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.

MRI- and Histologic-Molecular-Based Radio-Genomics Nomogram for Preoperative Assessment of Risk Classes in Endometrial Cancer.

High- and low-risk endometrial carcinoma (EC) differ in whether or not a lymphadenectomy is performed. We aimed to develop MRI-based radio-genomic models able to preoperatively assess lymph-vascular space invasion (LVSI) and discriminate between low- and high-risk EC according to the ESMO-ESGO-ESTRO 2020 guidelines, which include molecular risk classification proposed by "ProMisE". This is a retrospective, multicentric study that included 64 women with EC who underwent 3T-MRI before a hysterectomy. Radiomics features were extracted from T2WI images and apparent diffusion coefficient maps (ADC) after manual segmentation of the gross tumor volume. We constructed a multiple logistic regression approach from the most relevant radiomic features to distinguish between low- and high-risk classes under the ESMO-ESGO-ESTRO 2020 guidelines. A similar approach was taken to assess LVSI. Model diagnostic performance was assessed via ROC curves, accuracy, sensitivity and specificity on training and test sets. The LVSI predictive model used a single feature from ADC as a predictor; the risk class model used two features as predictors from both ADC and T2WI. The low-risk predictive model showed an AUC of 0.74 with an accuracy, sensitivity, and specificity of 0.74, 0.76, 0.94; the LVSI model showed an AUC of 0.59 with an accuracy, sensitivity, and specificity of 0.60, 0.50, 0.61. MRI-based radio-genomic models are useful for preoperative EC risk stratification and may facilitate therapeutic management.

Human placental microperfusion and microstructural assessment by intra-voxel incoherent motion MRI for discriminating intrauterine growth restriction: a pilot study.

OBJECTIVES: To evaluate the potential of Intravoxel Incoherent Motion (IVIM) Imaging in the quantification of placental micro-perfusion and microstructural features to identify and discriminate different forms of intrauterine growth restriction (IUGR) and normal fetuses pregnancies. METHODS: Small for gestational age SGA (n = 8), fetal growth restriction FGR (n = 10), and normal (n = 49) pregnancies were included in the study. Placental Magnetic Resonance Imaging (MRI) was performed at 1.5 T using a diffusion-weighted sequence with 10 b-values. IVIM fractional perfusion (fp), diffusion (D), and pseudodiffusion (D*) were evaluated on the fetal and maternal placental sides. Correlations between IVIM parameters, Gestational Age (GA), Birth Weight (BW), and the presence or absence of prenatal fetoplacental Doppler abnormalities at the US were investigated in SGA, FGR, and normal placentae. RESULTS: fp and D* of the placental fetal side discriminate between SGA and FGR (p = .021; p = .036, respectively), showing lower values in FGR. SGA showed an intermediate perfusion pattern in terms of fp and D* compared to FGR and normal controls. In the intrauterine growth restriction group (SGA + FGR), a significant positive correlation was found between fp and BW (p < .002) in the fetal placenta and a significant negative correlation was found between D and GA in both the fetal (p < .0009) and maternal (p < .006) placentas. CONCLUSIONS: Perfusion IVIM parameters fp and D* may be useful to discriminate different micro-vascularization patterns in IUGR being helpful to detect microvascular subtle impairment even in fetuses without any sign of US Doppler impairment in utero. Moreover, fp may predict fetuses' body weight in intrauterine growth restriction pregnancies. The diffusion IVIM parameter D may reflect more rapid microstructural rearrangement of the placenta due to aging processes in the IUGR group than in normal controls.

Role of prenatal magnetic resonance imaging in fetuses with isolated severe ventriculomegaly at neurosonography: A multicenter study.

OBJECTIVE: The aim of this study was to report the rate of additional anomalies detected exclusively at prenatal magnetic resonance imaging (MRI) in fetuses with isolated severe ventriculomegaly undergoing neurosonography. METHOD: Multicenter, retrospective, cohort study involving 20 referral fetal medicine centers in Italy, United Kingdom, Spain and Denmark. Inclusion criteria were fetuses affected by isolated severe ventriculomegaly (≥15 mm), defined as ventriculomegaly with normal karyotype and no other additional central nervous system (CNS) and extra-CNS anomalies on ultrasound. In all cases, a multiplanar assessment of fetal brain as suggested by ISUOG guidelines on fetal neurosonography had been performed. The primary outcome was the rate of additional CNS anomalies detected exclusively at fetal MRI within two weeks from neurosonography. Subgroup analyses according to gestational age at MRI (

Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

Structured reporting systems for endometriotic disease are gaining a central role in diagnostic imaging: our aim is to evaluate applicability and the feasibility of the recent ENZIAN score (2020) assessed by MRI. A total of 60 patients with suspected tubo-ovarian/deep endometriosis were retrospectively included in our study according to the following criteria: availability of MR examination; histopathological results from laparoscopic or surgical treatment; patients were not assuming estro-progestin or progestin therapy. Three different readers (radiologists with 2-, 5-, and 20-years of experience in pelvic imaging) have separately assigned a score according to the ENZIAN score (revised 2020) for all lesions detected by magnetic resonance imaging (MRI). Our study showed a high interobserver agreement and feasibility of the recent ENZIAN score applied to MRI; on the other hand, our experience highlighted some limitations mainly due to MRI's inability to assess tubal patency and mobility, as required by the recent score (2020). In view of the limitations which arose from our study, we propose a modified MRI-ENZIAN score that provides a complete structured reporting system, more suitable for MRI. The high interobserver agreement of the recent ENZIAN score applied to MRI confirms its validity as a complete staging system for endometriosis, offering a shared language between radiologists and surgeons.

Magnetic Resonance Imaging in endometriosis-associated pain.

INTRODUCTION: Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. However, nowadays two different non-invasive modalities are routinely used for a presumptive diagnosis: Transvaginal Ultrasound (TVUS) and Magnetic Resonance Imaging (MRI). EVIDENCE ACQUISITION: A structured search using PubMed was performed starting from October 2020 and including all relevant original and review articles published since 2000. The search used the following key word combinations: "endometriosis MRI" AND "DIE and MRI" (45); "MRI endometriosis and pelvic pain" OR "endometriosis and MRI technical development" (296). Ultimately, 87 articles were deemed relevant and used as the literature basis of this review. EVIDENCE SYNTHESIS: TVUS represents the first imaging approach for endometriosis showing a good diagnostic performance, but it is highly operator dependent. MRI is a second level examination often used in complex cases indeterminate after TVUS and in preoperative planning. MRI is considered the best imaging technique for mapping endometriosis since it provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound. We have analyzed and described the main forms of endometriosis: adnexal endometriosis, adenomyosis, peritoneal implants and deep infiltrating endometriosis, showing their appearance in the two imaging modalities. CONCLUSIONS: Endometriosis is one of the most common gynecologic disorders correlated to chronic pelvic pain whose treatment is still today complex and controversial. In this context, MRI has become an important additional non-invasive tool to investigate cases of chronic pelvic pain related to deep infiltrating endometriosis (DIE) with or without neural involvement.

IntraVoxel Incoherent Motion (IVIM) MRI of fetal lung and kidney: Can the perfusion fraction be a marker of normal pulmonary and renal maturation?

PURPOSE: To investigate the use of IntraVoxel Incoherent Motion (IVIM) MRI in the study of microstructural tissue changes occurring in fetal lung and kidney during gestation. METHODS: 34 normal pregnancies were enrolled. Patients were divided into two groups based on gestational age (GA): group A (21-29 weeks) and group B (30-39 weeks). MR examinations were performed at 1.5T, with a standard fetal MR protocol including a Diffusion-Weighted Echo-Planar Imaging sequence with 10 different b-values (0, 10, 30, 50, 75, 100, 200, 400, 700, 1000s/mm2). For each fetus, two bilateral ROIs were manually placed in lung and renal parenchyma. Mean values of perfusion fraction f, pseudo-diffusion coefficient D* and diffusion coefficient D were obtained. The correlation between IVIM parameters and GA was investigated. RESULTS: In renal ROIs a positive correlation between fkidney and GA (p < 0.005) was found; similarly flung showed a statistically significant correlation with GA (p < 0.001). F mean values were significantly higher in group B compared to group A in both renal (p = 0.0002) and lung (p = 0.018) ROIs. No correlation was found in D and D* as a function of GA. CONCLUSIONS: The IVIM perfusion fraction f may be considered as a potential marker of pulmonary and renal maturation in relation to hemodynamic changes described in intrauterine life. Our results highlight that IVIM model is useful as an additional prenatal diagnostic tool to study lung and renal development.