American Journal of Roentgenology

Editorial Comment: Defining the Role for ADC in the Evaluation of Uterine Leiomyosarcoma—Time for the ROI (With Caution)

Utility of ADC Values for Differentiating Uterine Sarcomas From Leiomyomas: Systematic Review and Meta-Analysis

Editorial Comment: Pros and Cons of Implementation of Synoptic Reporting in Oncologic Imaging

Systematic Review and Meta-Analysis of O-RADS Ultrasound and O-RADS MRI for Risk Assessment of Ovarian and Adnexal Lesions

Staging of Cervical Cancer: A Practical Approach Using MRI and FDG PET

This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.

Editorial Comment: On the Contemporary Role of MRI and FDG PET/CT in Managing Cervical Cancer

O-RADS for Ultrasound: A User's Guide, From the AJR Special Series on Radiology Reporting and Data Systems

The Ovarian-Adnexal Reporting and Data System (O-RADS) is a lexicon and risk stratification tool designed for the accurate characterization of adnexal lesions and is essential for optimal patient management. O-RADS is a recent addition to the American College of Radiology (ACR) reporting and data systems and consists of ultrasound (US) and MRI arms. Since most ovarian or adnexal lesions are first detected with US, O-RADS US is considered the primary assessment tool. Application of O-RADS US is recommended whenever a nonphysiologic lesion is encountered. Lesion characterization may be streamlined by use of an algorithmic approach focused on relevant features and an abbreviated version of the lexicon. Resources to expedite O-RADS US categorization and determination of a management recommendation include easy online access to the ACR color-coded risk stratification scorecards and an O-RADS US calculator that is available as a smartphone app. Reporting should be concise and include relevant features for risk stratification that adhere to lexicon terminology. Technical considerations include optimization of gray-scale and color Doppler technique and performance of problem-solving maneuvers to help avoid common pitfalls. This review provides a user-friendly summary of O-RADS US with practical tips for everyday clinical use.

Krukenberg Tumors: Update on Imaging and Clinical Features

Molecular Imaging of Peritoneal Carcinomatosis in Ovarian Carcinoma

Development of MRI-Based Radiomics Model to Predict the Risk of Recurrence in Patients With Advanced High-Grade Serous Ovarian Carcinoma

Intercostal Brown Adipose Tissue on FDG PET/CT

O-RADS Ultrasound Version 1: A Scenario-Based Review of Implementation Challenges

The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) risk stratification and management system was first published by the American College of Radiology in 2020. It provides standardized terminology for evaluation of ovarian and adnexal masses, aids risk stratification, and provides management guidelines for different categories of lesions. This system has been validated by subsequent research and found to be a useful diagnostic and management tool. However, as noted in the system's governing concepts, in some clinical scenarios, such as patients with acute symptoms or with a history of ovarian malignancy, O-RADS US does not apply, or the system's standard management may be adjusted. Additional scenarios, such as an adnexal mass in pregnancy, present challenges in the application of O-RADS US to assist diagnosis and management. The purpose of this article is to highlight 10 clinical scenarios in which O-RADS US version 1 may not apply, may be difficult to apply, or may require modified management. Additional scenarios in which O-RADS US can be appropriately applied are also described.

Role of MRI in Assessing the Feasibility of Fertility-Sparing Treatments for Early-Stage Endometrial and Cervical Cancers

Fertility-sparing treatment (FST) has become a key aspect of managing gynecologic cancers in reproductive-age patients who wish to preserve fertility. Several leading clinical societies, including the European Society of Gynecological Oncology, the European Society for Radiotherapy and Oncology, the European Society of Pathology, and the European Society of Human Reproduction and Embryology, have published evidence-based guidelines on fertility-sparing strategies and post-treatment surveillance of patients with early-stage gynecologic cancers, in particular endometrial and cervical cancers. These guidelines highlight MRI as essential to initial patient selection and follow-up. Properly tailored pelvic MRI protocols and clear MRI reports are key to performing accurate staging, assessing eligibility, and confirming the initial and ongoing feasibility of FST. Accordingly, radiologists, particularly those specializing in gynecologic imaging, play a critical role in the multidisciplinary approach to FST. They should be well-versed in FST eligibility criteria and key MRI findings before and after FST, ensuring these details are comprehensively communicated in structured MRI reports.

Cervical Cancer Reporting Lexicon: A Collaboration by the SAR Uterine and Ovarian Cancer DFP, ESUR Female Pelvic Imaging Working Group, and Asian Society of Abdominal Radiology

Cervical cancer treatment involves multidisciplinary care teams composed of gynecologic surgeons, gynecologic oncologists, radiation oncologists, pathologists, and radiologists. The 2018 update of the FIGO cervical cancer staging system incorporated imaging as a source of staging information, reflecting the critical role of imaging in evaluating patients with cervical cancer before and after therapy. However, the lack of standardized terminology has led to challenges in the updated system's application, including ambiguity in management decisions. This collaborative project between the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel, the European Society of Urogenital Radiology Female Pelvic Imaging Working Group, and the Asian Society of Abdominal Radiology aimed to develop a list of standardized consensus-based terms and definitions for reporting imaging findings in the initial staging, follow-up, and treatment planning of cervical cancer, as well as a report template leveraging the lexicon terms. The lexicon and report template were developed by 20 committee members (17 radiologists, two gynecologic oncologic surgeons, and one radiation oncologist), representing 19 institutions from North America, Europe, and Asia. These tools are intended to improve consistency in the reporting of cervical cancer imaging, to enhance communication among care teams and optimize patient management.

Comparison of International Ovarian Tumor Analysis Simple Rules to Society of Radiologists in Ultrasound Guidelines for Detection of Malignancy in Adnexal Cysts

Synoptic Reporting for Pretreatment CT Examination in Patients With Advanced Ovarian Cancer: Impact on Documentation of Disease Sites and Physician Satisfaction

O-RADS MRI After Initial Ultrasound for Adnexal Lesions: AJR Expert Panel Narrative Review

The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) and MRI risk stratification systems were developed by an international group of experts in adnexal imaging to aid radiologists in assessing adnexal lesions. The goal of imaging is to appropriately triage patients with adnexal lesions. US is the first-line imaging modality for assessment, whereas MRI can be used as a problem-solving tool. Both US and MRI can accurately characterize benign lesions such as simple cysts, endometriomas, hemorrhagic cysts, and dermoid cysts, avoiding unnecessary or inappropriate surgery. In patients with a lesion that does not meet criteria for one of these benign diagnoses, MRI can further characterize the lesion with an improved specificity for cancer and the ability to provide a probable histologic subtype in the presence of certain MRI features. This allows personalized treatment, including avoiding overly extensive surgery or allowing fertility-sparing procedures for suspected benign, borderline, or low-grade tumors. When MRI findings indicate a risk of an invasive cancer, patients can be expeditiously referred to a gynecologic oncologic surgeon. This narrative review provides expert opinion on the utility of multiparametric MRI when using the O-RADS US and MRI management systems.

Multimodality Imaging of Uterine Cervical Malignancies

Cervical Cancer: 2018 Revised International Federation of Gynecology and Obstetrics Staging System and the Role of Imaging

Value of Intratumoral Metabolic Heterogeneity and Quantitative 18F-FDG PET/CT Parameters in Predicting Prognosis for Patients With Cervical Cancer

A Review of Viral-Related Malignancies and the Associated Imaging Findings

Beyond the AJR: Endometrial Thickness Measurement on Ultrasound Underperforms in Detecting Endometrial Cancer in Black Women

Poor Evidence That Endometrial Thickness Underperforms in Detecting Endometrial Cancer in Black Women

Reply to “Poor Evidence That Endometrial Thickness Underperforms in Detecting Endometrial Cancer in Black Women”