The diagnostic value of multimodality MRI in endometrial carcinoma staging.

Background Multimodality magnetic resonance imaging (MRI) is an imaging technology that is used to integrate the structural and functional information of lesions. MRI can determine the staging of endometrial carcinoma, provide guidance for selection of surgical treatment and postoperative prognostic assessment, and has an important role in improving the survival of patients with endometrial carcinoma. Purpose To evaluate multimodality MRI staging accuracy for endometrial carcinoma based on the International Federation of Gynecology and Obstetrics (FIGO 2009) staging system. Material and Methods This is a retrospective study of the complete clinical and surgical pathology data from 83 patients with endometrial carcinoma treated between June 2011 and August 2015. Using a blind design, the preoperative clinical staging according to the current FIGO2009 MRI-based staging for each endometrial carcinoma was analyzed and corrected by postoperative histopathological results, which served as the staging standard. The role of multimodality MRI on clinical staging accuracy for endometrial carcinoma was studied. Results Based on the pathological evaluation after surgery, the 83 endometrial carcinoma patients were staged according to the current FIGO2009 staging criteria as: stage I, n = 56; stage II, n = 17; stage III, n = 7; and stage IV, n = 3. The multimodality MRI staging accuracy for endometrial carcinoma stages I-IV by FIGO2009 were 91.6% (76/83), 91.6% (76/83), 92.8% (77/83), and 97.6% (81/83), respectively. Conclusion Multimodality MRI is an important imaging tool in the pre-operative clinical staging of endometrial carcinoma. The current FIGO staging system appears to be a concise, reasonable, and practical set of criteria for the clinical management of endometrial carcinoma.

Application of Virtual Navigation with Multimodality Image Fusion in Foramen Ovale Cannulation.

OBJECTIVE: Idiopathic trigeminal neuralgia (ITN) can be effectively treated with radiofrequency thermocoagulation. However, this procedure requires cannulation of the foramen ovale, and conventional cannulation methods are associated with high failure rates. Multimodality imaging can improve the accuracy of cannulation because each imaging method can compensate for the drawbacks of the other. We aim to determine the feasibility and accuracy of percutaneous foramen ovale cannulation under the guidance of virtual navigation with multimodality image fusion in a self-designed anatomical model of human cadaveric heads. DESIGN: Five cadaveric head specimens were investigated in this study. Spiral computed tomography (CT) scanning clearly displayed the foramen ovale in all five specimens (10 foramina), which could not be visualized using two-dimensional ultrasound alone. The ultrasound and spiral CT images were fused, and percutaneous cannulation of the foramen ovale was performed under virtual navigation. After this, spiral CT scanning was immediately repeated to confirm the accuracy of the cannulation. RESULTS: Postprocedural spiral CT confirmed that the ultrasound and CT images had been successfully fused for all 10 foramina, which were accurately and successfully cannulated. The success rates of both image fusion and cannulation were 100%. CONCLUSIONS: Virtual navigation with multimodality image fusion can substantially facilitate foramen ovale cannulation and is worthy of clinical application.

Application of FLASH-3D dynamic contrast-enhanced imaging for diagnosis of endometrial carcinoma.

OBJECTIVE: To investigate the application and value of fast low-angle shot three-dimensional (FLASH-3D) dynamic contrast-enhanced MRI for the pre-operative staging of endometrial carcinoma. METHODS: This prospective study enrolled 48 patients with complete clinical data and pathologically confirmed endometrial carcinoma from July 2012 to March 2014. After routine MRI examination, subjects underwent FLASH-3D dynamic contrast-enhanced examination. The dynamically enhanced features of the uterine wall and tumours were analyzed. FLASH-3D pre-operative staging and findings in relation to myometrial invasion were compared with post-operative pathological results in a double-blind manner. RESULTS: There were 48 cases of pathologically proven endometrial carcinoma, including 34 patients with Stage I (Stage Ia 22 cases and Stage Ib 12 cases), 9 with Stage II, 3 with Stage III and 2 with Stage IV. The staging accuracy for endometrial carcinoma was 81% (39/48) using FLASH-3D dynamic contrast-enhanced sequences. The sensitivity, specificity and accuracy for the determination of deep myometrial invasion were 84%, 90% and 88%, respectively. There was no significant difference compared with the results of post-operative pathology (p > 0.05). CONCLUSION: FLASH-3D dynamic contrast-enhanced imaging may be valuable for the early diagnosis and pre-operative staging of endometrial carcinoma. Its high accuracy for assessing deep myometrial invasion makes FLASH-3D imaging an important tool for selecting the optimal therapeutic protocol and for prognosis estimation. ADVANCES IN KNOWLEDGE: FLASH-3D can significantly improve the accurate assessment of the depth of tumour invasion into the myometrium and may thus help to guide clinical surgical choices and post-operative evaluation. FLASH-3D is thus a promising technique for the routine examination of female pelvic tumours.

Diagnosis performance of positron emission tomography-computed tomography among cervical cancer patients.

OBJECTIVE: This study aims to investigate the value of PET/CT scanning in preoperative diagnosis of cervical carcinoma, especially for detecting lymph node metastasis. MATERIALS AND METHODS: The approval of the ethics committee which was granted by our hospital was obtained beforehand. Patients with CC were collected into this investigation between January 2011 and October 2015. Each participant received surgeries, as well as pelvic and paraaortic systematic lymph node dissection. After operations, CC types were confirmed by pathological examinations. The tumor stages were assessed by 3 experienced radiologists independently, according to FIGO examinations and positron emission tomography-computed tomography (PET/CT), and these above diagnostic results were compared with postoperative biopsy pathology, respectively. Statistical analysis was done by SPSS 16.0, and the diagnostic performance of PET/CT was calculated. RESULTS: 51 patients were identified in this investigation, and the mean age of these female individuals was 42.3±6.7 years (range, 34-58 years). Depending on statistical analysis, the staging accuracy of PET/CT to detect primary tumors was 84.31%, with sensitivity 88.00% and specificity 80.77%. With respect to lymph nodes, the accuracy could reach 76.47%, with sensitivity 82.61% and specificity 71.43%. On the other hand, FIGO staging performed poorly in detecting primary tumors, with sensitivity 44.12%, specificity 47.06% and accuracy 45.10%. In terms of testing lymph nodes, the diagnosis parameters were as followed, sensitivity 28.57%, specificity 8.70% and accuracy 19.61%. After statistical analysis, there was significantly different between two methods (P < 0.05). CONCLUSIONS: PET/CT scanning may be valuable in detecting primary tumors and lymph nodes, and more accurate staging may lead to improving therapeutic planning in CC patients.

[Value of magnetic resonance imaging in preoperative staging of endometrial carcinoma according to International Federation of Gynecology and Obstetrics (2009) staging criteria].

OBJECTIVE: To analyze the magnetic resonance imaging (MRI) features of endometrial carcinoma and their value in endometrial carcinoma staging according to the International Federation of Gynecology and Obstetrics (FIGO 2009) staging criteria. METHODS: Fifty-four patients with pathologically confirmed endometrial carcinoma and complete clinical data underwent preoperative MRI examination. According to FIGO 2009 staging criteria of endometrial carcinoma, the MRI features of the tumor lesions were evaluated for assessment of myometrial invasion and cervical involvement and preoperative staging. RESULTS: The 54 cases included 27 stage Ia cases, 9 stage Ib cases, 10 stage II cases, 5 stage III cases, and 3 stage IV cases. The total lesion display rate by MRI was 94% (51/54). With an isointensity or hypo-intensity on T1WI, the tumor lesions showed a moderate hyper-intensity on T2WI. In enhanced MRI scanning, the lesions showed a moderate heterogeneous enhancement, which had a lower intensity than the marked enhancement of the myometrium. Combination of T2WI and T1WI in fat suppression sequence enhanced scan had a diagnostic accuracy of 91% (49/54) for myometrial invasion, and the sensitivity, specificity and accuracy of MRI for detecting cervical involvement were 77%, 89%, and 83%, respectively. The accuracy of preoperative MRI-based staging of endometrial carcinoma was 89% (48/54), showing no significant difference from the results of postoperative FIGO 2009 staging and pathological examination (P>0.05). CONCLUSION: MRI has a high accuracy in the diagnosis, evaluation of myometrial and cervical invasion depth, and preoperative staging of endometrial carcinoma, and serves as an important modality in assisting clinical decisions on the optimal therapeutic protocols and in prognostic estimation.

[Diagnostic value of MRI in testicular tumor].

OBJECTIVE: To study the MRI manifestation of testicular tumor and the value of MRI in the diagnosis of the disease. METHODS: We retrospectively analyzed 23 cases of pathologically confirmed testicular tumor, and observed the morphological characteristics, signals and surrounding conditions of the tumor using plain and enhanced MRI scanning. RESULTS: Of the 23 cases, seminoma was identified in 7, mixed germinoma in 3, teratoma in 3, endodermal sinus tumor in 2, epidermoid in 1, Leydig cell tumor in 1, leucoma in 1, nonspecific inflammatory mass in 3, and tuberculosis in 2. MRI revealed the precise locations and specific characteristics of CONCLUSION: Based on MRI findings and clinical manifestation, most testicular tumors can be diagnosed correctly.