Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, ...magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence.
Key Points
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This report provides guidelines for MRI in endometriosis
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Minimal and optimal MRI acquisition protocols are provided
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Recommendations are proposed for patient preparation
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best MRI sequences and reporting criteria
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In intensity modulated particle therapy (IMPT), the adoption of spatially and temporally heterogeneous dose distributions allows to decouple the fractionation scheme from the patient anatomy, so that ...an hypofractionated schedule can be selectively created inside the tumour, while simultaneously exploiting the fractionation effect in the healthy tissues. In this paper, the authors show the reproducibility of the method on a set of prostate patients, quantifying the dependencies of the achievable benefit with respect to conventional and hypofractionated schemes and the sensitivity of the method to setup errors and range uncertainty.
On a cohort of 9 patients, non-uniform IMPT plans were optimised and compared to conventional and hypofractionated schedules. For each patient, the comparison of the three strategies has been based on the output of the cost function used to optimise the treatments. The analysis has been repeated considering different
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ratios for the tumour, namely 1.5, 3 and 4.5 Gy. For a single patient, setup errors and beam range uncertainty have been analysed: the plans, for each optimisation strategy, have been iteratively forward planned 500 times with randomly varying the patient position in each fraction, and 200 times for systematic range shift.
An average 10% benefit has been shown for the lowest
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ratio considered for the tumour, where the non-uniform schedule generally converges to hypofractionation; the benefit decreases to 5%-7% for higher
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ratios, for which the non-uniform schedule always showed better outcomes with respect to the other fractionation schedules. An increased sensitivity to uncertainty, especially for setup errors, has been shown, which can be associated to the spatial non-uniformity of the dose distributions peculiar of the spatiotemporal plans.
This work represents the first investigation of spatiotemporal fractionation for prostate cancer and the beginning of further investigations before clinical implementation can be considered.
•Overview of detectors for dose verification in scanned ion beam radiotherapy.•Review of commissioning and clinical Quality Assurance.•Strategies for patient specific dose verification and in vivo ...dosimetry.•Strategies for verification of treatments of moving targets.•Valuable selection of references on scanned ion beam radiotherapy.
In the last few years, the use of ions in radiation therapy is gaining interest and it is being considered medically necessary for a growing subset of tumours. Concurrently, the technologies involved in a particle therapy treatment are rapidly evolving, as well as the accuracy in the dose delivery in spite of the increased complexity.
Since nowadays, the pencil beam scanning technique is showing very interesting features in terms of dose conformation and overall treatment outcome, the present review is intended to summarize the main procedures, detectors and tools adopted for the clinical dose verification. A list of dose measurements is provided, with the aim of being a valuable guidance for starting and future particle therapy facilities.
Absorbed dose to water, relative dose, fluence and surrogates of the delivered dose are the main quantities measured by means of different detectors, specifically developed for point-like, 1D or 2D measurements.
The dosimetric procedures are here categorized according to their purpose, distinguishing between system commissioning and clinical quality assurance. A separate discussion is dedicated to patient specific, in vivo and 4D dose verification, which aim at assessing the actual delivered dose.
Together with the description of the currently used methods, challenges and perspectives toward an increasingly accurate and fast dose verification strategy are discussed.
Recent advances in machine learning research, combined with the reduced sequencing costs enabled by modern next-generation sequencing, paved the way to the implementation of precision medicine ...through routine multi-omics molecular profiling of tumours. Thus, there is an emerging need of reliable models exploiting such data to retrieve clinically useful information. Here, we introduce an original consensus clustering approach, overcoming the intrinsic instability of common clustering methods based on molecular data. This approach is applied to the case of non-small cell lung cancer (NSCLC), integrating data of an ongoing clinical study (PROMOLE) with those made available by The Cancer Genome Atlas, to define a molecular-based stratification of the patients beyond, but still preserving, histological subtyping. The resulting subgroups are biologically characterized by well-defined mutational and gene-expression profiles and are significantly related to disease-free survival (DFS). Interestingly, it was observed that (1) cluster B, characterized by a short DFS, is enriched in KEAP1 and SKP2 mutations, that makes it an ideal candidate for further studies with inhibitors, and (2) over- and under-representation of inflammation and immune systems pathways in squamous-cell carcinomas subgroups could be potentially exploited to stratify patients treated with immunotherapy.
The ovarian‐adnexal reporting and data system on magnetic resonance imaging (O‐RADS MRI) score is now a well‐established tool to characterize pelvic gynecological masses based on their likelihood of ...malignancy. The main added value of O‐RADS MRI over O‐RADS US is to correctly reclassify lesions that were considered suspicious on US as benign on MRI. The crucial issue when characterizing an adnexal mass is to determine the presence/absence of solid tissue and thus need to perform gadolinium injection. O‐RADS MR score was built on a multivariate analysis and must be applied as a step‐by‐step analysis: 1) Is the mass an adnexal mass? 2) Is there an associated peritoneal carcinomatosis? 3) Is there any significant amount of fatty content? 4) Is there any wall enhancement? 5) Is there any internal enhancement? 6) When an internal enhancement is detected, does the internal enhancement correspond to solid tissue or not? 7) Is the solid tissue malignant? With its high value to distinguish benign from malignant adnexal masses and its high reproducibility, the O‐RADS MRI score could be a valuable tool for timely referral of a patient to an expert center for the treatment of ovarian cancers. Finally, to make a precise diagnosis allowing optimal personalized treatment, the radiologist in gynecological imaging will combine the O‐RADS MRI score with many other clinical, biological, and other MR criteria to suggest a pathological hypothesis.
Level of Evidence
5
Technical Efficacy Stage
3.
Cervical cancer (CC) is the fourth leading cause of death in women worldwide and despite the introduction of screening programs about 30% of patients presents advanced disease at diagnosis and 30-50% ...of them relapse in the first 5-years after treatment. According to FIGO staging system 2018, stage IB3-IVA are classified as locally advanced cervical cancer (LACC); its correct therapeutic choice remains still controversial and includes neoadjuvant chemo-radiotherapy, external beam radiotherapy, brachytherapy, hysterectomy or a combination of these modalities. In this review we focus on the most appropriated therapeutic options for LACC and imaging protocols used for its correct follow-up. We explore the imaging findings after radiotherapy and surgery and discuss the role of imaging in evaluating the response rate to treatment, selecting patients for salvage surgery and evaluating recurrence of disease. We also introduce and evaluate the advances of the emerging imaging techniques mainly represented by spectroscopy, PET-MRI, and radiomics which have improved diagnostic accuracy and are approaching to future direction.
Fetal MRI of CNS abnormalities Masselli, G.; Vaccaro Notte, M.R.; Zacharzewska-Gondek, A. ...
Clinical radiology,
August 2020, 2020-08-00, 20200801, Letnik:
75, Številka:
8
Journal Article
Recenzirano
Ultrasound (US) is currently the standard approach for the initial evaluation of fetal anatomy and maternal conditions during pregnancy; however, fetal magnetic resonance imaging (MRI) has now become ...a valuable adjunct to US in confirming/excluding suspected abnormalities and in the detection of additional abnormalities, thus changing the outcome of pregnancy and optimising perinatal management. MRI is a non-invasive diagnostic examination that does not involve ionising radiation and has no known associated negative side effects or reported delayed sequela according to the Safety Committee of the Society for MRI. The main drawback of MRI is fetal motion. The development of fast MRI sequences has significantly decreased fetal motion artefacts allowing the evaluation of the highly mobile fetus. Single-shot fast spin-echo (SSFSE) T2-weighted imaging is a standard sequence. T1-weighted sequences are primarily used to demonstrate haemorrhage, fat, and calcification. Balanced steady-state free-precession (SSFP) sequences are beneficial in demonstrating fetal structures as well as the heart and vessels. Diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) have important applications in fetal brain imaging. In this review, we illustrate a spectrum of structural abnormalities affecting the central nervous system and the spine. The aim of this article is to provide a practical approach for radiologists and clinicians to fetal MRI performance and interpretation.
Objective
To prospectively evaluate microstructural abnormalities in sacral nerve roots in women affected by chronic pelvic pain associated with endometriosis.
Methods
We enrolled 30 women with an ...ultrasound diagnosis of endometriosis and moderate-severe chronic pelvic pain; 10 age-matched healthy women comprised the control group. All subjects underwent 3 T magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI); the sacral roots were reconstructed by post-processing the DTI data with dedicated software. Mean fractional anisotropy (FA) values in the S1, S2 and S3 roots were quantified. Analysis of FA values was performed by two radiologists in order to evaluate the interobserver agreement.
Results
The sacral nerve roots in healthy subjects were clearly visualised. Most of the patients with endometriosis displayed abnormalities of S1, S2 and S3 bilaterally at tractography, including an irregular and disorganised appearance. FA values in the S1, S2 and S3 roots were significantly lower in patients than in controls (
P
< 0.0001, <0.05 and <0.02, respectively) for both observers. No significant difference was found between observers.
Conclusion
DTI with tractography is a non-invasive means of detecting changes in the microarchitecture of the sacral nerve roots. It can qualitatively and quantitatively reveal sacral root abnormalities in patients with endometriosis-associated pain.
Key Points
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MRI is increasingly used for endometriosis and chronic pelvic pain (CPP).
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Magnetic resonance tractography can demonstrate microarchitectural abnormalities in sacral nerve roots.
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Tractography shows altered microstructure of sacral roots affected by endometriosis and CPP.
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S1–S3 fractional anisotropy values are lower in endometriosis than in healthy women.
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Sacral nerve root alteration may explain the nature of endometriosis-related CPP.
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