Ahmet Akçay

Diagnostic utility of Magnetic Resonance Imaging in discriminating immature teratoma: Insights from a case series

AbstractImmature teratomas (IT) are rare germ cell tumors with malignant behavior, distinct from the benign mature teratomas. Clinical differentiation poses challenges, demanding a comprehensive, multidisciplinary diagnostic approach. This case series delves into the detailed radiological imaging findings of ITs. Pelvic MRI was conducted on five cases with adnexal masses, all of which were histopathologically confirmed as ITs. Radiologically, larger tumor size and scattered fatty components were key diagnostic indicators. This study underlines the importance of comprehensive evaluation in IT diagnosis and management, with MRI as an essential tool in the clinical workflow.

Role of magnetic resonance imaging to differentiate between borderline and malignant serous epithelial ovarian tumors

We aimed to differentiate serous borderline ovarian tumors (SBOT) from serous epithelial ovarian carcinomas (SEOC) using morphological and functional MRI findings, to improve the patient management. We retrospectively investigated 24 ovarian lesions diagnosed with SBOT and 64 ovarian lesions diagnosed with SEOC. Additional to the demographic and morphological findings T2W signal intensity ratio, mean apparent diffusion coefficient (ADC Bilaterality, pelvic free fluid presence, serum CA-125 level (U/mL), presence of pelvic peritoneal implant were in favor of SEOC. Lower maximum size of solid component and solid size to maximum size ratio, dominantly cystic and solid-cystic appearance, exophytic growth pattern, presence of papiller projection and papillary architecture and internal branching pattern, higher T2W signal intensity ratio, ADC Our study revealed that morphological and functional imaging findings were valuable in differentiating BSOT from SEOC.

Updated endometrial cancer FIGO staging: the role of MRI in determining newly included histopathological criteria

Endometrial cancer (EC) is among the prevalent malignancies in gynecology, showing an increasing occurrence and mortality rate. The updated 2023 FIGO staging integrates both histopathological and molecular analyses, which significantly impact the prognosis and treatment approaches. This research aims to examine the effectiveness of MRI in identifying essential histopathological tumor features, including histological subtype, grade, and lymphovascular space invasion. A total of 106 patients diagnosed with EC from February 2018 to December 2023 underwent preoperative pelvic MRI. Surgical procedures followed ESMO guidelines, with histopathological assessments using FIGO 2009 criteria. Two radiologists independently evaluated MRI images, measuring maximum tumor size, minimum tumor ADC value (using a free-hand ROI technique), and ADC tumor/myometrium ratio. MRI findings were compared with histopathological data. Peritoneal implant presence and tumor size exhibited significant differences between endometrioid adenocarcinoma (EAC) and non-endometrioid endometrial carcinoma (NEEC), with p values of < 0.001 and 0.003, respectively. Significant differences in age, tumor size, ADC tumor, and ADC tumor/myometrium between low-grade and high-grade tumors were observed, with p values of < 0.001, 0.004, 0.006, and 0.011, respectively. Increased tumor size, reduced ADC tumor, ADC tumor/myometrium, and pelvic peritoneal implant presence were significantly associated with LVSI, with p values of < 0.001, 0.001, 0.002, and 0.001, respectively. The AUC values for tumor size, ADC tumor, and ADC tumor/myometrium were 0.842, 0.781 and 0.747, respectively, in distinguishing between low and high-grade endometrial tumors. Similarly, obtained AUC values for predicting LVSI were 0.836, 0.719, and 0.696, respectively. Our study emphasizes MRI's role in predicting tumor characteristics such as histological subtype, grade, and LVSI based on updated FIGO criteria. By highlighting the potential of MRI, this research contributes to our comprehension of improving diagnostic and clinical management for EC. Further multicenter studies are warranted to validate these findings and establish MRI's role in EC management.

Dynamic versus nondynamic magnetic resonance imaging (MRI) protocols in Ovarian-Adnexal Reporting and Data System for magnetic resonance imaging (O-RADS MRI) scoring of adnexal masses: a comparative performance analysis

AİM: To compare the diagnostic performance of the Ovarian-Adnexal Reporting and Data System for magnetic resonance imaging (O-RADS MRI) using dynamic and nondynamic contrast-enhanced protocols in the characterisation of adnexal masses. MATERİALS AND METHODS: This retrospective study included 369 patients (mean age, 43.6 ± 15 years) with 479 adnexal lesions who underwent pelvic MRI between January 2020 and March 2025. Dynamic contrast-enhanced MRI (DCE-MRI) was performed in 97 lesions and nondynamic contrast-enhanced MRI in 382. Two radiologists, with 8 and 4 years of experience, independently reviewed all examinations while blinded to clinical and histopathological data. Lesions scored as O-RADS 2-3 were classified as benign and O-RADS 4-5 as malignant. Histopathology or ≥12 months of imaging follow-up served as the reference standard. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both protocols. RESULTS: Among 479 lesions, 302 (76.8%) were benign, 28 (7.1%) borderline, and 63 (16.0%) malignant. The dynamic protocol achieved a sensitivity of 97.4%, specificity of 93.2%, PPV of 90.2%, NPV of 98.2%, and accuracy of 94.8%. The nondynamic protocol showed comparable results (sensitivity 96.4%, specificity 94.6%, PPV 91.2%, NPV 97.9%, accuracy 95.0%), with no significant difference in diagnostic accuracy (P =0.794). Malignancy rates increased progressively with higher O-RADS categories in both protocols. CONCLUSION: O-RADS MRI provides a reliable framework for risk stratification of adnexal masses. Nondynamic contrast-enhanced MRI achieves diagnostic performance equivalent to DCE-MRI and can be confidently used when dynamic acquisition is not feasible, supporting broader clinical adoption of simplified O-RADS MRI protocols.