S. Guruvare

Diagnostic accuracy of intravoxel incoherent motion and diffusion kurtosis imaging in evaluating endometrial lesions - A systematic review

Proper clinical management requires accurate differentiation of benign and malignant endometrial lesions. Intravoxel Incoherent Motion (IVIM) and Diffusion Kurtosis Imaging (DKI) are non-invasive MRI methods that have emerged as key tools in this differentiation. This systematic review compares the diagnostic accuracy of IVIM and DKI in evaluating endometrial lesions. A systematic review of the literature was conducted using pertinent databases. Inclusion criteria were studies that compared IVIM and DKI for the differentiation of benign and malignant endometrial lesions and provided diagnostic performance statistics like area under the curve (AUC), specificity, and sensitivity. Meta-analysis was not performed in this review due to heterogeneity of the included studies, such as variation in b-values, magnetic field strengths of the MRI scanners, no standardized scanning parameters, and differences in Region of interest (ROI) selection as reported in the articles. The risk of bias was assessed using the QUADAS-2 tool. In total, 11 studies were included, which evaluated endometrial lesions. F, D, D∗, MD, and MK IVIM and DKI parameters had different diagnostic performances, with AUC ranging from 0.601 to 0.98. Sensitivity and specificity also differed widely between studies. The majority of studies used Echo Planar Imaging (EPI) sequences. Risk of bias assessment indicated moderate-to-high methodological quality. IVIM and DKI could offer promising non-invasive methods for distinguishing endometrial lesions. Yet, differences in methodology and heterogeneity of studies emphasize the necessity for further standardization. IVIM and DKI MRI can be used as non-invasive quantitative tools to provide insights about tissue microstructure and perfusion characteristics which help clinicians in characterization of endometrial cancers.

Accuracy of 3-D Surface Rendering of 2-D Ultrasound Images of the Uterus Using a Novel Software in Mapping Uterine Fibroids

Three-dimensional surface rendering of 2-D ultrasound images of the uterus in mapping uterine fibroids is a fast-evolving imaging technique that holds great potential for gynecology. The purpose of this study was to assess the accuracy of 3-D surface rendering of 2-D ultrasound images of the uterus using a new Fibroid Mapping Reviewer Application (FMRA) software for mapping uterine fibroids as compared with the pathological evaluation of uterine fibroids in pre-menopausal women undergoing hysterectomy. We enrolled women aged 35-55 y scheduled for hysterectomy for symptomatic fibroids at a tertiary care hospital from 2019 to 2021. Per pre-set guidelines, we recorded 2-D images and videos of the uterus with fibroids during the transvaginal ultrasound. The recordings were transferred through USB, loaded in the FMRA software and post-processed to generate a 3-D rendered uterus model. An experienced pathologist assessed and documented the gross examination details per a set protocol. We compared the pre-specified dimensions related to the size (L1, L2) and location (X, Y) of fibroids between the 3-D model and the pathologist's assessment of the hysterectomy specimen. A total of 25 fibroids in 25 women, the single largest per woman, were considered for analysis. The two methods had good correlation with respect to size (for L1, R² = 0.9723, and for L2, R² = 0.9784) and location (for X, R² = 0.9618, and for Y, R² = 0.9753). Inter-observer analysis revealed that measurements from two sonologists were reproducible (Cronbach's α = 0.9 for the L1, L2 and L3 dimensions of fibroids from the 3-D model). The FMRA is a novel tool for mapping fibroids. With its proven accuracy, it will be helpful in planning surgeries and during guided procedures for managing uterine fibroids.