Diffusion-weighted MRI in assessing adnexal masses and breast cancers

ABSTRACTDiffusion-weighted magnetic resonance imaging (MRI) is a proven, quick, and noninvasive tech-nique which requires no ionizing radiation or contrast media administration and is able to de-tect, characterize and stage malignant tumors, and to monitor treatment response. Over the two last decades, many clinical applications of diffusion-weighted imaging (DWI) have emerged in the field of women’s oncology. This technique provides both qualitative and quanti-tative information offering a promising new tumor biomarker in clinical routine. This thesis work was therefore conducted to demonstrate the critical role of DWI in the man-agement of adnexal masses and breast cancers. The dissertation is divided into 5 chapters. Chapter 1 presents the general background. Chapter 2 is dedicated to the contribution of DWI in assessing adnexal masses. Chapter 3 is focused on the role of DWI in the evaluation of breast cancer response to neoadjuvant treatments with emphasis on the early response to neoadju-vant chemotherapy (NAC) and to neoadjuvant radiotherapy. Chapter 4 explores the performance of whole-body MRI (WB-MRI) including DWI in the initial staging of breast cancer patients at high risk of metastasis. Chapter 5 contains the discussion, future perspectives, and general con-clusion.Initially, we validated prospectively the ADNEX MR scoring system in the assessment of inde-terminate ovarian and adnexal masses with ultrasound (US) in 323 patients. We also evaluated a new, modified ADNEX MR scoring system that incorporates DWI including apparent diffusion coefficient (ADC) mapping. It showed an improvement of the classical ADNEX MR scoring sys-tem in diagnosing lesions with a score of 4 or 5 when adding DWI data analysis including ADC mapping, from 95.5% sensitivity and 86.6% specificity to 95.7% and 93.3%, respectively.Afterwards, we evaluated the added value of quantitative DWI in the diagnosis of indetermi-nate adnexal masses with US in a cohort of 163 patients with 201 adnexal masses. We meas-ured ADC with a region of interest (ROI) and ADC histogram after segmentation of the whole-lesion (WL) of malignant and benign adnexal masses, and we evaluated their value in the O-RADS MRI score. We showed that integrating ADC thresholds in O-RADS MRI score 4 may dis-criminate between low-to-indeterminate and intermediate-to-high malignancy risk groups. Otherwise, we assessed the role of DWI after one cycle of NAC in predicting the pathologic and radiologic responses in 48 patients with 50 breast cancers with two-dimensional ROI-ADC measurement and with three-dimensional WL histogram analysis of ADC obtained after seg-mentation. We showed that a significant increase in ROI-ADC values between MRI 1 (before NAC) and 2 (after 1 cycle of NAC) was predictive of pathologic complete response (pCR) and of radiologic complete response. Moreover, the ROI-ADC measurement method was superior to the WL-ADC measurement method.Furthermore, we compared ROI-ADC measurement with the Ki-67 proliferation index before and after NAC to assess ADC changes as a predictive marker of changes in Ki-67 index due to NAC in 47 patients with 49 invasive breast cancers. After NAC, a significant increase in breast cancer ADC value was observed, which predicted a significant decrease in the Ki-67 index in patients with radiologic response and in patients with pCR.Additionally, we studied DWI in the evaluation of tumor response after neoadjuvant preopera-tive radiotherapy in early-stage breast cancers. We also observed an inverse correlation be-tween ADC and Ki-67 index in 19 patients with 22 breast cancers.Finally, we proposed a prospective clinical trial evaluating the performance of WB-MRI includ-ing DWI in the initial staging of 45 breast cancer patients at high risk of metastases in compari-son with PET-CT as standard of reference. Correlations between outcomes of the two modali-ties for the M staging and interobserver agreement were almost perfect. The negative predic-tive value of WB-MRI in the diagnosis of bone metastases was 97%.In conclusion, after 6 years of prospective clinical work, we were able to propose a review of the literature on adnexal masses and breast cancers that summarized the contribution of DWI and opened new perspectives. Our work shows that MRI including DWI is a cornerstone in the management of female oncology patients, with great potential in the fields of pelvic MRI in assessing adnexal masses, breast MRI in monitoring breast cancer under neoadjuvant treat-ment, and WB-MRI in staging breast cancers. Further research is needed to assess the optimal strategies in staging and monitoring breast cancer patients with WB-MRI including DWI as a reliable complementary technique to PET-CT, especially in cases requiring repeat examinations, thereby avoiding multiple life-time doses of radiotracers, minimizing ionizing radiation, and saving costs.Doctorat en Sciences médicales (Médecine)info:eu-repo/semantics/nonPublishe

Masses annexielles pendant la grossesse

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Masses annexielles bilatérales durant la grossesse

The presence of adnexal masses during pregnancy is a rare situation but due to a broader use of sonography ;its occurrence is increasing. Their management essentially relies on imagery. We report the case of an 18 weeks-pregnant women presenting bilateral teratomas visualized by RMI. She was successfully treated by laparoscopy. This paper approaches the management of adnexal masses during pregnancy. The epidemiology, possible complications, diagnostic approach and the therapeutic management are discussed.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Unusual findings in two cases of Langerhans' cell histiocytosis.

We report unusual findings in two patients with Langerhans' cell histiocytosis (LCH), namely a cervical mass lesion with extensive destruction of the posterior elements of a cervical vertebra and gastrointestinal lesions as part of multisystem involvement. The aim of our report is threefold. Firstly, LCH can be responsible for osteolysis of the vertebral posterior arches, with or without involvement of the vertebral body, and should be included in the differential diagnoses of cervical mass lesions. Secondly, in a patient with confirmed LCH and additional protein-losing enteropathy, gastrointestinal involvement should be considered as a possibility since it is an important factor for establishing prognosis. Thirdly, LCH lesions can be very extensive and yet have a good response to therapy, whereas less spectacular lesions may not respond or respond only partially to therapy. Thus, an important factor in establishing prognosis is the presence of multisystem involvement at diagnosis, regardless of the extent of a lesion at a particular site.Case ReportsJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Does preoperative magnetic resonance imaging modify breast cancer surgery?

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Diffusion-Weighted MRI (DWI) in Ovarian Masses: Value of DWI compared to T2 and T1-weighted MRI and Histopathological Findings

Proc. Intl. Soc. Mag. Reson. Medinfo:eu-repo/semantics/publishe

Diffusion-weighted imaging of the prostate at 3T using high b-factors

Proc. Intl. Soc. Mag. Reson. Med.info:eu-repo/semantics/publishe

Evaluation of accuracy of fine needle aspiration cytology in BI-RADS3 category breast lesions: Cytohistological correlation in 337 cases

Objective: To evaluate the accuracy of fine needle aspiration cytology (FNAC) in BI-RADS3 breast lesions. Methods: Between January 2004 and December 2007, 337 cases from BI-RADS3 lesions underwent FNAC. Three to six needle passes were made on each patient. In 67 cases (20%) a histological biopsy was performed. Cytological and histological interpretations were performed by the same pathologist. Results: The histological diagnosis showed that 88% (59/67) of BI-RADS3 breast lesions were benign. Only 6% (4/67) were malignant, consisting of ductal carcinoma in situ and infiltrating ductal carcinoma. Conclusion: BI-RADS3 lesions remain disruptive in their management. However, the correlation between cytology and histology showed that most of these lesions were benign and that finally FNAC remains a useful and accurate test in the management of these lesions. © 2009 Blackwell Publishing Ltd.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

MR cholangiography with manganese dipyridoxyl diphosphate in the evaluation of biliary-enteric anastomoses: preliminary experience.

OBJECTIVE: The purpose of our study was to assess the usefulness of manganese dipyridoxyl diphosphate (Mn-DPDP)-enhanced T1-weighted MR cholangiography for evaluating patients with biliary-enteric anastomoses. CONCLUSION: Mn-DPDP-enhanced T1-weighted MR cholangiography may provide useful functional information and may aid in the assessment of the patency of biliary-enteric anastomoses.Journal Articleinfo:eu-repo/semantics/publishe

Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment--initial results.

To determine the accuracy of 3.0-T pelvic magnetic resonance (MR) imaging in the preoperative assessment of endometriosis and to evaluate colon wall involvement after intrarectal gel administration.Journal Articleinfo:eu-repo/semantics/publishe