Penelope Moyle

Evaluation of Depth of Myometrial Invasion and Overall Staging in Endometrial Cancer: Comparison of Diffusion-weighted and Dynamic Contrast-enhanced MR Imaging

PURPOSE To compare the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging with that of dynamic contrast material-enhanced (DCE) MR imaging in evaluating the depth of myometrial invasion and overall stage in patients with endometrial cancer. MATERIALS AND METHODS The institutional review board approved this retrospective study; patient consent was not required. From May 2008 to February 2010, 48 women with endometrial cancer underwent preoperative MR imaging, including T1- and T2-weighted imaging, DW MR imaging (b=0 and 800 sec/mm2) and DCE MR imaging. Two radiologists independently interpreted the depth of myometrial invasion, overall stage, and presence of pitfalls associated with inaccurate assessment of myometrial invasion at T1- and T2-weighted imaging, DW MR imaging, and DCE MR imaging. Myometrial invasion and overall stage were compared by using the McNemar test, and κ statistics were used for reader agreement. RESULTS For assessing the depth of myometrial invasion, diagnostic accuracy, sensitivity, and specificity, respectively, were as follows: DW MR imaging-reader 1, 90%, 84%, and 100%; reader 2, 85%, 84%, and 88%; DCE MR imaging-reader 1, 71%, 61%, and 88%; reader 2, 79%, 77%, and 82%. The improvement in diagnostic accuracy for reader 1 was significant (P=.035). For myometrial invasion, κ values were 0.75 with DW MR imaging and 0.26 with DCE MR imaging. There was no association between inaccurate assessment of myometrial invasion and standard pitfalls with DW MR imaging. Readers 1 and 2 correctly staged more patients by using DW MR imaging (39 and 38 patients, respectively) than by using DCE MR imaging (29 and 30 patients, respectively) (P<.05). For overall stage, κ values were 0.74 with DW MR imaging and 0.22 with DCE MR imaging. CONCLUSION DW MR imaging has superior diagnostic accuracy in the assessment of myometrial invasion and significantly higher staging accuracy compared with DCE MR imaging.

Pelvic Imaging Following Chemotherapy and Radiation Therapy for Gynecologic Malignancies

Gynecologic malignancies account for 10%-15% of all malignancies in females. A variety of oncologic options are available depending on organ of origin, histologic diagnosis, and disease grade and stage. Gynecologic malignancies are usually treated with surgery, chemotherapy, or radiation therapy. Posttreatment imaging plays a crucial role in the assessment of treatment response and tumor recurrence. Imaging of the female pelvis following chemotherapy and radiation therapy is particularly challenging due to alteration of the normal anatomy and loss of tissue planes. Expected changes in appearance occur following chemotherapy-radiation therapy, as do complications such as fistulas, proctitis, enteritis, typhlitis, cystitis, and insufficiency fractures. Radiologists should be familiar with both the expected posttreatment imaging findings and the imaging features of common complications to help make the correct interpretation and avoid possible pitfalls.

Exploratory Analysis of TP53 Mutations in Circulating Tumour DNA as Biomarkers of Treatment Response for Patients with Relapsed High-Grade Serous Ovarian Carcinoma: A Retrospective Study

Background Circulating tumour DNA (ctDNA) carrying tumour-specific sequence alterations may provide a minimally invasive means to dynamically assess tumour burden and response to treatment in cancer patients. Somatic TP53 mutations are a defining feature of high-grade serous ovarian carcinoma (HGSOC). We tested whether these mutations could be used as personalised markers to monitor tumour burden and early changes as a predictor of response and time to progression (TTP). Methods and Findings We performed a retrospective analysis of serial plasma samples collected during routine clinical visits from 40 patients with HGSOC undergoing heterogeneous standard of care treatment. Patient-specific TP53 assays were developed for 31 unique mutations identified in formalin-fixed paraffin-embedded tumour DNA from these patients. These assays were used to quantify ctDNA in 318 plasma samples using microfluidic digital PCR. The TP53 mutant allele fraction (TP53MAF) was compared to serum CA-125, the current gold-standard response marker for HGSOC in blood, as well as to disease volume on computed tomography scans by volumetric analysis. Changes after one cycle of treatment were compared with TTP. The median TP53MAF prior to treatment in 51 relapsed treatment courses was 8% (interquartile range [IQR] 1.2%–22%) compared to 0.7% (IQR 0.3%–2.0%) for seven untreated newly diagnosed stage IIIC/IV patients. TP53MAF correlated with volumetric measurements (Pearson r = 0.59, p < 0.001), and this correlation improved when patients with ascites were excluded (r = 0.82). The ratio of TP53MAF to volume of disease was higher in relapsed patients (0.04% per cm3) than in untreated patients (0.0008% per cm3, p = 0.004). In nearly all relapsed patients with disease volume > 32 cm3, ctDNA was detected at ≥20 amplifiable copies per millilitre of plasma. In 49 treatment courses for relapsed disease, pre-treatment TP53MAF concentration, but not CA-125, was associated with TTP. Response to chemotherapy was seen earlier with ctDNA, with a median time to nadir of 37 d (IQR 28–54) compared with a median time to nadir of 84 d (IQR 42–116) for CA-125. In 32 relapsed treatment courses evaluable for response after one cycle of chemotherapy, a decrease in TP53MAF of >60% was an independent predictor of TTP in multivariable analysis (hazard ratio 0.22, 95% CI 0.07–0.67, p = 0.008). Conversely, a decrease in TP53MAF of ≤60% was associated with poor response and identified cases with TTP < 6 mo with 71% sensitivity (95% CI 42%–92%) and 88% specificity (95% CI 64%–99%). Specificity was improved when patients with recent drainage of ascites were excluded. Ascites drainage led to a reduction of TP53MAF concentration. The limitations of this study include retrospective design, small sample size, and heterogeneity of treatment within the cohort. Conclusions In this retrospective study, we demonstrated that ctDNA is correlated with volume of disease at the start of treatment in women with HGSOC and that a decrease of ≤60% in TP53MAF after one cycle of chemotherapy was associated with shorter TTP. These results provide evidence that ctDNA has the potential to be a highly specific early molecular response marker in HGSOC and warrants further investigation in larger cohorts receiving uniform treatment.

T1-weighted fat-suppressed imaging of the pelvis with a dual-echo Dixon technique: initial clinical experience.

PURPOSE To compare the image quality of water-only images generated from a dual-echo Dixon technique with that of standard fast spin-echo T1-weighted chemical shift fat-suppressed images obtained in patients evaluated for pelvic pain with a 1.5-T magnetic resonance (MR) system. MATERIALS AND METHODS The ethics board granted approval for this retrospective study; patient consent was not required. Twenty-five women underwent both standard axial T1-weighted fast spin-echo chemical shift fat-suppressed imaging and dual-echo Dixon imaging of the pelvis. Two readers independently scored the acquisitions for image quality, fat suppression quality, and artifact. On the basis of signal intensity measurements, the uniformity of fat suppression, the contrast between fat-suppressed and non-fat-suppressed tissue, and the contrast between pathologic lesions and suppressed fat were calculated. Values obtained with the T1-weighted fat-suppressed and dual-echo Dixon techniques were compared by using the Wilcoxon signed rank test. RESULTS The images generated with the dual-echo Dixon technique were of higher quality, had better fat suppression, and had less artifact (qualitative scores: 4.4, 4.6, and 4.0, respectively) compared with the standard T1-weighted fat-suppressed images (qualitative scores: 3.4, 3.3, and 3.6, respectively; P < .01). Contrast between fat-suppressed and non-fat-suppressed tissue (contrast ratio: 0.86 for dual-echo Dixon technique vs 0.42 for T1-weighted fat-suppressed technique, P < .001) and between pathologic lesions and suppressed fat (contrast ratio: 0.88 for dual-echo Dixon technique vs 0.57 for T1-weighted fat-suppressed technique, P =.012) was significantly improved with the dual-echo Dixon technique. Twelve pathologic lesions were identified with dual-echo Dixon imaging versus eight that were identified with T1-weighted fat-suppressed imaging. CONCLUSION Compared with standard T1-weighted fat-suppressed imaging, dual-echo Dixon imaging facilitates improved image quality of fat-suppressed images of the pelvis, enabling better delineation of pathologic lesions.

Radiological Staging of Ovarian Carcinoma

Ovarian cancer is the sixth most commonly diagnosed cancer in the world, accounting for 4% of all female cancers. An estimated 1 in 71 women in the United States will develop ovarian cancer in their lifetime. Accurate staging of ovarian carcinoma is vital in the appropriate management and counseling of patients. The surgical staging proposed by the International Federation of Obstetrics and Gynaecology is the most universally used, and International Federation of Obstetrics and Gynaecology encourages the use of imaging techniques to assess prognostic factors, such as resectable disease and lymph node status. Identifying the volume and locations of tumor is valuable in planning percutaneous tissue biopsy, triaging patients to either primary cytoreductive surgery, or primary platinum-based chemotherapy. Contrast-enhanced computed tomography is the modality of choice for the staging of ovarian carcinoma, with magnetic resonance imaging being used as a problem-solving tool. In this article we discuss and illustrate the staging of ovarian carcinoma, with emphasis on the current imaging modalities and optimal image acquisition.

Diffusion-weighted imaging in gynaecological malignancy

Diffusion weighted imaging (DWI) has become an essential part of the gynaecological magnetic resonance imaging (MRI) protocol. DWI is used as an adjunct to conventional MRI sequences and has been shown to improve reporting accuracy in the imaging of gynaecological malignancy. In this review, we discuss the role of DWI in the diagnosis, staging, and assessment of treatment response of endometrial, cervical, and ovarian cancer. We also review the role of DWI in the assessment of the sonographically indeterminate ovarian lesion. Further, we highlight potential pitfalls that can beset the accurate interpretation of DWI in patients with gynaecological malignancy.

Retracted: Magnetic resonance imaging of uterine abnormalities

•  Congenital uterine abnormalities are a diverse and complex group of conditions which can cause anxiety and psychological distress because of infertility or issues with sexual identity. •  Magnetic resonance imaging (MRI) is the most accurate technique for the study of the anatomy of the female pelvis and the method of choice for evaluation of congenital uterine anomalies. •  MRI allows detailed anatomical mapping which is paramount in understanding patient management and for the planning of any surgical procedure aimed at re‐establishing normal anatomy and/or fertility in these challenging cases.

Optoacoustic Imaging Detects Hormone-Related Physiological Changes of Breast Parenchyma

PURPOSE  Optoacoustic imaging with ultrasound (OPUS) can assess in-vivo perfusion/oxygenation through surrogate measures of oxy, deoxy and total hemoglobin content in tissues. The primary aim of our study was to evaluate the ability of OPUS to detect physiological changes in the breast during the menstrual cycle and to determine qualitative/quantitative metrics of normal parenchymal tissue in pre-/post-menopausal women. The secondary aim was to assess the techniques repeatability. MATERIALS AND METHODS  We performed a prospective ethically approved study in volunteers using OPUS (700, 800 and 850 nm wavelengths) in the proliferative/follicular and secretory phase of the menstrual cycle. Regions of interest (ROIs) were drawn on the most superficial region of fibroglandular tissue and same-day intra-observer repeatability was assessed. We used t-tests to interrogate differences in the OPUS measurements due to hormonal changes and interclass correlation coefficients/Bland-Altman plots to evaluate the repeatability of mean ROI signal intensities. RESULTS  22 pre-menopausal and 8 post-menopausal volunteers were recruited. 21 participants underwent repeatability examinations. OPUS intensity values were significantly higher (p < 0.0001) at all excitation wavelengths in the secretory compared to the proliferative/follicular phase. Post-menopausal volunteers showed similar optoacoustic values to the proliferative/follicular phase of pre-menopausal volunteers. The repeatability of the technique was comparable to other handheld ultrasound modalities. CONCLUSION  OPUS detects changes in perfusion/vascularity related to the menstrual cycle and menopausal status of breast parenchyma.

Imaging benign gynaecological conditions

Abstract Radiology continues to play an essential role in the management of benign gynaecological conditions. Multiple imaging modalities are utilised to investigate benign conditions: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities and their recommended roles in the imaging benign gynaecological conditions. The imaging findings of common benign female pelvic pathology are discussed and illustrated.