ng/mL) was reached after 6 months. Of all patients recruited, 16% had clinically significant PCa, as confirmed by biopsy, of which 13.4% had TF. Notably, T‐stage and number of positive cores at initial biopsy were independent predictors of TF during follow‐up (HR 95% CI 1.27 1.02–1.59 and 5.02 1.80–14.03, respectively). Adverse events were minimal (17% and 8% early and late adverse events, respectively), with stable or improved functional outcomes in the majority of patients.
Conclusions
This interim analysis of a multinational study on HIFU therapy for the management of low‐to‐intermediate‐risk PCa reveals good functional outcomes, minimal adverse events and low incidence of TF over the short‐term. Data on long‐term outcomes, specifically as it relates to oncological outcomes, are awaited eagerly.
This study examines outcomes and predictors of treatment failure (TF) following high‐intensity focused ultrasound (HIFU) therapy for localized prostate cancer (PCa). A multinational prospective cohort study was conducted, analysing serial prostate specific antigen (PSA), MRI, biopsies, adverse events and functional outcomes. Results show low incidence of TF, with initial T‐stage and positive biopsy cores predicting TF. Minimal adverse events and positive functional outcomes were observed. The findings highlight HIFU as a promising treatment for low‐to‐intermediate‐risk PCa, though long‐term data are needed to assess oncological outcomes.
Objective
Non-mass enhancement (NME) in breast MRI is the most common feature of ductal carcinoma in situ (DCIS). We sought to evaluate the interobserver variability and positive predictive value ...(PPV) for malignancy of NME descriptors using the fifth edition BI-RADS lexicon focusing on the newly introduced “clustered ring enhancement” pattern.
Materials and methods
Breast MRIs of 129 patients who had undergone MRI-guided vacuum-assisted biopsy (VAB) in our institution were reviewed. Studies assessed as NME were classified according to the fifth edition BI-RADS lexicon by two breast radiologists. Consensus was reached by involving a third radiologist. Interobserver variability and PPV for malignancy were assessed.
Results
Seventy-two of 129 studies were assessed as NME. The disagreement rate in the first assessment step (mass vs. NME) was low at 9.3% (
ĸ
= 0.81, 95% confidence interval CI 0.71–0.91). The disagreement rate for distribution patterns was 23.6% (
ĸ
= 0.67, 95% CI 0.54–0.80) and 22.2% (
ĸ
= 0.69, 95% CI 0.56–0.81) for internal enhancement patterns. Clustered ring enhancement (PPV 53.85,
p =
0.038) and segmental distribution (PPV 62.5%,
p =
0.028) had the highest malignancy rates among internal enhancement and distribution patterns with a significant result; the combination of clustered ring enhancement and segmental distribution raised the malignancy rate by approximately 4% (PPV 66.67%,
p
= 0.049).
Conclusion
There was a high agreement rate among readers when differentiating NME from mass lesions. The agreement rate was lower when assessing the distribution and internal enhancement pattern descriptors, but still substantial. The descriptors clustered ring enhancement and segmental distribution were significant predictors of malignancy.
Key Points
• Non-mass enhancement is a common morphological feature of non-invasive breast cancer (DCIS) in MRI. Differentiation between potentially malignant and benign changes may be very challenging.
• Since clustered ring enhancement and segmental distribution are both significant predictors of malignancy, the awareness of this important finding, combined with high-quality image interpretation skills, may improve the tumor detection rate.
• The combination of clustered ring enhancement and segmental distribution increases the positive predictive value for malignancy, which may be relevant for clinical practice
.
Microcalcifications can be indicative in the diagnosis of early breast cancer. Here we report a non-invasive diagnostic method that may potentially distinguish between different types of ...microcalcifications using X-ray phase-contrast imaging. Our approach exploits the complementary nature of the absorption and small-angle scattering signals of microcalcifications, obtained simultaneously with an X-ray grating interferometer on a conventional X-ray tube. We demonstrate that the new approach has 100% sensitivity and specificity when applied to phantom data, and we provide evidence of the solidity of the technique by showing its discrimination power when applied to fixed biopsies, to non-fixed tissue specimens and to fresh, whole-breast samples. The proposed method might be further developed to improve early breast cancer diagnosis and has the potential to increase the diagnostic accuracy and reduce the number of uncomfortable breast biopsies, or, in case of widespread microcalcifications, to select the biopsy site before intervention.
Abstract Functional imaging by means of dynamic multiphase contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted magnetic resonance imaging (DW-MRI) is now part of the ...standard imaging protocols for evaluation of the female pelvis. DCE-MRI and DW-MRI are important MR imaging techniques which enable the radiologist to move from morphological to functional assessment of diseases of the female pelvis. This is mainly due to the limitations of morphologic imaging, particularly in lesion characterization, accurate lymph node staging, assessment of tumour response and inability to differentiate post-treatment changes from tumour recurrence. DCE-MRI improves the accuracy of T2WI in staging of endometrial cancer. It also helps differentiate tumour recurrence from radiation fibrosis in patients with cervical cancer. DCE-MRI improves characterization of cystic adnexal lesions and detection of small peritoneal implants in patients with ovarian cancer. DW-MRI is valuable in preoperative staging of patients with endometrial and cervical cancer, especially in detection of extra-uterine disease. It does increase reader's confidence for detection of recurrent disease in gynaecological malignancies and improves detection of small peritoneal implants in patients with ovarian cancer. In this review article we give an overview of both DCE-MRI and DW-MRI techniques, concentrating on their main clinical application in the female pelvis, and present a practical approach of the added value of these techniques according to the main pathological conditions, highlighting the pearls and pitfalls of each technique.
Phase-contrast and scattering-based x-ray imaging are known to provide additional and complementary information to conventional, absorption-based methods, and therefore have the potential to play a ...crucial role in medical diagnostics. We report on the first mammographic investigation of 5 native, that is, freshly dissected, breasts carried out with a grating interferometer and a conventional x-ray tube source. Four patients in this study had histopathologically proven invasive breast cancer. One male patient, without the presence of any malignant formations within the resected breast, was included as a control specimen.
We used a Talbot-Lau grating setup installed on a conventional, low-brilliance x-ray source; the interferometer operated at the fifth Talbot distance, at a tube voltage of 40 kVp with mean energy of 28 keV, and at a current of 25 mA. The device simultaneously recorded absorption, differential phase and small-angle scattering signals from the native breast tissue. These quantities were then combined into novel color- and high-frequency-enhanced radiographic images. Presurgical images (conventional mammography, ultrasonography, and magnetic resonance imaging) supported the findings and clinical relevance was verified.
Our approach yields complementary and otherwise inaccessible information on the electron density distribution and the small-angle scattering power of the sample at the microscopic scale. This information can be used to potentially answer clinically relevant, yet unresolved questions such as unequivocally discerning between malignant and premalignant changes and postoperative scars and distinguishing cancer-invaded regions within healthy tissue.
We present the first ex vivo images of fresh, native breast tissue obtained from mastectomy specimens using grating interferometry. This technique yields improved diagnostic capabilities when compared with conventional mammography, especially when discerning the type of malignant conversions and their breadth within normal breast tissue. These promising results advance us toward the ultimate goal, using grating interferometry in vivo on humans in a clinical setting.
Purpose
The second International Consensus Conference on B3 lesions was held in Zurich, Switzerland, in March 2018, organized by the International Breast Ultrasound School to re-evaluate the ...consensus recommendations.
Methods
This study (1) evaluated how management recommendations of the first Zurich Consensus Conference of 2016 on B3 lesions had influenced daily practice and (2) reviewed current literature towards recommendations to biopsy.
Results
In 2018, the consensus recommendations for management of B3 lesions remained almost unchanged: For flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL) and radial scars (RS) diagnosed on core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB), excision by VAB in preference to open surgery, and for atypical ductal hyperplasia (ADH) and phyllodes tumors (PT) diagnosed at VAB or CNB, first-line open surgical excision (OE) with follow-up surveillance imaging for 5 years. Analyzing the Database of the Swiss Minimally Invasive Breast Biopsies (MIBB) with more than 30,000 procedures recorded, there was a significant increase in recommending more frequent surveillance of LN 65% in 2018 vs. 51% in 2016 (
p
= 0.004), FEA (72% in 2018 vs. 62% in 2016 (
p
= 0.005)), and PL (76% in 2018 vs. 70% in 2016 (
p
= 0.04) diagnosed on VAB. A trend to more frequent surveillance was also noted also for RS 77% in 2018 vs. 67% in 2016 (
p
= 0.07).
Conclusions
Minimally invasive management of B3 lesions (except ADH and PT) with VAB continues to be appropriate as an alternative to first-line OE in most cases, but with more frequent surveillance, especially for LN.
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