Tsukasa Saida

Comparison of MR Imaging of High-grade Serous Carcinomas with and without Homologous Recombination-deficiency

MRI findings of high-grade serous carcinoma (HGSC) with and without homologous recombination deficiency (HRD) were compared to explore the feasibility of using MRI as a genetic predictor. We retrospectively reviewed MRI data from HRD-positive and HRD-negative HGSC and evaluated tumor size, appearance, apparent diffusion coefficient (ADC), time-intensity curve, and several dynamic contrast-enhanced curve descriptors. Age, primary site, tumor stage, bilaterality, presence of lymph node metastasis, presence of peritoneal metastasis, and tumor marker levels were also compared. Forty-eight patients with HRD-positive HGSC (17 patients with BRCA1 variant, 9 patients with BRCA2 variant, and 22 without BRCA variants) and 18 patients with HRD-negative HGSC were included. The HRD-negative patients' mean age was 67 years, which was significantly higher than that of the HRDpositive patients (60 years, P = 0.011). High-risk time-intensity curve (TIC) patterns were more common in HRD-negative tumors (94%) than in HRD-positive tumors (63%; P = 0.047). Tumors without HRD exhibited significantly higher wash-in rates (P = 0.023). Additionally, unresectable lymph node metastases were significantly more frequent in HRD-negative patients (P = 0.013). No significant differences were observed in the other evaluated factors. The comparison between HGSC with and without HRD revealed that HGSC without HRD was significantly associated with older age, a higher likelihood of exhibiting a high-risk TIC pattern, a higher wash-in rate, and a higher frequency of unresectable lymph node metastasis.

Multi–b-value diffusion-weighted imaging–derived parameters for differentiating high-grade serous ovarian carcinoma from other epithelial ovarian cancers

Abstract Objective High-grade serous carcinoma (HGSC) is the most common ovarian cancer subtype, and its differentiation from others is crucial for treatment. This study aimed to evaluate parameters derived from multi–b-value diffusion-weighted imaging (DWI), including apparent diffusion coefficient (ADC), and metrics based on intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI), for differentiating HGSC from other ovarian cancers. Methods We retrospectively analysed patients with primary epithelial ovarian cancer who underwent preoperative MRI including multi-b-value DWI. From the solid tissues of the tumours, diffusion parameters were derived from the multi–b-value DWI data using different models: ADC using a mono-exponential model; the true diffusion coefficient (Di), pseudo-diffusion coefficient (D*), and perfusion fraction (f) using the IVIM model; and kurtosis (K) using the DKI model. Results This study included 56 patients with different histological cancer subtypes (mean age, 60 years; range, 24–87 years). The mean values of HGSC compared to the other cancers showed lower ADC (0.58 ± 0.21 × 10⁻3 mm2/s vs. 0.76 ± 0.18 × 10⁻3 mm2/s, p < 0.001), lower Di (0.37 ± 0.09 × 10⁻3 mm2/s vs. 0.42 ± 0.15 × 10⁻3 mm2/s, p = 0.201), and lower f (35.79 ± 11.48% vs. 48.01 ± 17.21%, p = 0.003), with a higher K (1.06 ± 0.25 vs. 0.84 ± 0.20, p = 0.341). Among these parameters, ADC showed the highest diagnostic performance in differentiating HGSC from others, with an area under the receiver operating characteristic curve of 0.79. These trends were particularly pronounced between HGSC and clear cell carcinoma, with significant differences in all parameters except D*. Additionally, K Mean was the only parameter that showed a significant difference between HGSC and endometrioid carcinoma. Conclusion Multi–b-value DWI–derived parameters, particularly ADC, may aid in the non-invasive preoperative differentiation of HGSC from other ovarian cancers. Secondary Abstract Multi–b-value DWI–derived parameters, especially ADC, demonstrated utility in differentiating high-grade serous carcinoma (HGSC) from other ovarian cancers, highlighting their potential in non-invasive preoperative tumor characterization.

Comprehensive analysis of calcification frequency and patterns in ovarian tumours using non-contrast CT

Abstract Objectives To investigate the frequency and patterns of calcification in ovarian tumours and evaluate their association with various histological types and malignancy grades. Methods This retrospective study included patients who underwent non-contrast CT between March 2015 and March 2024 and had pathologically confirmed ovarian tumours. CT scans were reviewed for the presence and patterns of calcification (punctate, linear, coarse, and amorphous) by three radiologists. Statistical analysis was performed using the Fisher–Freeman–Halton exact test with Bonferroni correction. Results This study included 328 patients (mean age, 55 years; range, 18–88 years). Significant differences in calcification frequency were observed among major tumour categories (p < 0.001), with with germ cell tumours being more calcified and metastases less calcified. Similarly, a significant difference was also found among epithelial tumours (p = 0.005), where mucinous and Brenner tumours were more calcified, whereas serous tumours were less calcified. Benign epithelial tumours showed a significantly higher frequency of calcification than borderline tumours and carcinomas (p < 0.001). When comparing the calcification patterns observed among epithelial tumours, significant differences were found for all calcification patterns: punctate (p = 0.024), linear (p < 0.001), coarse (p < 0.001), and amorphous (p < 0.001). The linear pattern was more common in mucinous tumours, whereas the amorphous pattern was more common in serous and Brenner tumours. Among non-epithelial tumours, germ cell tumours frequently exhibited liner and many calcifications, and immature teratomas were characterised by a mixture of punctate, linear, and coarse calcifications. Granulosa cells and metastatic tumours did not exhibit calcification. Conclusions Among epithelial tumours, mucinous and Brenner tumours had a significantly higher frequency of calcification, and benign tumours had a significantly higher frequency of calcification. Amorphous patterns were significantly more common in serous and Brenner tumours, while linear patterns were significantly more common in mucinous tumours.

Diagnostic imaging analysis to differentiate struma ovarii from mucinous carcinomas, encompassing T2*-based imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging

Abstract Objectives To clarify the differences between struma ovarii (SO) and mucinous carcinomas (MC) on CT and MRI, including T2*-based images, diffusion-weighted images (DWI), and time-intensity curve (TIC) patterns, which have not been previously reported. Methods We retrospectively compared the presence of low intensity on T2-weighted and T2*-based images, high intensity on T1-weighted images, hyperattenuation on non-contrast CT, TIC pattern, T2 ratio, T1 ratio, CT value, and apparent diffusion coefficient (ADC) value in 15 patients with SO and 27 patients with MC. Results SO exhibited a significantly higher frequency of low intensity on T2-weighted and T2*-based images, and hyperattenuation on non-contrast CT than MC (P < .001, <.001, and .006, respectively). The T2 ratios and CT attenuation of the locules were also significantly different (P < .001, and .006, respectively). In SO, sites of low intensity on T2-weighted and T2*-based images and sites of hyperattenuation on CT images always coincided. Regarding the TIC pattern, most SO showed a high-risk pattern, with a significant difference (P = .003). The ADC values of SO were significantly lower, and only one case of SO showed high signal intensity on DWI. Conclusions SO were more frequently with low intensity on T2-weighted and T2*-based images, and hyperattenuation on non-contrast CT, and showed high-risk TIC patterns without diffusion restriction. Advances in knowledge SO shows a high-risk TIC pattern but can be specifically diagnosed in combination with the lack of diffusion restriction and loculi with marked hypointensity on T2-weighted and T2*-based images consistent with hyperattenuation on non-contrast CT.

Comparison of Benign, Borderline, and Malignant Ovarian Seromucinous Neoplasms on MR Imaging

This study aimed to compare MRI findings among benign, borderline, and malignant ovarian seromucinous neoplasms. We retrospectively analyzed MRI data from 24 patients with ovarian seromucinous neoplasms-seven benign, thirteen borderline, and six malignant. The parameters evaluated included age, tumour size, morphology, number, height, apparent diffusion coefficient (ADC) values, T2 ratios, time-intensity curve (TIC) descriptors, and TIC patterns of the mural nodules. Additionally, we examined the T2 and T1 ratios of the cyst contents, tumour markers, and the presence of endometriosis. We used statistical tests, including the Kruskal-Wallis and Fisher-Freeman-Halton exact tests, to compare these parameters among the three aforementioned groups. The cases showed papillary architecture with internal branching in 57% of benign, 92% of borderline, and 17% of malignant cases. Three or fewer mural nodules were seen in 57% of benign, 8% of borderline, and 17% of malignant cases. Compared to benign and borderline tumours, mural nodules of malignant neoplasms had significantly increased height (P = 0.015 and 0.011, respectively), lower means ADC values (P = 0.003 and 0.035, respectively). The mural nodules in malignant cases also demonstrated significantly lower T2 ratios than those in the benign cases (P = 0.045). Most neoplasms displayed an intermediate-risk TIC pattern, including 80% benign, 83% borderline, and 60% malignant neoplasms, and no significant differences were observed. Most benign and borderline tumours exhibited a papillary architecture with an internal branching pattern, whereas this feature was less common in malignant neoplasms. Additionally, benign tumours had fewer mural nodules compared to borderline tumours. Malignant neoplasms were characterized by mural nodules with increased height and lower ADC values than those in benign and borderline tumours. Interestingly, all three groups predominantly exhibited an intermediate-risk TIC pattern, emphasizing the complexity of diagnosing seromucinous neoplasms using MRI.

Assessment of the utility of intravoxel incoherent motion and diffusion kurtosis imaging for determining eligibility for fertility preservation

Background Accurate preoperative assessment of endometrial cancer (EC) is crucial in young women who may be eligible for fertility-preserving therapy, which is generally limited to patients with grade 1, endometrioid-type tumors without myometrial invasion (MI). Purpose To evaluate the utility of quantitative parameters derived from intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) for improving the diagnostic performance of magnetic resonance imaging (MRI). Material and Methods This retrospective study included 107 patients diagnosed with EC (mean age = 59 years; age range = 25–89 years) who underwent preoperative MRI, including multiple b-value (0–2000 s/mm 2 ) diffusion-weighted imaging, between January 2022 and March 2024. Quantitative parameters were extracted from the mono-exponential (ADC), IVIM (Di, D*, f), and DKI (Dk, K) models and compared across clinical and pathological features. Results ADC, Di, and Dk values were significantly higher in patients without MI ( P  = 0.015, 0.035, and 0.005, respectively). Di and Dk were significantly higher ( P  = 0.003 and 0.016), and K was significantly lower ( P  = 0.013) in the G1 group. Patients eligible for fertility preservation had significantly higher ADC, Di, and Dk values ( P  = 0.002, 0.002, and 0.001) and significantly lower K values ( P  = 0.044). The overall diagnostic performance of these parameters was moderate (area under the curve < 0.70). Conclusion IVIM and DKI-derived metrics may enhance preoperative assessment of tumor grade and MI, supporting decisions regarding fertility-preserving treatment.

The Utility of Apparent Water Diffusion Coefficient Maps for Evaluating the Presence of Myometrial Invasion in Patients with Endometrial Cancer

To assess the utility of apparent diffusion coefficient maps (ADC) for diagnosing myometrial invasion (MI) in endometrial cancer (EC). This retrospective study included 164 patients (mean age, 56 years; range, 25-89 years) who underwent preoperative MRI for EC with <1/2 MI or no MI between April 2016 and July 2023. Five sequences were evaluated: T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), ADC, dynamic contrast-enhanced T1-weighted imaging (DCE-T1WI), and contrast-enhanced T1WI (CE-T1WI). Three experienced radiologists independently assessed the sequences for MI. For ADC, MI was determined if the endometrial-myometrial junction-tumor boundary had disappeared. Additionally, the assessment of MI was performed using the combination of T2WI, DWI, and ADC, as well as T2WI, DCE-T1WI, and CE-T1WI. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) for the presence of MI were calculated and compared between the sequences and combinations. Inter-reader agreement was assessed using kappa (κ) statistics. The sensitivity of ADC was significantly higher than T2WI (P < 0.001) and DCE-T1WI (P = 0.018) for one reader and significantly higher than CE-T1WI (P = 0.045 and 0.043) for two readers. The specificity of ADC was significantly lower than T2WI (P = 0.015 and < 0.001) and CE-T1WI (P = 0.031 and 0.01) for two readers and significantly lower than DCE-T1WI (P = 0.031) for one reader. The AUC of ADC was significantly higher than T2WI (P = 0.048) and DCE-T1WI (P = 0.049) for one reader. The combination including ADC showed higher positive predictive value for all three readers compared to any sequence or combination including contrast enhancement. Additionally, ADC demonstrated the highest agreement rates. ADC had high sensitivity for MI and the highest agreement rate among all sequences. Thus, this sequence, combined with other sequences, can be crucial for a comprehensive evaluation of MI.

Cervical cancer in the modern era: cutting-edge strategies for diagnosis and treatment

Abstract Cervical cancer remains a major cause of mortality among women worldwide, highlighting the need for advances in diagnostic and therapeutic strategies. This review provides a comprehensive overview of recent developments in histopathological classification based on human papillomavirus association, as well as progress in imaging and treatment approaches supported by current research. Emerging technologies, such as artificial intelligence-assisted imaging, targeted molecular therapies, and personalized radiotherapy, hold substantial promise for improving patient outcomes. These innovations offer new possibilities for precision medicine in cervical cancer care, and their current applications are discussed in this review.

MRI localization evaluation to distinguish gastric-type adenocarcinoma and lobular endocervical glandular hyperplasia from other cystic lesions

Abstract Objectives To quantitatively differentiate MRI localization of gastric-type adenocarcinoma (GAS) and lobular endocervical glandular hyperplasia (LEGH) from other benign cystic lesions (OBC). Methods We retrospectively reviewed T1-weighted (T1WI) and T2-weighted images (T2WI) and measured the lesion volume, the ratio of cervical canal position at the maximum cross-section (deviation ratio), the ratio of the lesion’s centre within the craniocaudal length (longitudinal location ratio), distance from the internal and external os, maximum cyst diameter, and signal intensities of the cyst content on T1WI and T2WI (T1 and T2 ratios). These parameters were compared between GAS or LEGH and OBC, where OBC was clinically suspected of LEGH. Results Seventeen patients with GAS, 18 with LEGH (52 ± 11 years), and 42 with OBC (45 ± 10 years) were included. GAS/LEGH were larger in volume (29.25/15.24 cm3, P &amp;lt; .001), and had a greater deviation ratio (0.82/0.84, P &amp;lt; .001), shorter distance to the internal and external os (3.4/3.6 mm, P = .040, and 3.3/3.3 mm, P = .003, respectively), and a lower T1 ratio (1.08/0.91, P &amp;lt; .001). The area under the curve (AUC) of these parameters using their respective optimal cut-off values was 0.818, 0.756, 0.629, 0.711, and 0.731, respectively. When 3 or more positive criteria were considered, the AUC increased to 0.896. Conclusions Compared with OBC, GAS/LEGH displayed a larger volume, cervical canal deviation, proximity to the internal and external os, and a lower T1 ratio of cyst content. Advances in knowledge Considering both the lesion and its relationship to the cervical canal is imperative for differentiating between the conditions.

Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma

To clarify imaging and clinical characteristics of ovarian carcinosarcoma (CS) compared with high-grade serous carcinoma (HGSC). We retrospectively reviewed MR imagings of 12 patients with CS and 30 patients with HGSC and evaluated tumor size, shape, appearance, nature of cystic and solid components, hemorrhage, and necrosis. Age, premenopausal or postmenopausal, histologic subtype, presence of endometriosis, tumor markers, and stage were also evaluated. These parameters were compared using the Mann-Whitney U test and the chi-square test/Fisher's exact test. The mean size of CSs was 13.6 cm, and significantly larger than that of HGSCs (mean 9.0 cm, p = 0.022). The stained-glass appearance (67% vs. 23%, p = 0.013), hemorrhage (100% vs. 50%, p = 0.003), necrosis (75.0% vs. 13%, p = 0.000), and endometriosis (33% vs. 7%, p = 0.012) were significantly more common in CSs. The postmenopausal ratio of CSs was 100% and significantly higher than that of HGSCs (70.0%, p = 0.041). Among the tumor makers, only CA-125 was significantly lower in CSs than in HGSCs (mean 715.1 U/ml vs. 1677.1 U/ml, p = 0.009). The stage distribution was similar and was not significantly different. CSs formed larger masses, and the stained-glass appearance, hemorrhage, and necrosis were more frequently observed in CSs.

Ovarian and non-ovarian teratomas: a wide spectrum of features

Teratoma is a germ cell tumor (GCT) derived from stem cells of the early embryo and the germ line. Teratoma is the most common neoplasm of the ovaries and is usually diagnosed easily using imagings by detecting fat components. However, there are various histopathological types and the imaging findings differ according to the type. Teratoma usually occurs in the gonads or in the midline due to migration of primordial germ cells during development. The clinical course of teratomas depends on the age of the patient, histological type, and anatomical site. Sometimes teratomas show unusual manifestations, such as mature teratoma without demonstrable fat components, torsion, rupture, growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and autoimmune hemolytic anemia. For all of these reasons, teratomas demonstrate a wide spectrum of imaging features and radiologists should be familiar with these variabilities. The present article aims to introduce a model encompassing types of GCTs based on their developmental potential, and to review several histopathological types in various anatomical sites and unusual manifestations of teratomas, with representative imaging findings.