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Nakazono T, Yoshinaga Y, Yamaguchi K, Yokoyama M, Kai K, Fukui S, Egashira R, Ichinohe K, Nagaoka S, Irie H. MRI features of ovarian teratomas with somatic-type malignancy and mature cystic teratomas. Abdom Radiol (NY) 2024:10.1007/s00261-024-04287-8. [PMID: 38856767 DOI: 10.1007/s00261-024-04287-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE We evaluated the magnetic resonance imaging (MRI) features of ovarian teratomas with somatic-type malignancy (TSMs) and benign ovarian mature cystic teratomas (MCTs) to determine the diagnostic contribution of the MRI findings for differentiating these two teratomas. METHODS We compared the MRI findings between ovarian TSMs (n = 10) and MCTs (n = 193), and we conducted a receiver operating characteristic (ROC) analysis to determine the MRI findings' contribution to the differentiation of TSMs from MCTs. RESULTS The maximum diameters of whole lesion and the largest solid component in the TSMs were larger than those of the MCTs (p = 0.0001 and p < 0.0001, respectively). Fat tissue in solid components was seen in 73/116 (62.9%) MCTs but in none of the TSMs (p = 0.0001). Ring-like enhancement in solid components was seen in 60/116 (51.7%) MCTs and none of the TSMs (p = 0.0031). On dynamic contrast-enhanced MRI (DCE MRI), all of the solid components in the TSMs showed a high- or intermediate-risk time intensity curve (TIC), and those in 113 of the 116 (97.4%) MCTs showed a low-risk TIC (p < 0.0001). The area under the curve of the ROC analysis using the high-/intermediate-risk TIC on DCE MRI was the highest (0.99) for differentiating TSMs from MCTs: sensitivity 100%, specificity 97.4%, positive predictive value 75.0%, negative predictive value 100%, and accuracy, 97.6%. CONCLUSION Compared to ovarian MCTs, ovarian TSMs are larger and have larger solid components with high- or intermediate-risk TICs on DCE MRI. Ovarian MCTs frequently show small solid components with fat tissue, ring-like enhancement, and a low-risk TIC on DCE MRI.
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Affiliation(s)
- Takahiko Nakazono
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan.
| | - Yutaka Yoshinaga
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Keita Kai
- Department of Pathology, Saga University Hospital, Saga, Japan
| | - Shuichi Fukui
- Department of Radiology, Takagi Hospital, Fukuoka, Japan
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Kanto Ichinohe
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Shigeru Nagaoka
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, Japan
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Fukuzawa T, Ohya A, Tanaka M, Shimizu M, Kobayashi K, Matsushita T, Watanabe T, Kobara H, Fujinaga Y. MR diagnosis of SCC arising within ovarian cystic teratomas: analysis of mural nodule characteristics. Abdom Radiol (NY) 2024; 49:1264-1274. [PMID: 38393356 PMCID: PMC10955018 DOI: 10.1007/s00261-024-04186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE This study aims to evaluate and identify magnetic resonance (MR) findings of mural nodules to detect squamous cell carcinoma arising from ovarian mature cystic teratoma (SCC-MCT). METHODS This retrospective study examined 135 patients (SCC-MCTs, n = 12; and benign MCTs, n = 123) with confirmed diagnoses across five different institutions between January 2010 and June 2022. Preoperative MR images for each patient were independently assessed by two experienced radiologists and analyzed following previously reported findings (PRFs): age, tumor size, presence of mural nodules, size of mural nodule, and the angle between mural nodule and cyst wall (acute or obtuse). Furthermore, this study evaluated four mural nodule features-diffusion restriction, fat intensity, Palm tree appearance, and calcification-and the presence of transmural extension. RESULTS There were significant differences between the SCC-MCT and benign MCT groups in terms of all PRFs and all mural nodule findings (p < 0.01). Among the PRFs, "tumor size" demonstrated the highest diagnostic performance, with a sensitivity of 83.3% and a specificity of 88.6%. A combination of the aforementioned four mural nodule findings showed a sensitivity and specificity of 83.3% and 97.6%, respectively, for the diagnosis of SCC-MCT. Regarding diagnosis based on a combination of four mural nodule findings, the specificity was significantly higher than the diagnosis based on tumor size (p = 0.021). Based on these mural nodule findings, three SCC-MCT patients without transmural invasion could be diagnosed. CONCLUSION Mural nodule MR findings had a higher diagnostic performance than PRFs for SCC-MCT and can potentially allow early detection of SCC-MCTs.
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Affiliation(s)
- Takuya Fukuzawa
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Ayumi Ohya
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Mika Tanaka
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Marika Shimizu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kentaro Kobayashi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tomohito Matsushita
- Department of Radiology, Fujimi Kogen Hospital, 11100 Ochiai, Fujimi-Cho, Suwa-Gun, 399-0214, Japan
| | - Tomofumi Watanabe
- Department of Radiology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502, Japan
| | - Hisanori Kobara
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Yang Q, Zhang H, Ma PQ, Peng B, Yin GT, Zhang NN, Wang HB. Value of ultrasound and magnetic resonance imaging combined with tumor markers in the diagnosis of ovarian tumors. World J Clin Cases 2023; 11:7553-7561. [DOI: 10.12998/wjcc.v11.i31.7553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Compare the diagnostic performance of ultrasound (US), magnetic resonance imaging (MRI), and serum tumor markers alone or in combination for detecting ovarian tumors.
AIM To investigate the diagnostic value of US, MRI combined with tumor markers in ovarian tumors.
METHODS The data of 110 patients with ovarian tumors, confirmed by surgery and pathology, were collected in our hospital from February 2018 to May 2023. The dataset included 60 cases of benign tumors and 50 cases of malignant tumors. Prior to surgery, all patients underwent preoperative US and MRI examinations, as well as serum tumor marker tests [carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4)]. The aim of the study was to compare the diagnostic performance of these three methods individually and in combination for ovarian tumors.
RESULTS This study found statistically significant differences in the ultrasonic imaging characteristics between benign and malignant tumors. These differences include echo characteristics, presence or absence of a capsule, blood flow resistance index, clear tumor shape, and blood flow signal display rate (P < 0.05). The apparent diffusion coefficient values of the solid and cystic parts in benign tumors were found to be higher compared to malignant tumors (P < 0.05). Additionally, the time-intensity curve image features of benign and malignant tumors showed significant statistical differences (P < 0.05). The levels of serum CA125 and HE4 in benign tumors were lower than those in malignant tumors (P < 0.05). The combined use of US, MRI, and tumor markers in the diagnosis of ovarian tumors demonstrates higher accuracy, sensitivity, and specificity compared to using each method individually (P < 0.05).
CONCLUSION US, MRI, and tumor markers each have their own advantages and disadvantages when it comes to diagnosing ovarian tumors. However, by combining these three methods, we can significantly enhance the accuracy of ovarian tumor diagnosis, enabling early detection and identification of the tumor’s nature, and providing valuable guidance for clinical treatment.
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Affiliation(s)
- Qian Yang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
- Taihe Hospital of Traditional Chinese Medicine, Fuyang 236000, Anhui Province, China
| | - Hui Zhang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Pei-Qi Ma
- Fuyang People’s Hospital, Fuyang 236000, Anhui Province, China
| | - Bin Peng
- Fuyang People’s Hospital, Fuyang 236000, Anhui Province, China
| | - Gui-Tao Yin
- No. 2 People’s Hospital of Fuyang City, Fuyang 236000, Anhui Province, China
| | - Nan-Nan Zhang
- Linquan People’s Hospital, Fuyang 236000, Anhui Province, China
| | - Hai-Bao Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Bourgioti C, Konidari M, Moulopoulos LA. Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI. Cancers (Basel) 2023; 15:cancers15072106. [PMID: 37046767 PMCID: PMC10093428 DOI: 10.3390/cancers15072106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life.
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Affiliation(s)
- Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Marianna Konidari
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
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Wei M, Bo F, Cao H, Zhou W, Shan W, Bai G. Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging for malignant ovarian tumors: a systematic review and meta-analysis. Acta Radiol 2021; 62:966-978. [PMID: 32741199 DOI: 10.1177/0284185120944916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Accurate preoperative diagnosis of malignant ovarian tumors (MOTs) is particularly important for selecting the optimal treatment strategy and avoiding overtreatment. PURPOSE To evaluate the diagnostic efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for MOTs. MATERIAL AND METHODS A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science databases to find relevant original articles up to October 2019. The included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Studies on the diagnosis of MOTs with quantitative or semi-quantitative DCE-MRI were analyzed separately. The bivariate random-effects model was used to assess the diagnostic authenticity. Meta-regression analyses were performed to analyze the potential heterogeneity. RESULTS For semi-quantitative DCE-MRI, the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic curves (AUC) were 85% (95% confidence interval [CI] 0.75-0.92), 85% (95% CI 0.77-0.91), 5.8 (95% CI 3.8-8.8), 0.17 (95% CI 0.10-0.30), 33 (95% CI 18-61), and 0.92 (95% CI 0.89-0.94), respectively. For quantitative DCE-MRI, the pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 88% (95% CI 0.65-0.96), 93% (95% CI 0.78-0.98), 12.3 (95% CI 3.4-43.9), 0.13 (95% CI 0.04-0.45), 91 (95% CI 10-857), and 0.96 (95% CI 0.94-0.98), respectively. CONCLUSION DCE-MRI has great diagnostic value for MOTs. Semi-quantitative DCE-MRI may be a relatively mature approach; however, quantitative DCE-MRI appears to be more promising than semi-quantitative DCE-MRI.
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Affiliation(s)
- Mingxiang Wei
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Fan Bo
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Hui Cao
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wei Zhou
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wenli Shan
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Genji Bai
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
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Thomassin-Naggara I, Belghitti M, Milon A, Abdel Wahab C, Sadowski E, Rockall AG. O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort. Eur Radiol 2021; 31:9588-9599. [PMID: 34041567 DOI: 10.1007/s00330-021-08054-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/18/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To retrospectively review the causes of categorization errors using O-RADS-MRI score and to determine the presumptive causes of these misclassifications. METHODS EURAD database was retrospectively queried to identify misclassified lesions. In this cohort, 1194 evaluable patients with 1502 pelvic masses (277 malignant / 1225 benign lesions) underwent standardized MRI to characterize adnexal masses with histology or 2 years' follow-up as a reference standard. An expert radiologist reviewed cases with two junior radiologists and lesions termed misclassified if malignant lesion was scored ≤ 3, a benign lesion was scored ≥ 4, the site of origin was incorrect, or a non-adnexal mass was incorrectly categorized as benign or malignant. RESULTS There were 139 / 1502 (9.2%) misclassified masses in 116 women including 109 adnexal and 30 non-adnexal masses. False-negative cases corresponded to 16 borderline or invasive malignant adnexal masses rated score ≤ 3 (16 / 139, 11.5%). False-positive cases corresponded to 88 benign masses were rated score 4 (67 / 139, 48.2%) or 5 (18 / 139,12.9%) or considered suspicious non-adnexal lesions (3 / 139, 2.2%). Misclassifications were only due to origin error in 12 adnexal masses (8 benign, 4 malignant) (8.6%, 12 / 139) and 23 non-adnexal masses (18 benign, 5 malignant,16.5%, 23 / 139) perceived respectively as non-adnexal and adnexal masses. Interpretive error (n = 104), failure to recognize technical insufficient exams (n = 9), and perceptual errors (n = 4) were found. Most interpretive was due to misinterpretation of solid tissue or incorrect assignment of mass origin. Eighty-four out of 139 cases were correctly reclassified by the readers with strict adherence to the score rules. CONCLUSION Most errors were due to misinterpretation of solid tissue or incorrect assignment of mass origin. KEY POINTS • Prospective assignment of O-RADS-MRI score resulted in misclassification of 9.25% of sonographically indeterminate pelvic masses. • Most errors were interpretive (74.8%) due to misinterpretation of solid tissue as defined by the lexicon or incorrect assignment of mass origin. • Pelvic inflammatory disease is a common source of misclassification (8.9%) (12 / 139).
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Affiliation(s)
- I Thomassin-Naggara
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France. .,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France.
| | - M Belghitti
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France.,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France
| | - A Milon
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France.,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France
| | - C Abdel Wahab
- APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France.,Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France
| | - E Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA
| | - A G Rockall
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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Wang N, Wang K, Xie X, Cao L, He H, Li N. Ovarian teratoma with recurrent urinary retention is misdiagnosed as bladder disease: A rare case report and review of the literature. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219847008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a 22-year-old ovarian teratoma female patient with recurrent urinary retention. It was first misdiagnosed as bladder disease and the treatment is catheterization. During the follow-up, urinary abdominopelvic examination showed a heterogeneous hypoechoic zone of 66 mm × 25 mm on the upper wall of the bladder with 1125 mL residual urine, so the patient was reevaluated. Vaginal ultrasound showed no obvious abnormalities in the uterus and accessories. In the further evaluation, urinary computed tomography (CT) revealed a visible huge space-occupying lesions in the pelvis and lower abdomen, was considered a benign lesion, and it might be the accessories teratoma. Abdominal magnetic resonance imaging (MRI) revealed a visible huge cystic shadow in the pelvis and lower abdomen. Post-operative pathology confirmed the presence of pelvic mature cystic teratoma and mature neural tissue. Post-operative follow-up for 1 year, the patient had no symptoms such as abdominal pain, dysuria, or urinary retention. The clinical manifestations of ovarian teratoma are complex, but imaging examinations (e.g. CT, MRI, and ultrasound) are characteristic and valuable for clinical diagnosis.
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Affiliation(s)
- Ning Wang
- Department of Medical Examination Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Wang
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Xi Xie
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Cao
- Department of Urology, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Huadong He
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ning Li
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Bordonné C, Merzoug V, Brzakowski M, Tran Ba S, Maitrot-Mantelet L, Chapron C, Dion É. Imagerie du pelvis de l’adolescente. IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gil R, Cunha TM, Rolim I. Mature cystic teratoma with high proportion of solid thyroid tissue: a controversial case with unusual imaging findings. J Radiol Case Rep 2017; 11:20-30. [PMID: 29299099 PMCID: PMC5743149 DOI: 10.3941/jrcr.v11i7.2853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We describe a case of a mature cystic teratoma of the ovary with high proportion of solid thyroid tissue (< 50% of the entire tumor) in a childbearing woman. The patient presented with non-specific abdominal bloating. Pelvic ultrasound and magnetic resonance imaging revealed a complex cystic-solid tumor confined to the left ovary with an anterior fat-containing locus compatible with mature cystic teratoma and a posterior predominantly solid component with low signal intensity on T2-weighted images that was histopatologically diagnosed as benign thyroid tissue. Thyroglobulin levels were in normal range. Although thyroid tissue is present in up to 20% of mature cystic teratomas, with exception of struma ovarii, it is not usually macroscopically nor radiologically identified. The differential diagnosis should include T2-hypointense adnexal lesions associated with mature cystic teratoma, malignant transformation of mature teratoma, and immature teratoma.
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Affiliation(s)
- Rui Gil
- Serviço de Radiologia, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Serviço de Radiologia, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ines Rolim
- Serviço de Anatomia Patológica, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Sahin H, Abdullazade S, Sanci M. Mature cystic teratoma of the ovary: a cutting edge overview on imaging features. Insights Imaging 2017; 8:227-241. [PMID: 28105559 PMCID: PMC5359144 DOI: 10.1007/s13244-016-0539-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/11/2016] [Accepted: 12/16/2016] [Indexed: 01/30/2023] Open
Abstract
Mature cystic teratoma (MCT) is the most common neoplasm of the ovary and includes at least two well- differentiated germ cell layers. Different combinations of mature tissue derivatives with varying arrangements in the tumour cause a wide spectrum of radiological presentation ranging from a purely cystic mass to a complex cystic mass with a considerable solid component. In different imaging modalities, each radiological feature reflects a specific pathologic equivalent that forms because of diverse compositions of histological components. Understanding uncommon findings as well as the classic signs with basic knowledge of pathological equivalents permits a more accurate diagnosis and guides adequate treatment. In this review, radiological features of MCT in different imaging modalities (US, CT, MR imaging) including specific signs and useful radiological artefacts with brief emphasis on pathological basics are discussed. Teaching points • Ovarian mature cystic teratomas (MCTs) have a wide spectrum of radiological presentation. • Each radiological feature of MCT reflects a specific pathologic equivalent. • Understanding radiological signs with basic knowledge of pathology can permit a more accurate diagnosis.
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Affiliation(s)
- Hilal Sahin
- Department of Radiology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey.
| | - Samir Abdullazade
- Department of Pathology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Training and Research Hospital, 35110, Yenisehir, Izmir, Turkey
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Forstner R, Thomassin-Naggara I, Cunha TM, Kinkel K, Masselli G, Kubik-Huch R, Spencer JA, Rockall A. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol 2016; 27:2248-2257. [PMID: 27770228 PMCID: PMC5408043 DOI: 10.1007/s00330-016-4600-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/28/2016] [Accepted: 09/07/2016] [Indexed: 01/23/2023]
Abstract
Abstract An update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques is provided. An algorithmic approach using sagittal T2 and a set of transaxial T1 and T2WI allows categorization of adnexal masses in one of the following three types according to its predominant signal characteristics. T1 'bright' masses due to fat or blood content can be simply and effectively determined using a combination of T1W, T2W and FST1W imaging. When there is concern for a solid component within such a mass, it requires additional assessment as for a complex cystic or cystic-solid mass. For low T2 solid adnexal masses, DWI is now recommended. Such masses with low DWI signal on high b value image (e.g. > b 1000 s/mm2) can be regarded as benign. Any other solid adnexal mass, displaying intermediate or high DWI signal, requires further assessment by contrast-enhanced (CE)T1W imaging, ideally with DCE MR, where a type 3 curve is highly predictive of malignancy. For complex cystic or cystic-solid masses, both DWI and CET1W—preferably DCE MRI—is recommended. Characteristic enhancement curves of solid components can discriminate between lesions that are highly likely malignant and highly likely benign. Key Points • MRI is a useful complementary imaging technique for assessing sonographically indeterminate masses. • Categorization allows confident diagnosis in the majority of adnexal masses. • Type 3 contrast enhancement curve is a strong indicator of malignancy. • In sonographically indeterminate masses, complementary MRI assists in triaging patient management. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4600-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosemarie Forstner
- Department of Radiology, Landeskliniken Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, A-5020, Salzburg, Austria.
| | - Isabelle Thomassin-Naggara
- Sorbonne Universités, UPMC Univ. Paris 06, Institut Universitaire de Cancérologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Radiologie, 54 avenue Gambetta, 75020, Paris, France
| | - Teresa Margarida Cunha
- Serviço de Radiologia, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, CH 1224, Chêne-Bougeries, Switzerland
| | - Gabriele Masselli
- Radiology Department, Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Rahel Kubik-Huch
- Institut of Radiology, Departement of Medical Services, Kantonsspital Baden, Im Ergel, CH-5404, Baden, Switzerland
| | - John A Spencer
- Department of Radiology, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Andrea Rockall
- Consultant Radiologist, The Royal Marsden Hospital NHS Foundation Trust, London, UK.,Visiting Professor, Imperial College, London, UK
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Jalaguier-Coudray A, Jacquemier J, Villard-Mahjoub R, Delarbre B, Thomassin-Piana J. Pourquoi la macroscopie est-elle essentielle pour comprendre et analyser les tumeurs ovariennes ? IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Malek M, Pourashraf M, Mousavi AS, Rahmani M, Ahmadinejad N, Alipour A, Hashemi FS, Shakiba M. 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. Asian Pac J Cancer Prev 2015; 16:3407-12. [DOI: 10.7314/apjcp.2015.16.8.3407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Elkind L, Jalaguier-Coudray A, Lambaudie E, Villard-Mahjoub R, Delarbre B, Juhan V, Thomassin-Piana J, Houvenaeghel G. Tératome immature ovarien chez une patiente de 38ans : intérêt de l’IRM pelvienne préopératoire. IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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The clinical value of dynamic contrast-enhanced MRI in differential diagnosis of malignant and benign ovarian lesions. Tumour Biol 2015; 36:5515-22. [DOI: 10.1007/s13277-015-3219-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022] Open
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Feasibility of a fast method for B1-inhomogeneity correction for FSPGR sequences. Magn Reson Imaging 2014; 33:312-8. [PMID: 25460328 DOI: 10.1016/j.mri.2014.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 01/08/2023]
Abstract
The Fast Spoiled Gradient Echo (FSPGR) sequence is often used in MRI to create T1-weighted images. The signal intensity generated by this sequence depends on the applied flip angle. Knowing the correct flip angle is essential for the determination of T1-maps by means of an FSPGR based Variable Flip Angle (VFA) approach. Also, quantitatively determining the concentration of contrast agent in case of Dynamic Contrast Enhanced MRI (DCE-MRI) requires knowledge of the applied flip angle. In both cases, the B1-field (in)homogeneity significantly affects the results. In this paper, we present a new method to obtain both the T1-map and B1-inhomogeneity map using scans that can each be acquired within a breath-hold. We combine two short sequences for T1 quantification: Variable Flip Angle and Look-Locker (LL). The T1-maps obtained from the LL data were used to estimate the B1-inhomogeneity inherently present in the VFA data, which was then used to correct for the VFA method's inaccurate flip angles. This way, a reliable T1-map could be computed, which was validated using both in vitro and in vivo scans. The in vitro results show that the procedure yields a substantially smaller mean deviation in T1 from the T1 measurement's gold standard (the Inversion Recovery method), while the in vivo results show both a more accurate estimation of T1 and a reduction of the influence of the B1-inhomogeneity on the signal intensity.
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Algorithmic approach to solid adnexal masses and their mimics: utilization of anatomic relationships and imaging features to facilitate diagnosis. ABDOMINAL IMAGING 2014; 39:1284-96. [PMID: 24852312 DOI: 10.1007/s00261-014-0163-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Solid adnexal masses, while less common than their cystic counterparts, may present a challenge for radiologists given the wide range of histologic entities that occur in this region. Pelvic masses, especially when large, can seem overwhelming at first but application of an algorithmic approach allows for more confident assessment. This approach focuses first on the use of anatomic relationships and interactions of various pelvic structures to localize the mass' origin. For instance, the directionality of ureteral displacement can suggest if a mass is intra or extraperitoneal. Then, key discriminating imaging features, such as the presence of fat, hypervascularity, or low T2 signal on magnetic resonance imaging (MRI) can be applied to further narrow the list of diagnostic possibilities. Entities such as leiomyomas, nerve sheath tumors, congenital uterine anomalies, and vascular abnormalities (ovarian torsion or iliac vessel aneurysm) in particular are often accurately characterized with sonography and/or MRI. For solid adnexal masses in which a definitive diagnosis by imaging is not reached, information germane to clinicians regarding further management can still be provided, principally with regard to surgical vs. nonsurgical treatment.
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