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Dabi Y, Rockall A, Razakamanantsoa L, Guerra A, Fournier LS, Fotopoulou C, Touboul C, Thomassin-Naggara I. O-RADS MRI scoring system has the potential to reduce the frequency of avoidable adnexal surgery. Eur J Obstet Gynecol Reprod Biol 2024; 294:135-142. [PMID: 38237312 DOI: 10.1016/j.ejogrb.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To assess the potential impact of the O-RADS MRI score on the decision-making process for the management of adnexal masses. METHODS EURAD database (prospective, European observational, multicenter study) was queried to identify asymptomatic women without history of infertility included between March 1st and March 31st 2018, with available surgical pathology or clinical findings at 2-year clinical follow-up. Blinded to final diagnosis, we stratified patients into five categories according to the O-RADS MRI score (absent i.e. non adnexal, benign, probably benign, indeterminate, probably malignant). Prospective management was compared to theoretical management according to the score established as following: those with presumed benign masses (scored O-RADS MRI 2 or 3) (follow-up recommended) and those with presumed malignant masses (scored O-RADS MRI 4 or 5) (surgery recommended). RESULTS The accuracy of the score for assessing the origin of the mass was of 97.2 % (564/580, CI95% 0.96-0.98) and was of 92.0 % (484/526) for categorizing lesions with a negative predictive value of 98.1 % (415/423, CI95% 0.96-0.99). Theoretical management using the score would have spared surgery in 229 patients (87.1 %, 229/263) with benign lesions and malignancy would have been missed in 6 borderline and 2 invasive cases. In patients with a presumed benign mass using O-RADS MRI score, recommending surgery for lesions >= 100 mm would miss only 4/77 (4.8 %) malignant adnexal tumors instead of 8 (50 % decrease). CONCLUSION The use of O-RADS MRI scoring system could drastically reduce the number of asymptomatic patients undergoing avoidable surgery.
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Affiliation(s)
- Yohann Dabi
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service de gynécologie et obstétrique, Hôpital Tenon, France.
| | - Andrea Rockall
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom; Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
| | - Léo Razakamanantsoa
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS) - Hôpital Tenon, France
| | | | - Laure S Fournier
- Assistance Publique des Hopitaux de Paris, Service de radiologie, Hôpital Européeen Georges Pompidou, France
| | - Christina Fotopoulou
- Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
| | - Cyril Touboul
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service de gynécologie et obstétrique, Hôpital Tenon, France
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Paris, France; Assistance Publique des Hopitaux de Paris, Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS) - Hôpital Tenon, France
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Kocak B, Akinci D'Antonoli T, Mercaldo N, Alberich-Bayarri A, Baessler B, Ambrosini I, Andreychenko AE, Bakas S, Beets-Tan RGH, Bressem K, Buvat I, Cannella R, Cappellini LA, Cavallo AU, Chepelev LL, Chu LCH, Demircioglu A, deSouza NM, Dietzel M, Fanni SC, Fedorov A, Fournier LS, Giannini V, Girometti R, Groot Lipman KBW, Kalarakis G, Kelly BS, Klontzas ME, Koh DM, Kotter E, Lee HY, Maas M, Marti-Bonmati L, Müller H, Obuchowski N, Orlhac F, Papanikolaou N, Petrash E, Pfaehler E, Pinto Dos Santos D, Ponsiglione A, Sabater S, Sardanelli F, Seeböck P, Sijtsema NM, Stanzione A, Traverso A, Ugga L, Vallières M, van Dijk LV, van Griethuysen JJM, van Hamersvelt RW, van Ooijen P, Vernuccio F, Wang A, Williams S, Witowski J, Zhang Z, Zwanenburg A, Cuocolo R. METhodological RadiomICs Score (METRICS): a quality scoring tool for radiomics research endorsed by EuSoMII. Insights Imaging 2024; 15:8. [PMID: 38228979 DOI: 10.1186/s13244-023-01572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024] Open
Abstract
PURPOSE To propose a new quality scoring tool, METhodological RadiomICs Score (METRICS), to assess and improve research quality of radiomics studies. METHODS We conducted an online modified Delphi study with a group of international experts. It was performed in three consecutive stages: Stage#1, item preparation; Stage#2, panel discussion among EuSoMII Auditing Group members to identify the items to be voted; and Stage#3, four rounds of the modified Delphi exercise by panelists to determine the items eligible for the METRICS and their weights. The consensus threshold was 75%. Based on the median ranks derived from expert panel opinion and their rank-sum based conversion to importance scores, the category and item weights were calculated. RESULT In total, 59 panelists from 19 countries participated in selection and ranking of the items and categories. Final METRICS tool included 30 items within 9 categories. According to their weights, the categories were in descending order of importance: study design, imaging data, image processing and feature extraction, metrics and comparison, testing, feature processing, preparation for modeling, segmentation, and open science. A web application and a repository were developed to streamline the calculation of the METRICS score and to collect feedback from the radiomics community. CONCLUSION In this work, we developed a scoring tool for assessing the methodological quality of the radiomics research, with a large international panel and a modified Delphi protocol. With its conditional format to cover methodological variations, it provides a well-constructed framework for the key methodological concepts to assess the quality of radiomic research papers. CRITICAL RELEVANCE STATEMENT A quality assessment tool, METhodological RadiomICs Score (METRICS), is made available by a large group of international domain experts, with transparent methodology, aiming at evaluating and improving research quality in radiomics and machine learning. KEY POINTS • A methodological scoring tool, METRICS, was developed for assessing the quality of radiomics research, with a large international expert panel and a modified Delphi protocol. • The proposed scoring tool presents expert opinion-based importance weights of categories and items with a transparent methodology for the first time. • METRICS accounts for varying use cases, from handcrafted radiomics to entirely deep learning-based pipelines. • A web application has been developed to help with the calculation of the METRICS score ( https://metricsscore.github.io/metrics/METRICS.html ) and a repository created to collect feedback from the radiomics community ( https://github.com/metricsscore/metrics ).
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Affiliation(s)
- Burak Kocak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Tugba Akinci D'Antonoli
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.
| | - Nathaniel Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bettina Baessler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ilaria Ambrosini
- Department of Translational Research, Academic Radiology, University of Pisa, Pisa, Italy
| | - Anna E Andreychenko
- Laboratory for Digital Public Health Technologies, ITMO University, St. Petersburg, Russian Federation
| | - Spyridon Bakas
- Division of Computational Pathology, Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
- Center for Federated Learning in Precision Medicine, Indiana University, Indianapolis, IN, USA
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Keno Bressem
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Irene Buvat
- Institut Curie, Inserm, PSL University, Laboratory of Translational Imaging in Oncology, Orsay, France
| | - Roberto Cannella
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | | | - Armando Ugo Cavallo
- Division of Radiology, Istituto Dermopatico dell'Immacolata (IDI) IRCCS, Rome, Italy
| | - Leonid L Chepelev
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Linda Chi Hang Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Aydin Demircioglu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital , Essen, Germany
| | - Nandita M deSouza
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Department of Imaging, The Royal Marsden National Health Service (NHS) Foundation Trust, London, UK
| | - Matthias Dietzel
- Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | | | - Andrey Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laure S Fournier
- Department of Radiology, Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris, France
| | | | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Kevin B W Groot Lipman
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Georgios Kalarakis
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Division of Radiology, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Medical School, University of Crete, Heraklion, Greece
| | - Brendan S Kelly
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
- Insight Centre for Data Analytics, UCD, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, FORTH, Heraklion, Crete, Greece
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Elmar Kotter
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Mario Maas
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Luis Marti-Bonmati
- Medical Imaging Department and Biomedical Imaging Research Group, Hospital Universitario y Politécnico La Fe and Health Research Institute, Valencia, Spain
| | - Henning Müller
- University of Applied Sciences of Western Switzerland (HES-SO Valais), Sierra, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UniGe), Geneva, Switzerland
| | - Nancy Obuchowski
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fanny Orlhac
- Institut Curie, Inserm, PSL University, Laboratory of Translational Imaging in Oncology, Orsay, France
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
- Department of Radiology, Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Ekaterina Petrash
- Radiology department, Research Institute of Pediatric Oncology and Hematology n. a. L.A. Durnov, National Medical Research Center of Oncology n. a. N.N. Blokhin Ministry of Health of Russian Federation, Moscow, Russia
- Medical Department IRA-Labs, Moscow, Russia
| | - Elisabeth Pfaehler
- Institute for advanced simulation (IAS-8): Machine learning and data analytics, Forschungszentrum Jülich, Jülich, Germany
| | - Daniel Pinto Dos Santos
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
- Institute for Diagnostic and Interventional Radiology, Goethe-University Frankfurt Am Main, Frankfurt, Germany
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sebastià Sabater
- Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Philipp Seeböck
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alberto Traverso
- Department of Radiotherapy, Maastro Clinic, Maastricht, the Netherlands
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter van Ooijen
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, Palermo, 90127, Italy
| | - Alan Wang
- Centre for Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Stuart Williams
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK
| | - Jan Witowski
- Department of Radiology, New York University Grossman School of Medicine, New York, USA
| | - Zhongyi Zhang
- School of Information and Communication Technology, Griffith University, Nathan, Brisbane, Australia
| | - Alex Zwanenburg
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
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deSouza NM, Oprea-Lager DE, Fournier LS. Editorial: Quantitative Imaging for Clinical Decisions. Front Oncol 2022; 12:858372. [PMID: 35311084 PMCID: PMC8929672 DOI: 10.3389/fonc.2022.858372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nandita Maria deSouza
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Daniela Elena Oprea-Lager
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers, VU University, Amsterdam, Netherlands
| | - Laure S Fournier
- Université de Paris, PARCC, INSERM, Radiology Department, AP-HP, Hopital Europeen Georges Pompidou, Paris, France
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Oprea-Lager DE, Cysouw MC, Boellaard R, Deroose CM, de Geus-Oei LF, Lopci E, Bidaut L, Herrmann K, Fournier LS, Bäuerle T, deSouza NM, Lecouvet FE. Bone Metastases Are Measurable: The Role of Whole-Body MRI and Positron Emission Tomography. Front Oncol 2021; 11:772530. [PMID: 34869009 PMCID: PMC8640187 DOI: 10.3389/fonc.2021.772530] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022] Open
Abstract
Metastatic tumor deposits in bone marrow elicit differential bone responses that vary with the type of malignancy. This results in either sclerotic, lytic, or mixed bone lesions, which can change in morphology due to treatment effects and/or secondary bone remodeling. Hence, morphological imaging is regarded unsuitable for response assessment of bone metastases and in the current Response Evaluation Criteria In Solid Tumors 1.1 (RECIST1.1) guideline bone metastases are deemed unmeasurable. Nevertheless, the advent of functional and molecular imaging modalities such as whole-body magnetic resonance imaging (WB-MRI) and positron emission tomography (PET) has improved the ability for follow-up of bone metastases, regardless of their morphology. Both these modalities not only have improved sensitivity for visual detection of bone lesions, but also allow for objective measurements of bone lesion characteristics. WB-MRI provides a global assessment of skeletal metastases and for a one-step "all-organ" approach of metastatic disease. Novel MRI techniques include diffusion-weighted imaging (DWI) targeting highly cellular lesions, dynamic contrast-enhanced MRI (DCE-MRI) for quantitative assessment of bone lesion vascularization, and multiparametric MRI (mpMRI) combining anatomical and functional sequences. Recommendations for a homogenization of MRI image acquisitions and generalizable response criteria have been developed. For PET, many metabolic and molecular radiotracers are available, some targeting tumor characteristics not confined to cancer type (e.g. 18F-FDG) while other targeted radiotracers target specific molecular characteristics, such as prostate specific membrane antigen (PSMA) ligands for prostate cancer. Supporting data on quantitative PET analysis regarding repeatability, reproducibility, and harmonization of PET/CT system performance is available. Bone metastases detected on PET and MRI can be quantitatively assessed using validated methodologies, both on a whole-body and individual lesion basis. Both have the advantage of covering not only bone lesions but visceral and nodal lesions as well. Hybrid imaging, combining PET with MRI, may provide complementary parameters on the morphologic, functional, metabolic and molecular level of bone metastases in one examination. For clinical implementation of measuring bone metastases in response assessment using WB-MRI and PET, current RECIST1.1 guidelines need to be adapted. This review summarizes available data and insights into imaging of bone metastases using MRI and PET.
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Affiliation(s)
- Daniela E. Oprea-Lager
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Matthijs C.F. Cysouw
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Christophe M. Deroose
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS – Humanitas Research Hospital, Milan, Italy
| | - Luc Bidaut
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- College of Science, University of Lincoln, Lincoln, United Kingdom
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Laure S. Fournier
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM), Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hopital europeen Georges Pompidou, Université de Paris, Paris, France
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
| | - Tobias Bäuerle
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nandita M. deSouza
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Frederic E. Lecouvet
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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Chamming's F, Hangard C, Gennisson JL, Reinhold C, Fournier LS. Diagnostic Accuracy of Four Levels of Manual Compression Applied in Supersonic Shear Wave Elastography of the Breast. Acad Radiol 2021; 28:481-486. [PMID: 32307273 DOI: 10.1016/j.acra.2020.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the diagnostic accuracy of applying four levels of manual pressure in Shear Wave Elastography (SWE) of the breast and to assess inter-rater reliability. MATERIALS AND METHODS Single-center prospective preliminary study including patients receiving ultrasound examination of breast lesions as part of routine clinical practice. SWE was performed on 60 breast masses (26 benign and 34 malignant) in 54 patients by a breast fellowship trained radiologist. Stiffness values were compared between benign and malignant masses at four levels of manual compression: none, mild, moderate, and marked. Accuracy of SWE was assessed using receiving operating characteristics analysis at each level. In 18 patients, a second radiologist repeated the SWE acquisitions to evaluate reproducibility. Reproducibility was assessed using intraclass correlation coefficient. RESULTS Without compression, we observed no significant difference in stiffness (p > 0.99) between benign and malignant lesions, and SWE demonstrated low accuracy (area under the curve = 0.64). Stiffness was higher in malignant lesions at all levels of compression (p < 0.001). SWE demonstrated good accuracy at all three levels of compression (from area under the curve = 0.71 to 0.84 across Emax and Emean), with high interobserver agreement. CONCLUSION This preliminary study suggests that not using compression during SWE for breast lesion characterization offers suboptimal results. On the contrary, application of compression yields high diagnostic performance with good interobserver agreement and, as such, should be included in routine clinical practice.
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Abdel Wahab C, Jannot AS, Bonaffini PA, Bourillon C, Cornou C, Lefrère-Belda MA, Bats AS, Thomassin-Naggara I, Bellucci A, Reinhold C, Fournier LS. Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI. Radiology 2020; 297:E347. [DOI: 10.1148/radiol.2020209020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abdel Wahab C, Jannot AS, Bonaffini PA, Bourillon C, Cornou C, Lefrère-Belda MA, Bats AS, Thomassin-Naggara I, Bellucci A, Reinhold C, Fournier LS. Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI. Radiology 2020; 297:361-371. [PMID: 32930650 DOI: 10.1148/radiol.2020191658] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Improving the differentiation of uterine sarcomas from atypical leiomyomas remains a clinical challenge and is needed to avoid inappropriate surgery. Purpose To develop a diagnostic algorithm including diffusion-weighted MRI criteria to differentiate malignant uterine sarcomas from benign atypical leiomyomas. Materials and Methods This case-control retrospective study identified women with an atypical uterine mass at MRI between January 2000 and April 2017, with surgery or MRI follow-up after 1 year or longer. A diagnostic algorithm including T2-weighted MRI and diffusion-weighted imaging (DWI) signal and apparent diffusion coefficient (ADC) values was developed to predict for sarcoma. The training set consisted of 51 sarcomas and 105 leiomyomas. Two external validation sets were used to evaluate interreader reproducibility (16 sarcomas; 26 leiomyomas) and impact of reader experience (29 sarcomas; 30 leiomyomas). Wilson confidence intervals (CIs) were calculated for sensitivity and specificity. Results Evaluated were 156 women (median age, 50 years; interquartile range, 44-63 years). Predictive MRI criteria for malignancy were enlarged lymph nodes or peritoneal implants, high DWI signal greater than that in endometrium, and ADC less than or equal to 0.905 × 10-3 mm2/sec. Conversely, a global or focal area of low T2 signal intensity and a low or an intermediate DWI signal less than that in endometrium or lymph nodes allowed readers to confidently diagnose as benign a uterine mass demonstrating one or more of these signs (P < .001) in 100% cases in all three data sets. The sensitivities and specificities of the algorithm for diagnosis of malignancy were 98% (50 of 51 masses; 95% CI: 90%, 100%) and 94% (99 of 105 masses; 95% CI: 88%, 98%) in the training set; 88% (14 of 16 masses; 95% CI: 64%, 97%) and 100% (26 of 26 masses; 95% CI: 87%, 100%) in the validation set; and 83% (24 of 29 masses; 95% CI: 65%, 92%) and 97% (29 of 30 masses; 95% CI: 83%, 99%) for the less experienced reader, respectively. Conclusion A diagnostic algorithm with predictive features including lymphadenopathy, high diffusion-weighted imaging signal with reference to endometrium, and low apparent diffusion coefficient enabled differentiation of malignant sarcomas from atypical leiomyomas, and it may assist inexperienced readers. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Méndez in this issue.
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Affiliation(s)
- Cendos Abdel Wahab
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Anne-Sophie Jannot
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Pietro A Bonaffini
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Camille Bourillon
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Caroline Cornou
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Marie-Aude Lefrère-Belda
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Anne-Sophie Bats
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Alexandre Bellucci
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Caroline Reinhold
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
| | - Laure S Fournier
- From the Departments of Radiology (C.A.W., C.B., A.B., L.S.F.), Medical Informatics and Public Health (A.S.J.), Gynecologic and Breast Oncologic Surgery (C.C., A.S.B.), and Pathology (M.A.L.B.), AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Université de Paris, F-75015 Paris, France; Department of Radiology McGill University Health Centre, Montreal, Canada (P.A.B., C.R.); Department of Radiology, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France (I.T.N.); and Université de Paris, PARCC, INSERM, France (A.B., L.F.)
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8
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Neri E, Gabelloni M, Bäuerle T, Beets-Tan R, Caruso D, D'Anastasi M, Dinkel J, Fournier LS, Gourtsoyianni S, Hoffmann RT, Mayerhöfer ME, Regge D, Schlemmer HP, Laghi A. Involvement of radiologists in oncologic multidisciplinary team meetings: an international survey by the European Society of Oncologic Imaging. Eur Radiol 2020; 31:983-991. [PMID: 32833089 PMCID: PMC7813742 DOI: 10.1007/s00330-020-07178-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/30/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Objectives Multidisciplinary tumour boards (MTBs) play an increasingly important role in managing cancer patients from diagnosis to treatment. However, many problems arise around the organisation of MTBs, both in terms of organisation-administration and time management. In this context, the European Society of Oncologic Imaging (ESOI) conducted a survey among its members, aimed at assessing the quality and amount of involvement of radiologists in MTBs, their role in it and related issues. Methods All members were invited to fill in a questionnaire consisting of 15 questions with both open and multiple-choice answers. Simple descriptive analyses and graphs were performed. Results A total of 292 ESOI members in full standing for the year 2018 joined the survey. Most respondents (89%) declared to attend MT-Bs, but only 114 respondents (43.9%) review over 70% of exams prior to MTB meetings, mainly due to lack of time due to a busy schedule for imaging and reporting (46.6%). Perceived benefits (i.e. surgical and histological feedback (86.9%), improved knowledge of cancer treatment (82.7%) and better interaction between radiologists and referring clinicians for discussing rare cases (56.9%)) and issues (i.e. attending MTB meetings during regular working hours (71.9%) and lack of accreditation with continuing medical education (CME) (85%)) are reported. Conclusions Despite the value and benefits of radiologists’ participation in MTBs, issues like improper preparation due to a busy schedule and no counterpart in CME accreditation require efforts to improve the role of radiologists for a better patient care. Key Points • Most radiologists attend multidisciplinary tumour boards, but less than half of them review images in advance, mostly due to time constraints. • Feedback about radiological diagnoses, improved knowledge of cancer treatment and interaction with referring clinicians are perceived as major benefits. • Concerns were expressed about scheduling multidisciplinary tumour boards during regular working hours and lack of accreditation with continuing medical education.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Michela Gabelloni
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Tobias Bäuerle
- Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Damiano Caruso
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Sant'Andrea University Hospital, Rome, Italy
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Valletta, Malta
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Laure S Fournier
- Radiology Department, Hôpital européen Georges Pompidou, AP-HP, Université de Paris, 20 Rue Leblanc, F-75015, Paris, France
| | - Sofia Gourtsoyianni
- 1st Department of Radiology, School of Medicine, Areteion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ralf-Thorsten Hoffmann
- Diagnostische und Interventionelle Radiologie Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Marius Erik Mayerhöfer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, A-1090, Vienna, Austria
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, University of Torino, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Heinz Peter Schlemmer
- German Cancer Research Center (DKFZ) Foundation Under Public Law, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Andrea Laghi
- Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome "Sapienza", Sant'Andrea University Hospital, Rome, Italy
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9
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Fournier LS, Bats AS, Durdux C. Diffusion MRI: Technical principles and application to uterine cervical cancer. Cancer Radiother 2020; 24:368-373. [PMID: 32360093 DOI: 10.1016/j.canrad.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 01/15/2023]
Abstract
Imaging is involved in the management of uterine cervical cancer with several objectives: 1/to assess local and lymph node extension of the initial disease; 2/evaluate treatment response to conservative therapy; 3/detect recurrences. Pelvic MRI is the first-line examination in all these indications. It is the key element for delineation after image fusion when the indication of chemoradiation therapy is made. It is also essential for guiding the placement of applicators and optimising the dosimetry of brachytherapy. The diffusion-weighted acquisition is a sequence sensitive to the motion of water molecules. It allows distinguishing water molecules with free diffusion from water molecules with diffusion restricted by obstacles such as cell membranes or the cytoskeleton. The diffusion is thus connected to the cellularity of the explored tissue, and the cancers, being hypercellular, will present a high signal. It thus provides additional information thanks to a high contrast between the tumour and the surrounding tissues, facilitating detection, evaluation of the volume and extent of the disease.
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Affiliation(s)
- L S Fournier
- Radiology Department, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Inserm, 56, rue Leblanc, 75015 Paris, France.
| | - A-S Bats
- Oncological and Gynaecological Surgery Department, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - C Durdux
- Radiation Oncology Department, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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10
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Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, Guerra A, Fournier LS, Stojanovic S, Millet I, Bharwani N, Juhan V, Cunha TM, Masselli G, Balleyguier C, Malhaire C, Perrot NF, Sadowski EA, Bazot M, Taourel P, Porcher R, Darai E, Reinhold C, Rockall AG. Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) Score for Risk Stratification of Sonographically Indeterminate Adnexal Masses. JAMA Netw Open 2020; 3:e1919896. [PMID: 31977064 PMCID: PMC6991280 DOI: 10.1001/jamanetworkopen.2019.19896] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Approximately one-quarter of adnexal masses detected at ultrasonography are indeterminate for benignity or malignancy, posing a substantial clinical dilemma. OBJECTIVE To validate the accuracy of a 5-point Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study was conducted between March 1, 2013, and March 31, 2016. Among patients undergoing expectant management, 2-year follow-up data were completed by March 31, 2018. A routine pelvic MRI was performed among consecutive patients referred to characterize a sonographically indeterminate adnexal mass according to routine diagnostic practice at 15 referral centers. The MRI score was prospectively applied by 2 onsite readers and by 1 reader masked to clinical and ultrasonographic data. Data analysis was conducted between April and November 2018. MAIN OUTCOMES AND MEASURES The primary end point was the joint analysis of true-negative and false-negative rates according to the MRI score compared with the reference standard (ie, histology or 2-year follow-up). RESULTS A total of 1340 women (mean [range] age, 49 [18-96] years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 [67.9%]; 2-year follow-up, 362 [32.1%]). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (κ = 0.784; 95% CI, 0.743-0824). Of 580 of 1130 women (51.3%) with a mass on MRI and no specific gynecological symptoms, 362 (62.4%) underwent surgery. Of them, 244 (67.4%) had benign lesions and a score of 3 or less. The MRI score correctly reclassified the mass origin as nonadnexal with a sensitivity of 0.99 (95% CI, 0.98-0.99; 1360 of 1372 patients) and a specificity of 0.78 (95% CI, 0.71-0.85; 102 of 130 patients). CONCLUSIONS AND RELEVANCE In this study, the O-RADS MRI score was accurate when stratifying the risk of malignancy in adnexal masses.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
| | - Edouard Poncelet
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | - Laure S. Fournier
- Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Sanja Stojanovic
- Centre for Radiology, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia and Montenegro
| | - Ingrid Millet
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Nishat Bharwani
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Teresa M. Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Gabriele Masselli
- Department of Radiology, Umberto I Hospital, Sapienza University Roma, Rome, Italy
| | | | | | | | - Elizabeth A. Sadowski
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- University of Wisconsin, Madison, Wisconsin
| | - Marc Bazot
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
| | - Patrice Taourel
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Raphaël Porcher
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Institute national de la santé et de la recherche médicale, Joint Research Unit 1153, Paris, France
| | - Emile Darai
- Service de Gynecologie et Obstetrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Hôpitaux Univesitaires Est Parisien, Paris, France
- Faculté de Médecine Pierre et Marie Curie, Sorbonne Université, Paris, France
| | - Caroline Reinhold
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Medical Imaging, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea G. Rockall
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
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11
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Lecler A, Duron L, Balvay D, Savatovsky J, Bergès O, Zmuda M, Farah E, Galatoire O, Bouchouicha A, Fournier LS. Combining Multiple Magnetic Resonance Imaging Sequences Provides Independent Reproducible Radiomics Features. Sci Rep 2019; 9:2068. [PMID: 30765732 PMCID: PMC6376058 DOI: 10.1038/s41598-018-37984-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022] Open
Abstract
To evaluate the relative contribution of different Magnetic Resonance Imaging (MRI) sequences for the extraction of radiomics features in a cohort of patients with lacrimal gland tumors. This prospective study was approved by the Institutional Review Board and signed informed consent was obtained from all participants. From December 2015 to April 2017, 37 patients with lacrimal gland lesions underwent MRI before surgery, including axial T1-WI, axial Diffusion-WI, coronal DIXON-T2-WI and coronal post-contrast DIXON-T1-WI. Two readers manually delineated both lacrimal glands to assess inter-observer reproducibility, and one reader performed two successive delineations to assess intra-observer reproducibility. Radiomics features were extracted using an in-house software to calculate 85 features per region-of-interest (510 features/patient). Reproducible features were defined as features presenting both an intra-class correlation coefficient ≥0.8 and a concordance correlation coefficient ≥0.9 across combinations of the three delineations. Among these features, the ones yielding redundant information were identified as clusters using hierarchical clustering based on the Spearman correlation coefficient. All the MR sequences provided reproducible radiomics features (range 14(16%)−37(44%)) and non-redundant clusters (range 5–14). The highest numbers of features and clusters were provided by the water and in-phase DIXON T2-WI and water and in-phase post-contrast DIXON T1-WI (37, 26, 26 and 26 features and 14,12, 9 and 11 clusters, respectively). A total of 145 reproducible features grouped into 51 independent clusters was provided by pooling all the MR sequences. All MRI sequences provided reproducible radiomics features yielding independent information which could potentially serve as biomarkers.
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Affiliation(s)
- A Lecler
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. .,Université Paris Descartes Sorbonne Paris Cité, INSERM UMR-S970, Cardiovascular Research Center - PARCC, Paris, France.
| | - L Duron
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Université Paris Descartes Sorbonne Paris Cité, INSERM UMR-S970, Cardiovascular Research Center - PARCC, Paris, France
| | - D Balvay
- Université Paris Descartes Sorbonne Paris Cité, INSERM UMR-S970, Cardiovascular Research Center - PARCC, Paris, France
| | - J Savatovsky
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - O Bergès
- Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M Zmuda
- Department of Orbitopalpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - E Farah
- Department of Orbitopalpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - O Galatoire
- Department of Orbitopalpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - A Bouchouicha
- Université Paris Descartes Sorbonne Paris Cité, INSERM UMR-S970, Cardiovascular Research Center - PARCC, Paris, France
| | - L S Fournier
- Université Paris Descartes Sorbonne Paris Cité, INSERM UMR-S970, Cardiovascular Research Center - PARCC, Paris, France.,Sorbonne Paris Cité University, Paris Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Radiology Department, Paris, France
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12
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Chamming's F, Le-Frère-Belda MA, Latorre-Ossa H, Fitoussi V, Redheuil A, Assayag F, Pidial L, Gennisson JL, Tanter M, Cuénod CA, Fournier LS. Supersonic Shear Wave Elastography of Response to Anti-cancer Therapy in a Xenograft Tumor Model. Ultrasound Med Biol 2016; 42:924-30. [PMID: 26746382 DOI: 10.1016/j.ultrasmedbio.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 05/21/2023]
Abstract
Our objective was to determine if supersonic shear wave elastography (SSWE) can detect changes in stiffness of a breast cancer model under therapy. A human invasive carcinoma was implanted in 22 mice. Eleven were treated with an anti-angiogenic therapy and 11 with glucose for 24 d. Tumor volume and stiffness were assessed during 2 wk before treatment and 0, 7, 12, 20 and 24 d after the start of therapy using SSWE. Pathology was assessed after 12 and 24 d of treatment. We found that response to therapy was associated with early softening of treated tumors only, resulting in a significant difference from non-treated tumors after 12 d of treatment (p = 0.03). On pathology, large areas of necrosis were observed at 12 d in treated tumors. Although treatment was still effective, treated tumors subsequently stiffened during a second phase of the treatment (days 12-24), with a small amount of necrosis observed on pathology on day 24. In conclusion, SSWE was able to measure changes in the stiffness of tumors in response to anti-cancer treatment. However, stiffness changes associated with good response to treatment may change over time, and increased stiffness may also reflect therapy efficacy.
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Affiliation(s)
- Foucauld Chamming's
- Cardiovascular Research Center-PARCC, Université Paris Descartes Sorbonne Paris Cité, UMR-S970, Paris, France; Radiology Department, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
| | - Marie-Aude Le-Frère-Belda
- Pathology Department, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Heldmuth Latorre-Ossa
- Institut Langevin-ondes et images, Ecole Supérieure de Physique et de Chimie Industrielle (ESPCI), Paris, France
| | - Victor Fitoussi
- Cardiovascular Research Center-PARCC, Université Paris Descartes Sorbonne Paris Cité, UMR-S970, Paris, France
| | - Alban Redheuil
- Radiology Department, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Franck Assayag
- U612 Institut National de la Sante et de la Recherche Medicale, Pharmacologie Pre-clinique Antitumorale, Paris, France
| | - Laetitia Pidial
- Cardiovascular Research Center-PARCC, Université Paris Descartes Sorbonne Paris Cité, UMR-S970, Paris, France
| | - Jean-Luc Gennisson
- Institut Langevin-ondes et images, Ecole Supérieure de Physique et de Chimie Industrielle (ESPCI), Paris, France
| | - Mickael Tanter
- Institut Langevin-ondes et images, Ecole Supérieure de Physique et de Chimie Industrielle (ESPCI), Paris, France
| | - Charles-André Cuénod
- Cardiovascular Research Center-PARCC, Université Paris Descartes Sorbonne Paris Cité, UMR-S970, Paris, France; Radiology Department, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Laure S Fournier
- Cardiovascular Research Center-PARCC, Université Paris Descartes Sorbonne Paris Cité, UMR-S970, Paris, France; Radiology Department, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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Fournier LS, Bennani S, Bats AS, Rousseau C, Bensaid C, Lecuru F, Chamming's F. Pitfalls in imaging for advanced ovarian cancer. Semin Roentgenol 2015; 50:284-93. [PMID: 26542429 DOI: 10.1053/j.ro.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laure S Fournier
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Radiology Department, Paris, France; Université Paris Descartes Sorbonne Paris Cité, INSERM UMRS970, Cardiovascular Research Center-PARCC, Paris, France.
| | - Souhail Bennani
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Radiology Department, Paris, France
| | - Anne Sophie Bats
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Gynecological Oncology Surgery Department, Paris, France
| | - Caroline Rousseau
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Radiology Department, Paris, France
| | - Cherazade Bensaid
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Gynecological Oncology Surgery Department, Paris, France
| | - Fabrice Lecuru
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Gynecological Oncology Surgery Department, Paris, France
| | - Foucauld Chamming's
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Radiology Department, Paris, France; Université Paris Descartes Sorbonne Paris Cité, INSERM UMRS970, Cardiovascular Research Center-PARCC, Paris, France
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Fournier LS, Chamming's F, Bennani S, Bensaid C, Seror J, Rousseau C, Lecuru F, Bats AS. Carcinose péritonéale secondaire d’origine ovarienne. Imagerie de la Femme 2015. [DOI: 10.1016/j.femme.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vano YA, Tartour E, Fournier LS, Beuselinck B, Mejean A, Oudard S. Prognostic factors in patients with advanced renal cell carcinoma treated with VEGF-targeted agents. Expert Rev Anticancer Ther 2014; 14:523-42. [DOI: 10.1586/14737140.2014.882773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Faye N, Clément O, Balvay D, Fitoussi V, Pidial L, Sandoval F, Autret G, Silvestre JS, Dean CL, Alison M, Fournier LS. Multiparametric optical and MR imaging demonstrate inhibition of tumor angiogenesis natural history by mural cell therapy. Magn Reson Med 2013; 72:841-9. [DOI: 10.1002/mrm.24970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/08/2013] [Accepted: 09/05/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Nathalie Faye
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
- CHRU Lille; Hôpital Jeanne de Flandre; Women medical imaging Lille France
| | - Olivier Clément
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
- Assistance Publique-Hôpitaux de Paris; Hôpital Européen Georges Pompidou; Radiology Department Paris France
| | - Daniel Balvay
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
| | - Victor Fitoussi
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
| | - Laetitia Pidial
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
| | - Federico Sandoval
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
| | - Gwennhael Autret
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
| | | | | | - Marianne Alison
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
| | - Laure S. Fournier
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970 Paris France
- Assistance Publique-Hôpitaux de Paris; Hôpital Européen Georges Pompidou; Radiology Department Paris France
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Fitoussi V, Faye N, Chamming's F, Clement O, Cuenod CA, Fournier LS. In vivo imaging of tumor angiogenesis using fluorescence confocal videomicroscopy. J Vis Exp 2013. [PMID: 24056503 DOI: 10.3791/50347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Fibered confocal fluorescence in vivo imaging with a fiber optic bundle uses the same principle as fluorescent confocal microscopy. It can excite fluorescent in situ elements through the optical fibers, and then record some of the emitted photons, via the same optical fibers. The light source is a laser that sends the exciting light through an element within the fiber bundle and as it scans over the sample, recreates an image pixel by pixel. As this scan is very fast, by combining it with dedicated image processing software, images in real time with a frequency of 12 frames/sec can be obtained. We developed a technique to quantitatively characterize capillary morphology and function, using a confocal fluorescence videomicroscopy device. The first step in our experiment was to record 5 sec movies in the four quadrants of the tumor to visualize the capillary network. All movies were processed using software (ImageCell, Mauna Kea Technology, Paris France) that performs an automated segmentation of vessels around a chosen diameter (10 μm in our case). Thus, we could quantify the 'functional capillary density', which is the ratio between the total vessel area and the total area of the image. This parameter was a surrogate marker for microvascular density, usually measured using pathology tools. The second step was to record movies of the tumor over 20 min to quantify leakage of the macromolecular contrast agent through the capillary wall into the interstitium. By measuring the ratio of signal intensity in the interstitium over that in the vessels, an 'index leakage' was obtained, acting as a surrogate marker for capillary permeability.
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Affiliation(s)
- Victor Fitoussi
- Université Paris Descartes Sorbonne Paris Cité, INSERM UMR-S970
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Faye N, Pellerin O, Thiam R, Chammings F, Brisa M, Marques E, Cuénod CA, Sapoval M, Fournier LS. Diffusion-weighted imaging for evaluation of uterine arterial embolization of fibroids. Magn Reson Med 2013; 70:1739-47. [DOI: 10.1002/mrm.24624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/16/2012] [Accepted: 12/07/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Nathalie Faye
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970, Cardiovascular Research Center-PARCC; Paris France
| | - Olivier Pellerin
- Vascular Radiology Department; Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Paris France
| | - Rokhaya Thiam
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970, Cardiovascular Research Center-PARCC; Paris France
| | - Foucauld Chammings
- Radiology Department; Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Paris France
| | - Marie Brisa
- Radiology Department; Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Paris France
| | - Enio Marques
- Vascular Radiology Department; Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Paris France
| | - Charles A. Cuénod
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970, Cardiovascular Research Center-PARCC; Paris France
- Radiology Department; Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Paris France
| | - Marc Sapoval
- Vascular Radiology Department; Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Paris France
| | - Laure S. Fournier
- Université Paris Descartes Sorbonne Paris Cité; INSERM UMR-S970, Cardiovascular Research Center-PARCC; Paris France
- Radiology Department; Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Paris France
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Pécuchet N, Fournier LS, Oudard S. New Insights into the Management of Renal Cell Cancer. Oncology 2013; 84:22-31. [DOI: 10.1159/000342962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/27/2012] [Indexed: 01/14/2023]
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Balvay D, Kachenoura N, Espinoza S, Thomassin-Naggara I, Fournier LS, Clement O, Cuenod CA. Signal-to-Noise Ratio Improvement in Dynamic Contrast-enhanced CT and MR Imaging with Automated Principal Component Analysis Filtering. Radiology 2011; 258:435-45. [DOI: 10.1148/radiol.10100231] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Fournier LS, Oudard S, Thiam R, Trinquart L, Banu E, Medioni J, Balvay D, Chatellier G, Frija G, Cuenod CA. Metastatic Renal Carcinoma: Evaluation of Antiangiogenic Therapy with Dynamic Contrast-enhanced CT. Radiology 2010; 256:511-8. [DOI: 10.1148/radiol.10091362] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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22
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Thiam R, Fournier LS, Trinquart L, Medioni J, Chatellier G, Balvay D, Escudier B, Dromain C, Cuenod CA, Oudard S. Optimizing the size variation threshold for the CT evaluation of response in metastatic renal cell carcinoma treated with sunitinib. Ann Oncol 2009; 21:936-41. [PMID: 19889607 DOI: 10.1093/annonc/mdp466] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In metastatic renal cell carcinoma (mRCC), antiangiogenic treatments rarely achieve a reduction of -30% in the sum of longest diameters (SLD) of target lesions required by RECIST for an 'objective response', although they objectively improve progression-free survival (PFS). We sought to determine a threshold for the computed tomography evaluation of these patients' best reflecting patient outcome. PATIENTS AND METHODS In 334 mRCC patients treated with sunitinib, we tested thresholds from -45% to +10%. We classified patients as 'responders' when the best relative variation of the sum of longest diameters (DeltaSLD) reached the tested threshold and as 'nonresponders' otherwise. For each tested threshold, the median PFS of the two groups were compared. Receiver operating characteristic (ROC) analysis was also carried out among the 103 patients that progressed during follow-up. Finally, the 'optimal' threshold was retested on an independent cohort of 39 patients. RESULTS The DeltaSLD threshold of -10% gave the most significant difference. It divided patients into 256 responders and 78 nonresponders (median PFS 11.1 and 5.6 months). The same -10% threshold was found using the ROC analysis. Results were confirmed on the external validation cohort. CONCLUSION A variation of -10% in the SLD accurately and rapidly identifies mRCC patients benefiting from sunitinib.
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Affiliation(s)
- R Thiam
- Department of Radiology, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
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Fournier LS, Vanel D, Athanasiou A, Gatzemeier W, Masuykov IV, Padhani AR, Dromain C, Galetti K, Sigal R, Costa A, Balleyguier C. Dynamic optical breast imaging: a novel technique to detect and characterize tumor vessels. Eur J Radiol 2008; 69:43-9. [PMID: 18829193 DOI: 10.1016/j.ejrad.2008.07.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To prospectively determine the diagnostic accuracy of optical absorption imaging in patients with Breast Imaging Reporting and Data System (BI-RADS) 3-5 breast lesions. MATERIALS AND METHODS Forty-six patients with BI-RADS classification 3 (11%), 4 (44%) or 5 (44%) lesions, underwent a novel optical imaging examination using red light to illuminate the breast. Pressure was applied on the breast, and time-dependent curves of light absorption were recorded. Curves that consistently increased or decreased over time were classified as suspicious for malignancy. All patients underwent a core or surgical biopsy. RESULTS Optical mammography showed a statistical difference in numbers of suspect pixels between benign (N=12) and malignant (N=35) lesions (respectively 1325 vs. 3170, P=0.002). In this population, optical imaging had a sensitivity of 74%, specificity of 92%, and diagnostic accuracy of 79%. The optical signal did not vary according to any other parameter including breast size or density, age, hormonal status or histological type of lesions. CONCLUSION Optical imaging is a low-cost, non-invasive technique, yielding physiological information dependent on breast blood volume and oxygenation. It appears to have a good potential for discriminating benign from malignant lesions. Further studies are warranted to define its potential role in breast cancer imaging.
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Affiliation(s)
- Laure S Fournier
- Université Paris Descartes, Hôpital Européen Georges Pompidou, Radiology Department, 20 rue Leblanc, 75015 Paris, France.
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Abstract
Imaging plays a crucial role in oncology to assist in the management of patients and selection of drug regimen. Recent advances in imaging techniques allowing to predict and evaluate response to treatments in oncology will be reviewed. The standard in the evaluation of response to treatment is based on the measurement of lesion size. Functional imaging assesses physiological or molecular processes that may be earlier indicators of early response to treatment. Dynamic imaging of tumor vascularization assesses the biodistribution of a contrast agent within tumoral tissues. Diffusion-weighted MR imaging can differentiate free water from water restricted by tissues, providing an assessment of tumor cellularity. MR spectroscopy assesses the relative quantity of specific chemical components within normal and tumoral tissues. 18 FDG PET imaging provides an assessment of the metabolic activity of tissues. FDG uptake is proportional to cellular proliferation and number of viable cells within a tumor. Results from studies assessing the role of these emerging imaging techniques remain preliminary and the medical community must determine their respective role in the routine evaluation of response to treatment in oncological patients.
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Affiliation(s)
- L S Fournier
- Service de Radiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris.
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Thariat J, Fournier LS, Badoual C, Marcy PY, Housset M. Aggressive adenoid cystic carcinoma with asymptomatic spinal cord compression revealed by a "curtain sign". J Radiol Case Rep 2008; 2:12-5. [PMID: 22470582 DOI: 10.3941/jrcr.v2i1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors present a case of unusually aggressive adenoid cystic carcinoma of the head and neck. The patient presented with sciatica one year after initial diagnosis. She was otherwise asymptomatic. Complete work-up for bone involvement, included bone scan and MRI. The patient had painful osteolytic sacral metastasis and asymptomatic thoracic (T5) vertebral metastasis revealed by a typical curtain sign on MRI. The curtain sign, originally described by Trolard, is due to the displacement of the Trolard's membrane with the median ligament attaching the dura to the bone while there is a dorsal displacement and loosening of the posterior longitudinal ligament. The patient benefited from radiotherapy and did not develop respiratory distress, paraplegia or pain but died of liver metastases.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Anticancer Research Institute Antoine Lacassagne. Nice, France
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Fu Y, Raatschen HJ, Nitecki DE, Wendland MF, Novikov V, Fournier LS, Cyran C, Rogut V, Shames DM, Brasch RC. Cascade Polymeric MRI Contrast Media Derived from Poly(ethylene glycol) Cores: Initial Syntheses and Characterizations. Biomacromolecules 2007; 8:1519-29. [PMID: 17402781 DOI: 10.1021/bm061141h] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diagnostic contrast media for magnetic resonance imaging (MRI) are often applied to enhance the signal of blood allowing for quantitative definition of vascular functional characteristics including tissue blood volume, flow, and leakiness. Well-tolerated and safe macromolecular formulations are currently being sought that remain in the blood for a relatively long period and that leak selectively from diseased vessels, particularly cancer vessels. We synthesized a new class of macromolecular, water-soluble MRI contrast media by introducing two diverging polylysine cascade amplifiers at each end of a poly(ethylene glycol) (PEG) backbone, followed by substitution of terminal lysine amino groups with Gd-DTPA chelates. Four candidate PEG cascade conjugates are reported here, PEG3400-Gen4-(Gd-DTPA)8, PEG6000-Gen4-(Gd-DTPA)8, PEG12000-Gen4-(Gd-DTPA)8, and PEG3400-Gen5-(Gd-DTPA)13 with descriptions of their basic physical, biological, and kinetic properties, including real and effective molecular sizes, proton T1 relaxivities in water and plasma, partition coefficients, osmolalities, chelate stability, stability in plasma, stability to autoclaving, certain in vivo pharmacokinetics (blood half-life, blood clearance, volume of distribution), and whole body elimination profiles in normal rodents. These candidate PEG-core cascade MRI contrast media showed a range of effective molecular sizes similar to proteins weighing 74-132 kDa, although their actual molecular weights were much smaller, 12-20 kDa. All compounds exhibited a narrow range of size dispersity and relatively high T1 relaxivities (approximately 3 times the value for unconjugated Gd-DTPA at 2 T and 37 degrees C). Representative compounds also showed a high degree of hydrophilicity, stability in solution buffer and plasma, and lack of binding to proteins. The two candidate compounds with the largest effective molecular sizes, PEG12000-Gen4-(Gd-DTPA)8 and PEG3400-Gen5-(Gd-DTPA)13, had longer blood half-lives, 36 and 73 min, respectively (monoexponential kinetics for both), and showed strong, prolonged MRI enhancement of vessels. Results also indicate that in vivo pharmacokinetics and bodily elimination profiles can be adjusted by the selection of molecular size for the PEG core and the selection of the amplification degree of the cascade polylysine clusters. The initially evaluated compounds from this new class of contrast media show acceptable, desirable characteristics in many, but not all, respects. Further efforts are directed toward candidate macromolecules having higher thermodynamic stability, higher degree of substitution by gadolinium chelates, and more rapid bodily elimination.
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Affiliation(s)
- Yanjun Fu
- Center for Pharmaceutical and Molecular Imaging, Department of Radiology, University of California San Francisco (UCSF), 513 Parnassus Avenue, San Francisco, California 94143-0628, USA.
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Fournier LS, Novikov V, Lucidi V, Fu Y, Miller T, Floyd E, Shames DM, Brasch RC. MR Monitoring of Cyclooxygenase-2 Inhibition of Angiogenesis in a Human Breast Cancer Model in Rats. Radiology 2007; 243:105-11. [PMID: 17329684 DOI: 10.1148/radiol.2431050658] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the ability of macromolecular contrast medium (MMCM)-enhanced dynamic magnetic resonance (MR) imaging to depict vascular changes in response to cyclooxygenase-2 (COX-2) inhibition of angiogenesis in a human breast cancer model. MATERIALS AND METHODS The institutional committee for animal research approved this study. A human breast cancer cell line, MDA-MB-231, was implanted in 30 female homozygotous athymic rats that were alternately assigned to either a drug treatment group that received celecoxib on a daily basis for 7 days or a control group that received saline. Each animal underwent MR imaging after intravenous administration of a high-molecular-weight contrast agent at baseline and again 24 hours and 7 days after administration. Eleven rats in each group successfully underwent all three studies and had data sets of sufficient technical quality. A bidirectional two-compartment tissue model was used to estimate transendothelial permeability (K(PS)) and fractional plasma volume (fPV) for each tumor. Microvessel density was also measured to enable histologic assessment of angiogenesis. Repeated-measures analysis of variance and unpaired two-tailed t tests were used to evaluate differences in mean values between MR examinations performed in the same rats and between baseline values in treated and control rats, respectively. RESULTS MR imaging-assayed microvascular K(PS) decreased significantly after 7 days of treatment with celecoxib (P < .05), but it was not significantly changed after 7 days in the control group. Likewise, microvascular density, a histologic surrogate of angiogenesis, was significantly (P < .05) lower in the treatment group than in the control group. The fPV did not significantly change in either group. CONCLUSION Dynamic MR imaging revealed microvascular permeability to a high-molecular-weight contrast agent was significantly reduced by treatment with celecoxib.
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Affiliation(s)
- Laure S Fournier
- Center for Pharmaceutical and Molecular Imaging, University of California, San Francisco, USA.
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Fournier LS, Lucidi V, Berejnoi K, Miller T, Demos SG, Brasch RC. In-vivo NIR autofluorescence imaging of rat mammary tumors. Opt Express 2006; 14:6713-6723. [PMID: 19516853 DOI: 10.1364/oe.14.006713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We investigate in vivo detection of mammary tumors in a rat model using autofluorescence imaging in the red and far-red spectral regions. The objective was to explore this method for non-invasive detection of malignant tumors and correlation between autofluorescence properties of tumors and their pathologic status. Eighteen tumor-bearing rats, bearing eight benign and seventeen malignant tumors were imaged. Autofluorescence images were acquired using spectral windows centered at 700-nm, 750-nm and 800-nm under laser excitation at 632.8-nm and 670- nm. Intensity in the autofluorescence images of malignant tumors under 670-nm excitation was higher than that of the adjacent normal tissue. whereas intensity of benign tumors was lower compared to normal tissue.
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Simon GH, Fu Y, Berejnoi K, Fournier LS, Lucidi V, Yeh B, Shames DM, Brasch RC. Initial computed tomography imaging experience using a new macromolecular iodinated contrast medium in experimental breast cancer. Invest Radiol 2006; 40:614-20. [PMID: 16118555 DOI: 10.1097/01.rli.0000174477.11541.ce] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate computed tomography (CT) enhancement characteristics for a new iodinated macromolecular contrast medium (MMCM), PEG12000-Gen4-triiodo, for angiographic effect and for assessment of abnormal vascular permeability in cancer. MATERIALS AND METHODS Time persistence of angiographic effect was evaluated on rat CT images acquired over 30 minutes using the iodinated polyethyleneglycol- (PEG) based macromolecule. Dynamic CT imaging after PEG12000-Gen4-triiodo-enhancement in tumor-bearing rats was used to quantitatively estimate plasma volume and microvascular transendothelial permeability for both tumor and normal soft tissue. Using identical doses of iodine, 300 mg iodine/kg, blood curves for this MMCM and iohexol were compared. RESULTS Serial whole-body CT angiograms using PEG12000-Gen4-triiodo showed diagnostic vascular detail through 20 minutes, and the blood enhancement curve was higher and more persistent than with small-molecular iohexol. Permeability estimates were significantly (P<0.02; paired t test) higher in tumors (48.2+/-18.1 microL/min-1 100 mL) than in muscle (2.5+/-5.7 microL/min-1 100 mL). CONCLUSIONS Use of PEG-based MMCM for experimental CT allowed for a persistent angiographic enhancement and for quantitative estimation of tumor microvascular characteristics.
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Affiliation(s)
- Gerhard H Simon
- Center for Pharmaceutical and Molecular Imaging (CPMI), Department of Radiology, University of California San Francisco, San Francisco, California 94143, USA.
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Fournier LS, Lucidi V, Berejnoi K, Shames DM, Brasch RC. Acute microvascular effects of anti-angiogenic treatment in a rat model of human breast cancer using macromolecular contrast-enhanced magnetic resonance imaging. Acad Radiol 2005. [DOI: 10.1016/j.acra.2005.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wiart M, Fournier LS, Novikov VY, Shames DM, Roberts TP, Fu Y, Shalinsky DR, Brasch RC. Magnetic resonance imaging detects early changes in microvascular permeability in xenograft tumors after treatment with the matrix metalloprotease inhibitor Prinomastat. Technol Cancer Res Treat 2004; 3:377-82. [PMID: 15270589 DOI: 10.1177/153303460400300408] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Macromolecular contrast medium-enhanced magnetic resonance imaging was applied to monitor the effect of matrix metalloprotease (MMP) inhibition on microvascular characteristics of human breast cancers implanted in athymic rats. Twice-daily intraperitoneal administration of Prinomastat over 1.5 days induced significant declines in MRI-assayed microvascular permeabilities (p<0.05); but this leak suppression effect had extinguished by the 10(th) day of MMP treatment using the same dose and time schedule. Results demonstrate that Prinomastat produces a rapid but transient decrease in tumor vascular permeability. Contrast-enhanced MRI using macromolecular contrast medium may prove useful as a biomarker for the dynamic MMP biological effect in cancers.
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Affiliation(s)
- Marlene Wiart
- Center for Pharmaceutical and Molecular Imaging, Department of Radiology, Box 0628, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0628, USA
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Fournier LS, Cuenod CA, de Bazelaire C, Siauve N, Rosty C, Tran PL, Frija G, Clement O. Early modifications of hepatic perfusion measured by functional CT in a rat model of hepatocellular carcinoma using a blood pool contrast agent. Eur Radiol 2004; 14:2125-33. [PMID: 15503038 DOI: 10.1007/s00330-004-2339-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2003] [Revised: 10/17/2003] [Accepted: 03/16/2004] [Indexed: 12/22/2022]
Abstract
Macromolecular contrast-enhanced functional CT was performed to characterize early perfusion changes in hepatocellular carcinoma (HCC). Fourteen rats with chemically induced primary liver tumors ranging pathologically from hyperplasia to HCC and 15 control rats were investigated. Two dynamic CT scans using an experimental macromolecular contrast agent were performed on a single slice 11 and 18 weeks after tumor induction followed by pathological examination. A deconvolution mathematical model was applied, yielding the hepatic perfusion index (HPI), mean transit time (MTT), liver distribution volume (LDV) and arterial, portal and total blood flows (FA, FP, FT). Analysis was performed on one slice per rat, containing overall two hyperplasia, six dysplasia and 15 HCC. On the first scans, HCC at an early pathological stage had a low FP (-30%, P=0.002) but a normal arterial-portal balance. On the scan contemporary to pathology, HCC perfusion parameters showed an inversion of the arterial-portal balance (HPI +212%, P<0.0001), with a high FA (+56%, P=0.002) and a low FP (-69%, P<0.0001). Sensitivity and specificity of detection of HCC by perfusion CT were high (87 and 80%) on late scans; but also on the earlier scans (86 and 65%), even though only one (7%) was visible to the eye. Perfusion-CT allowed early detection of HCC. This technique could contribute in the detection and characterization of liver lesions in clinical studies.
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MESH Headings
- Animals
- Blood Flow Velocity/physiology
- Carcinoma, Hepatocellular/blood supply
- Carcinoma, Hepatocellular/chemically induced
- Carcinoma, Hepatocellular/diagnostic imaging
- Contrast Media/administration & dosage
- Disease Models, Animal
- Image Processing, Computer-Assisted/methods
- Iodine Compounds
- Liver/blood supply
- Liver/diagnostic imaging
- Liver/pathology
- Liver Circulation
- Liver Neoplasms, Experimental/blood supply
- Liver Neoplasms, Experimental/chemically induced
- Liver Neoplasms, Experimental/diagnostic imaging
- Male
- Organic Chemicals
- Rats
- Rats, Wistar
- Sensitivity and Specificity
- Time Factors
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Laure S Fournier
- Laboratoire de Recherche en Imagerie, INSERM U494, Necker Institute, 156 rue de Vaugirard, 75015 Paris, France.
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Brun V, Revel MP, Danel C, Fournier LS, Souilamas R, Frija G. Case report. Pyothorax-associated lymphoma: Diagnosis at percutaneous core biopsy with CT guidance. AJR Am J Roentgenol 2003; 180:969-71. [PMID: 12646437 DOI: 10.2214/ajr.180.4.1800969] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD20/analysis
- Biopsy, Needle
- Collapse Therapy
- Empyema, Pleural/diagnostic imaging
- Empyema, Pleural/pathology
- Humans
- Lung/diagnostic imaging
- Lung/pathology
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/pathology
- Lymphoma, Non-Hodgkin/diagnostic imaging
- Lymphoma, Non-Hodgkin/pathology
- Male
- Opportunistic Infections/diagnostic imaging
- Opportunistic Infections/pathology
- Tomography, X-Ray Computed
- Tuberculosis/complications
- Tuberculosis/therapy
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Affiliation(s)
- Vincent Brun
- Department of Radiology, Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
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Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G, Reynaud P, Frija G. Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? AJR Am J Roentgenol 2002; 179:1217-24. [PMID: 12388502 DOI: 10.2214/ajr.179.5.1791217] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We assessed the capacity of chest radiography and CT to determine the cause and site of bleeding in patients with either large or massive hemoptysis compared with bronchoscopy. MATERIALS AND METHODS We reviewed the chest radiographs, CT scans, and bronchoscopic findings in 80 patients with either large or massive hemoptysis who were admitted to our intensive care unit between January 1995 and June 1999. RESULTS Findings on chest radiography were normal in only 13% of patients, of whom 70% had bronchiectasis. The chest radiographs revealed the site of bleeding in 46% of the patients and the cause in 35%, most of whom had tuberculosis or tumors. CT was more efficient than bronchoscopy for identifying the cause of bleeding (77% vs 8%, respectively; p < 0.001), whereas the two methods were comparable for identifying the site of bleeding (70% vs 73%, respectively; p = not significant). CONCLUSION These data suggest that CT could replace bronchoscopy as the first-line procedure for screening patients with large and those with massive hemoptysis. However, these results must be confirmed in a prospective multicenter study.
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Affiliation(s)
- Marie Pierre Revel
- Department of Radiology, Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
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Le Pennec A, Lacroix J, Fournier LS, Schmutz GR, Boute V, Crouet H, Denoux Y. [Is mammography useful in Paget's disease of the breast?]. J Gynecol Obstet Biol Reprod (Paris) 2000; 29:655-61. [PMID: 11119037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE Interest of the mammogram in Paget's disease of the breast, especially for a therapeutic decision in otherwise asymptomatic women with Paget's disease, who would be candidates for conservative treatment. MATERIALS AND METHODS 61 women with histological Paget's disease of the nipple, treated by mastectomy, were retrospectively analyzed with clinical, radiological and pathological correlations. RESULTS An underlying carcinoma was found in 60 cases (98.4%), atypical epithelial hyperplasia in one. In the 24 women without breast palpable mass, 17 (71%) had a normal mammogram, 12 (50%) had carcinoma with an invasive component, 14 (58%) had a cancer at a distance from the nipple, 17 (71%) had a multifocal carcinoma. All 37 women with a palpable mass had a pathological mammogram, 36 of them had carcinoma with an invasive component, 35 (95%) a cancer at a distance from the nipple, 31 (84%) a multifocal carcinoma. CONCLUSION Mammogram is of limited value in management of Paget's disease of the breast for women without breast palpable mass; it can not predict the site of malignancy, nor the invasive component.
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Affiliation(s)
- A Le Pennec
- Service de Radiologie Générale, C.H. Argentan, Service IRM, C.H.U Caen
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