246 results found
Maheshwari E, Nougaret S, Stein EB, et al., 2022, Update on MRI in Evaluation and Treatment of Endometrial Cancer., Radiographics
Endometrial cancer is the second most common gynecologic cancer worldwide and the most common gynecologic cancer in the United States, with an increasing incidence in high-income countries. Although the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer is a surgical staging system, contemporary published evidence-based data and expert opinions recommend MRI for treatment planning as it provides critical diagnostic information on tumor size and depth, extent of myometrial and cervical invasion, extrauterine extent, and lymph node status, all of which are essential in choosing the most appropriate therapy. Multiparametric MRI using a combination of T2-weighted sequences, diffusion-weighted imaging, and multiphase contrast-enhanced imaging is the mainstay for imaging assessment of endometrial cancer. Identification of important prognostic factors at MRI improves both treatment selection and posttreatment follow-up. MRI also plays a crucial role for fertility-preserving strategies and in patients who are not surgical candidates by helping guide therapy and identify procedural complications. This review is a product of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel and reflects a multidisciplinary international collaborative effort to summarize updated information highlighting the role of MRI for endometrial cancer depiction and delineation, treatment planning, and follow-up. The article includes information regarding dedicated MRI protocols, tips for MRI reporting, imaging pitfalls, and strategies for image quality optimization. The roles of MRI-guided radiation therapy, hybrid PET/MRI, and advanced MRI techniques that are applicable to endometrial cancer imaging are also discussed. Online supplemental material is available for this article. ©RSNA, 2022.
Sadowski EA, Stein EB, Thomassin-Naggara I, et al., 2022, O-RADS MRI After Initial Ultrasound for Adnexal Lesions: AJR Expert Panel Narrative Review., AJR Am J Roentgenol
The O-RADS ultrasound (US) and MRI risk stratification systems were developed by an international group of experts in adnexal imaging to aid radiologists in assessing adnexal lesions. The goal of imaging is to help appropriately triage patients with adnexal lesions. Ultrasound is the first-line imaging modality for the assessment, while MRI can be used as a problem-solving tool. Both ultrasound and MRI can accurately characterize benign lesions such as simple cysts, endometriomas, hemorrhagic cysts, and dermoids, avoiding unnecessary or inappropriate surgery. In patients with a lesion that does not meet criteria for one of these benign diagnoses, MRI can further characterize the lesion with an improved specificity for cancer and the ability to provide a probable histologic subtype in the presence of certain MRI features. This allows for personalized treatment, including avoiding overly extensive surgery or allowing for fertility-sparing procedures for suspected benign, borderline, or low-grade tumors. When MRI findings indicate a risk of an invasive cancer, women can be expeditiously referred to a gynecologic oncologic surgeon. This narrative review provides expert opinion on the utility of multiparametric MRI when using the O-RADS US and MRI management systems.
ElGendy K, Barwick T, Auner HW, et al., 2022, Repeatability and test-retest reproducibility of mean apparent diffusion coefficient measurements of focal and diffuse disease in relapsed multiple myeloma at 3t whole body diffusion weighted MRI (WB-DW-MRI), The British Journal of Radiology, ISSN: 0007-1285
Objectives:To assess the test-retest reproducibility and intra/inter observer agreement of Apparent Diffusion Coefficient (ADC) measurements of myeloma lesions using WB-DW-MRI at 3T MRI.Methods:Following ethical approval, eleven consenting patients with relapsed multiple myeloma were prospectively recruited and underwent baseline WB-DW-MRI. For a single bed position, axial DWI was repeated after a short interval to permit test- retest measurements.Mean ADC measurement was performed by two experienced observers. Intra and inter observer agreement and test-retest reproducibility were assessed, using coefficient of variation (CV) and interclass correlation coefficient (ICC) measures, for diffuse and focal lesions (small ≤10 mm and large >10 mm).Results:Forty seven sites of disease were outlined (23 focal, 24 diffuse) in different bed positions (pelvis = 22, thorax = 20, head and neck = 5). For all lesions, there was excellent intra observer agreement with ICC of 0.99 (0.98–0.99) and COV of 5%. For inter observer agreement, ICC was 0.89 (0.8–0.934) and COV was 17%. There was poor inter observer agreement for diffuse (ICC = 0.46) and small lesions (ICC = 0.54).For test-retest reproducibility, excellent ICC (0.916) and COV (14.5%) values for mean ADC measurements were observed. ICCs of test-retest were similar between focal lesions (0.83) and diffuse infiltration (0.80), while ICCs were higher in pelvic (0.95) compared to thoracic (0.81) region and in small (0.96) compared to large (0.8) lesions.Conclusions:ADC measurements of focal lesions in multiple myeloma are repeatable and reproducible, while there is more variation in ADC measurements of the diffuse disease in patients with multiple myeloma.Advances in knowledge:Mean ADC measurements are repeatable and reproducible in focal lesions in multiple myeloma, while the ADC measurements of diffuse disease in multiple myeloma are more subject to variation. The evidence supports the future pot
, 2022, The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR), INSIGHTS INTO IMAGING, Vol: 13, ISSN: 1869-4101
Wengert GJ, Dabi Y, Kermarrec E, et al., 2022, O-RADS MRI Classification of Indeterminate Adnexal Lesions: Time-Intensity Curve Analysis Is Better Than Visual Assessment., Radiology, Vol: 303
Sadowski EA, Thomassin-Naggara I, Rockall A, et al., 2022, O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee, RADIOLOGY, Vol: 303, Pages: 35-47, ISSN: 0033-8419
Carrie D, Cruwys C, Brady A, et al., 2022, What radiologists need to know about patients' expectations: PATIENTS CARERS AIMS, INSIGHTS INTO IMAGING, Vol: 13, ISSN: 1869-4101
Mahoney MC, McGinty G, Figueroa Sanchez GM, et al., 2022, Summary of the proceedings of the International Forum 2021: "A more visible radiologist can never be replaced by AI", Insights into Imaging, Vol: 13, Pages: 1-9, ISSN: 1869-4101
The ESR International Forum at the ECR 2021 discussed effects of artificial intelligence on the future of radiology and the need for increased visibility of radiologists. The participating societies were invited to submit written reports detailing the current situation in their country or region. The European Society of Radiology (ESR) established the ESR International Forum in order to discuss hot topics in the profession of radiology with non-European radiological partner societies. At the ESR International Forum 2021, different strategies, initiatives and ideas were presented with regard to radiology community’s response to the changes caused by the emerging AI technology.
Wengert GJ, Dabi Y, Kermarrec E, et al., 2022, O-RADS MRI classification of indeterminate adnexal lesions: time-intensity curve analysis is better than visual assessment, Radiology, Vol: 303, Pages: 1-10, ISSN: 0033-8419
Background The MRI Ovarian-Adnexal Reporting and Data System (O-RADS) enables risk stratification of sonographically indeterminate adnexal lesions, partly based on time-intensity curve (TIC) analysis, which may not be universally available. Purpose To compare the diagnostic accuracy of visual assessment with that of TIC assessment of dynamic contrast-enhanced MRI scans to categorize adnexal lesions as benign or malignant and to evaluate the influence on the O-RADS MRI score. Materials and Methods The European Adnex MR Study Group, or EURAD, database, a prospective multicenter study of women undergoing MRI for indeterminate adnexal lesions between March 2013 and March 2018, was queried retrospectively. Women undergoing surgery for an adnexal lesion with solid tissue were included. Solid tissue enhancement relative to outer myometrium was assessed visually and with TIC. Contrast material washout was recorded. Lesions were categorized according to the O-RADS MRI score with visual and TIC assessment. Per-lesion diagnostic accuracy was calculated. Results A total of 320 lesions (207 malignant, 113 benign) in 244 women (mean age, 55.3 years ± 15.8 [standard deviation]) were analyzed. Sensitivity for malignancy was 96% (198 of 207) and 76% (157 of 207) for TIC and visual assessment, respectively. TIC was more accurate than visual assessment (86% [95% CI: 81, 90] vs 78% [95% CI: 73, 82]; P < .001) for benign lesions, predominantly because of higher specificity (95% [95% CI: 92, 98] vs 76% [95% CI: 68, 81]). A total of 21% (38 of 177) of invasive lesions were rated as low risk visually. Contrast material washout and high-risk enhancement (defined as earlier enhancement than in the myometrium) were highly specific for malignancy for both TIC (97% [95% CI: 91, 99] and 94% [95% CI: 90, 97], respectively) and visual assessment (97% [95% CI: 92, 99] and 93% [95% CI: 88, 97], respectively). O-RADS MRI score was more accurate with TIC than with visual assessment (area und
Rockall AG, Justich C, Helbich T, et al., 2022, Patient communication in radiology: Moving up the agenda, European Journal of Radiology, ISSN: 0720-048X
Optimised communication between patients and the imaging team is an essential component of providing patient-centred and value-based care. Communication with patients can be challenging in the setting of busy radiology departments where there is a focus on efficient and accurate diagnosis. Traditionally, most results are provided directly to the referring clinician. However, the importance of direct communication between the radiologist and patient is increasingly relevant, particularly in the context of face-to-face settings such as rapid assessment and ultrasound clinics, and interventional radiology, as well as in written form through electronic patient portals. Artificial intelligence tools may improve efficiency, allowing more time for radiologists to communicate directly with patients. There is a need for dedicated training in communication skills for imaging professionals. This review considers the topic of patient communication in the setting of imaging departments and discusses the ways that communication skills may be improved through training and through harnessing emerging digital technologies that may enhance the quality of communication.
Fotopoulou C, Rockall A, Lu H, et al., 2021, Validation analysis of the novel imaging-based prognostic radiomic signature in patients undergoing primary surgery for advanced high-grade serous ovarian cancer (HGSOC), British Journal of Cancer, Vol: 126, Pages: 1047-1054, ISSN: 0007-0920
BackgroundPredictive models based on radiomics features are novel, highly promising approaches for gynaecological oncology. Here, we wish to assess the prognostic value of the newly discovered Radiomic Prognostic Vector (RPV) in an independent cohort of high-grade serous ovarian cancer (HGSOC) patients, treated within a Centre of Excellence, thus avoiding any bias in treatment quality.MethodsRPV was calculated using standardised algorithms following segmentation of routine preoperative imaging of patients (n = 323) who underwent upfront debulking surgery (01/2011-07/2018). RPV was correlated with operability, survival and adjusted for well-established prognostic factors (age, postoperative residual disease, stage), and compared to previous validation models.ResultsThe distribution of low, medium and high RPV scores was 54.2% (n = 175), 33.4% (n = 108) and 12.4% (n = 40) across the cohort, respectively. High RPV scores independently associated with significantly worse progression-free survival (PFS) (HR = 1.69; 95% CI:1.06–2.71; P = 0.038), even after adjusting for stage, age, performance status and residual disease. Moreover, lower RPV was significantly associated with total macroscopic tumour clearance (OR = 2.02; 95% CI:1.56–2.62; P = 0.00647).ConclusionsRPV was validated to independently identify those HGSOC patients who will not be operated tumour-free in an optimal setting, and those who will relapse early despite complete tumour clearance upfront. Further prospective, multicentre trials with a translational aspect are warranted for the incorporation of this radiomics approach into clinical routine.
Reinhold C, Sadowski EA, Rockall A, et al., 2021, Clarifying Postcontrast Enhancement Sequences for Implementation and Interpretation of the ACR OvarianAdnexal Reporting and Data Systems MRI Risk Stratification and Management System Response, JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY, Vol: 18, Pages: 1594-1595, ISSN: 1546-1440
Shinagare AB, Sadowski EA, Park H, et al., 2021, Ovarian cancer reporting lexicon for computed tomography (CT) and magnetic resonance (MR) imaging developed by the SAR Uterine and Ovarian Cancer Disease-Focused Panel and the ESUR Female Pelvic Imaging Working Group, EUROPEAN RADIOLOGY, Vol: 32, Pages: 3220-3235, ISSN: 0938-7994
Raison N, Servian P, Patel A, et al., 2021, Is tumour volume an independent predictor of outcome after radical prostatectomy for high-risk prostate cancer?, PROSTATE CANCER AND PROSTATIC DISEASES, ISSN: 1365-7852
Seebacher V, Rockall A, Nobbenhuis M, et al., 2021, The impact of nutritional risk factors and sarcopenia on survival in patients treated with pelvic exenteration for recurrent gynaecological malignancy: a retrospective cohort study, ARCHIVES OF GYNECOLOGY AND OBSTETRICS, Vol: 305, Pages: 1343-1352, ISSN: 0932-0067
Cushnan D, Berka R, Bertolli O, et al., 2021, Towards nationally curated data archives for clinical radiology image analysis at scale: learnings from national data collection in response to a pandemic, Digital Health, Vol: 7, Pages: 1-13, ISSN: 2055-2076
The prevalence of the coronavirus SARS-CoV-2 disease has resulted in the unprecedented collection of health data to support research. Historically, coordinating the collation of such datasets on a national scale has been challenging to execute for several reasons, including issues with data privacy, the lack of data reporting standards, interoperable technologies, and distribution methods. The coronavirus SARS-CoV-2 disease pandemic has highlighted the importance of collaboration between government bodies, healthcare institutions, academic researchers and commercial companies in overcoming these issues during times of urgency. The National COVID-19 Chest Imaging Database, led by NHSX, British Society of Thoracic Imaging, Royal Surrey NHS Foundation Trust and Faculty, is an example of such a national initiative. Here, we summarise the experiences and challenges of setting up the National COVID-19 Chest Imaging Database, and the implications for future ambitions of national data curation in medical imaging to advance the safe adoption of artificial intelligence in healthcare.
Thomassin-Naggara I, Sadowski E, Rockall A, et al., 2021, Correspondence on "ESGO/ISUOG/IOTA/ESGE consensus statement on pre-operative diagnosis of ovarian tumors" by Timmerman et al, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 31, Pages: 1394-1395, ISSN: 1048-891X
Qaiser T, Winzeck S, Barfoot T, et al., 2021, Multiple instance learning with auxiliary task weighting for multiple myeloma classification, International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI), Publisher: Springer, Pages: 786-796, ISSN: 0302-9743
Whole body magnetic resonance imaging (WB-MRI) is the recommended modality for diagnosis of multiple myeloma (MM). WB-MRI is used to detect sites of disease across the entire skeletal system, but it requires significant expertise and is time-consuming to report due to the great number of images. To aid radiological reading, we propose an auxiliary task-based multiple instance learning approach (ATMIL) for MM classification with the ability to localize sites of disease. This approach is appealing as it only requires patient-level annotations where an attention mechanism is used to identify local regions with active disease. We borrow ideas from multi-task learning and define an auxiliary task with adaptive reweighting to support and improve learning efficiency in the presence of data scarcity. We validate our approach on both synthetic and real multi-center clinical data. We show that the MIL attention module provides a mechanism to localize bone regions while the adaptive reweighting of the auxiliary task considerably improves the performance.
Rockall A, Barwick T, Wilson W, et al., 2021, Diagnostic accuracy of FEC-PET/CT, FDG-PET/CT and diffusion-weighted MRI in detection of nodal metastases in surgically treated endometrial and cervical carcinoma, Clinical Cancer Research, Vol: 27, Pages: 6457-6466, ISSN: 1078-0432
Purpose:Pre-operative nodal staging is important for planning treatment in cervical cancer (CC) and endometrial cancer (EC) but remains challenging. We compare nodal staging accuracy of 18F-ethyl-choline-(FEC)-PET/CT, 18F-Fluoro-deoxy-glucose-(FDG)-PET/CT and diffusion-weighted-MRI (DW-MRI) with conventional morphological MRI.Experimetal Design:A prospective, multicentre observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centres. FEC-PET/CT, FDG-PET/CT and DW-MRI were compared to nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable CC stage=>1B1 or EC (grade 3 any stage with myometrial invasion or grade 1-2 stage=>II). Results:Among 162 consenting participants, 136 underwent study DW-MRI and FDG-PET/CT, and 60 underwent FEC-PET/CT. 267 nodal regions in 118 women were strictly correlated at histology (nodal positivity rate 25%). Sensitivity per-patient (n=118) for nodal size, morphology, DW-MRI, FDG- and FEC-PET/CT were 40%*, 53%, 53%, 63%* and 67% for all cases (*p=0.016); 10%, 10%, 20%, 30% and 25% in CC (n=40); 65%, 75%, 70%, 80% and 88% in EC (n=78). FDG-PET/CT outperformed nodal size (p=0.006) and size ratio (p=0.04) for per-region sensitivity. False positive rates were all <10%. Conclusions:All imaging techniques had low sensitivity for detection of nodal metastases and cannot replace surgical nodal staging. The performance of FEC-PET/CT was not statistically different to other techniques that are more widely available. FDG-PET/CT had higher sensitivity than size in detecting nodal metastases. False positive rates were low across all methods. The low false positive rate demonstrated by FDG-PET/CT may be helpful in arbitration of challenging surgical planning decisions.
Bass E, Pantovic A, Connor M, et al., 2021, A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk, Prostate Cancer and Prostatic Diseases, Vol: 24, Pages: 596-611, ISSN: 1365-7852
IntroductionMultiparametric magnetic resonance imaging (mpMRI), the use of three multiple imaging sequences, typically T2-weighted, diffusion weighted (DWI) and dynamic contrast enhanced (DCE) images, has a high sensitivity and specificity for detecting significant cancer. Current guidance now recommends its use prior to biopsy. However, the impact of DCE is currently under debate regarding test accuracy. Biparametric MRI (bpMRI), using only T2 and DWI has been proposed as a viable alternative. We conducted a contemporary systematic review and meta-analysis to further examine the diagnostic performance of bpMRI in the diagnosis of any and clinically significant prostate cancer.MethodsA systematic review of the literature from 01/01/2017 to 06/07/2019 was performed by two independent reviewers using predefined search criteria. The index test was biparametric MRI and the reference standard whole-mount prostatectomy or prostate biopsy. Quality of included studies was assessed by the QUADAS-2 tool. Statistical analysis included pooled diagnostic performance (sensitivity; specificity; AUC), meta-regression of possible covariates and head-to-head comparisons of bpMRI and mpMRI where both were performed in the same study.ResultsForty-four articles were included in the analysis. The pooled sensitivity for any cancer detection was 0.84 (95% CI, 0.80–0.88), specificity 0.75 (95% CI, 0.68–0.81) for bpMRI. The summary ROC curve yielded a high AUC value (AUC = 0.86). The pooled sensitivity for clinically significant prostate cancer was 0.87 (95% CI, 0.78–0.93), specificity 0.72 (95% CI, 0.56–0.84) and the AUC value was 0.87. Meta-regression analysis revealed no difference in the pooled diagnostic estimates between bpMRI and mpMRI.ConclusionsThis meta-analysis on contemporary studies shows that bpMRI offers comparable test accuracies to mpMRI in detecting prostate cancer. These data are broadly supportive of the bpMRI approach but heterogeneity does not al
Brady AP, Visser J, Frija G, et al., 2021, Value-based radiology: what is the ESR doing, and what should we do in the future?, INSIGHTS INTO IMAGING, Vol: 12, ISSN: 1869-4101
Manganaro L, Lakhman Y, Bharwani N, et al., 2021, Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018 (Apr, 10.1007/s00330-020-07632-9, 2021), EUROPEAN RADIOLOGY, Vol: 32, Pages: 738-738, ISSN: 0938-7994
Thomassin-Naggara I, Belghitti M, Milon A, et al., 2021, O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort, EUROPEAN RADIOLOGY, Vol: 31, Pages: 9588-9599, ISSN: 0938-7994
Reinhold C, Rockall A, Sadowski EA, et al., 2021, Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee, JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY, Vol: 18, Pages: 713-729, ISSN: 1546-1440
Manganaro L, Lakhman Y, Bharwani N, et al., 2021, Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018, EUROPEAN RADIOLOGY, Vol: 31, Pages: 7802-7816, ISSN: 0938-7994
Bernstein D, Taylor A, Nill S, et al., 2021, An Inter-observer Study to Determine Radiotherapy Planning Target Volumes for Recurrent Gynaecological Cancer Comparing Magnetic Resonance Imaging Only With Computed Tomography-Magnetic Resonance Imaging, CLINICAL ONCOLOGY, Vol: 33, Pages: 307-313, ISSN: 0936-6555
Dawood MT, Naik M, Bharwani N, et al., 2021, Adnexal Torsion: Review of Radio-logic Appearances, RADIOGRAPHICS, Vol: 41, Pages: 609-624, ISSN: 0271-5333
Fuchsjaeger M, 2021, Patient survey of value in relation to radiology: results from a survey of the European Society of Radiology (ESR) value-based radiology subcommittee, INSIGHTS INTO IMAGING, Vol: 12, ISSN: 1869-4101
Barwick T, Orton M, Koh DM, et al., 2021, Repeatability and reproducibility of apparent diffusion coefficient and fat fraction measurement of focal myeloma lesions on whole body magnetic resonance imaging, BRITISH JOURNAL OF RADIOLOGY, Vol: 94, ISSN: 0007-1285
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