ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update

An update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques is provided. An algorithmic approach using sagittal T2 and a set of transaxial T1 and T2WI allows categorization of adnexal masses in one of the following three types according to its predominant signal characteristics. T1 'bright' masses due to fat or blood content can be simply and effectively determined using a combination of T1W, T2W and FST1W imaging. When there is concern for a solid component within such a mass, it requires additional assessment as for a complex cystic or cystic-solid mass. For low T2 solid adnexal masses, DWI is now recommended. Such masses with low DWI signal on high b value image (e.g. > b 1000 s/mm2 ) can be regarded as benign. Any other solid adnexal mass, displaying intermediate or high DWI signal, requires further assessment by contrast-enhanced (CE)T1W imaging, ideally with DCE MR, where a type 3 curve is highly predictive of malignancy. For complex cystic or cystic-solid masses, both DWI and CET1W—preferably DCE MRI—is recommended. Characteristic enhancement curves of solid components can discriminate between lesions that are highly likely malignant and highly likely benign

Impact of DWI and ADC values in ovarian-adnexal reporting and data system (O-RADS) MRI score

Purpose: Introduce DWI and quantitative ADC evaluation in O-RADS MRI system and observe how diagnostic performance changes. Assess its validity and reproducibility between readers with different experience in female pelvic imaging. Finally, evaluate any correlation between ADC value and histotype in malignant lesions. Materials and methods: In total, 173 patients with 213 indeterminate adnexal masses (AMs) on ultrasound were subjected to MRI examination, from which 140 patients with 172 AMs were included in the final analysis. Standardised MRI sequences were used, including DWI and DCE sequences. Two readers, blinded to histopathological data, retrospectively classified AMs according to the O-RADS MRI scoring system. A quantitative analysis method was applied by placing a ROI on the ADC maps obtained from single-exponential DWI sequences. AMs considered benign (O-RADS MRI score 2) were excluded from the ADC analysis. Results: Excellent inter-reader agreement was found in the classification of lesions according to the O-RADS MRI score (K = 0.936; 95% CI). Two ROC curves were created to determine the optimal cut-off value for the ADC variable between O-RADS MRI categories 3-4 and 4-5, respectively, 1.411 × 10-3 mm2/sec and 0.849 × 10-3 mm2/sec. Based on these ADC values, 3/45 and 22/62 AMs were upgraded, respectively, to score 4 and 5, while 4/62 AMs were downgraded to score 3. ADC values correlated significantly with the ovarian carcinoma histotype (p value < 0.001). Conclusion: Our study demonstrates the prognostic potential of DWI and ADC values in the O-RADS MRI classification for better radiological standardisation and characterisation of AMs

Diffusionâ weighted imaging outside the brain: Consensus statement from an ISMRMâ sponsored workshop

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134160/1/jmri25196_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134160/2/jmri25196.pd

Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI).

Unilateral axillary lymphadenopathy is a frequent mild side effect of COVID-19 vaccination. European Society of Breast Imaging (EUSOBI) proposes ten recommendations to standardise its management and reduce unnecessary additional imaging and invasive procedures: (1) in patients with previous history of breast cancer, vaccination should be performed in the contralateral arm or in the thigh; (2) collect vaccination data for all patients referred to breast imaging services, including patients undergoing breast cancer staging and follow-up imaging examinations; (3) perform breast imaging examinations preferentially before vaccination or at least 12 weeks after the last vaccine dose; (4) in patients with newly diagnosed breast cancer, apply standard imaging protocols regardless of vaccination status; (5) in any case of symptomatic or imaging-detected axillary lymphadenopathy before vaccination or at least 12 weeks after, examine with appropriate imaging the contralateral axilla and both breasts to exclude malignancy; (6) in case of axillary lymphadenopathy contralateral to the vaccination side, perform standard work-up; (7) in patients without breast cancer history and no suspicious breast imaging findings, lymphadenopathy only ipsilateral to the vaccination side within 12 weeks after vaccination can be considered benign or probably-benign, depending on clinical context; (8) in patients without breast cancer history, post-vaccination lymphadenopathy coupled with suspicious breast finding requires standard work-up, including biopsy when appropriate; (9) in patients with breast cancer history, interpret and manage post-vaccination lymphadenopathy considering the timeframe from vaccination and overall nodal metastatic risk; (10) complex or unclear cases should be managed by the multidisciplinary team

Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging

Abstract: We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as “high-risk” or B3 lesions). Finally, seven frequently asked questions are answered

Développement et validation d'un modèle d'interprétation en IRM pelvienne pour caractériser une masse annexielle complexe

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Apport de l IRM fonctionnelle pour la caractérisation des masses annexielles

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Impact de l'IRM mammaire en Sénologie en 2011 (intérêt de l'IRM en cas de Bilan Conentionnel Non Concluant)

Le cancer du sein est un enjeu majeur de santé publique, puisqu'une femme sur huit sera concernée au cours de sa vie. De nombreuses techniques d'imagerie peuvent être utilisées mais certaines questions restent en suspens. Quel est l'impact de l'IRM dans la prise en charge des patients et quel est la place de l'IRM en cas de bilan conventionnel non concluant ? Matériels et méthodes Dans un premier temps, l'analyse rétrospective de 422 IRM mammaires consécutives pratiquées à l'hôpital Tenon entre le 01/01 et le 31/12/2008 a concerné par indication, le classement ACR de l'IRM, la VPP de malignité des prélèvements percutanés et l'impact de l'IRM sur la prise en charge des patientes. Ces données ont été comparées à une population similaire de 428 patientes étudiée en IRM au CHU de Montréal, la même année.Dans un second temps, 66 patientes explorées en IRM à l'hôpital Tenon entre le 01/01/2008 et le 30/06/2009 pour anomalie mammographique visible sur une incidence sans traduction clinique ou échographique ont été étudiées. Le Gold standard était l'analyse anatomopathologique obtenue par chirurgie pour les lésions malignes. La preuve histologique était obtenue par biopsie et suivi de 2 ans voire par un suivi de 2 ans pour les lésions bénignes. Résultats A l'hôpital Tenon, les IRM étaient classées ACR I ou II dans 62.8%, ACR III dans 11% et ACR IV ou V dans 26.2%. La VPP de malignité était de 35.2%. L'IRM avait un impact contributif dans 23.6%. un impact délétère dans 28% et enfin, l'IRM n'avait aucun impact sur la prise en charge des patientes dans 48.4%. Concernant les HM pratiquées pour anomalie mammographique visible sur une incidence sans traduction clinique ou échographique, la sensibilité, la spécificité, la valeur prédictive positive, la valeur prédictive négative et la performance diagnostique étaient de 100%, 79.1%, 44.4%, 100%, 82.1%. Dans 12.5%, un cancer, diagnostiqué par l'IRM, était responsable de l'anomalie mammographique. Aucun cancer n'a été manqué après deux ans de suivi. Conclusion L'IRM mammaire est utile à la prise en charge des patientes, lorsqu'elle est pratiquée dans certaines indications. Son utilisation n'est pas encore validée en cas de bilan conventionnel non concluant mais il semblerait qu'elle permette, grâce à sa forte valeur prédictive négative, de surseoir à une surveillance inutile voire d'éviter la réalisation de prélèvements percutanés dans cette indication.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF