Patients with high-grade serous ovarian cancer suffer poor prognosis and variable response to treatment. Known prognostic factors for this disease include homologous recombination deficiency status, age, pathological stage and residual disease status after debulking surgery. Recent work has highlighted important prognostic information captured in computed tomography and histopathological specimens, which can be exploited through machine learning. However, little is known about the capacity of combining features from these disparate sources to improve prediction of treatment response. Here, we assembled a multimodal dataset of 444 patients with primarily late-stage high-grade serous ovarian cancer and discovered quantitative features, such as tumor nuclear size on staining with hematoxylin and eosin and omental texture on contrast-enhanced computed tomography, associated with prognosis. We found that these features contributed complementary prognostic information relative to one another and clinicogenomic features. By fusing histopathological, radiologic and clinicogenomic machine-learning models, we demonstrate a promising path toward improved risk stratification of patients with cancer through multimodal data integration.

A key advantage of cardiac magnetic resonance (CMR) imaging over other cardiac imaging modalities is the ability to perform detailed tissue characterization. CMR techniques continue to evolve, with advanced imaging sequences being developed to provide a reproducible, quantitative method of tissue interrogation. The T 1 mapping technique, a pixel-by-pixel method of quantifying T 1 relaxation time of soft tissues, has been shown to be promising for characterization of diseased myocardium in a wide variety of cardiomyopathies. In this review, we describe the basic principles and common techniques for T 1 mapping and its use for native T 1 , postcontrast T 1 , and extracellular volume mapping. We will review a wide range of clinical applications of the technique that can be used for identification and quantification of myocardial edema, fibrosis, and infiltrative diseases with illustrative clinical examples. In addition, we will explore the current limitations of the technique and describe some areas of ongoing development. Level of Evidence: 5 Technical Efficacy: Stage 2

Background Standard‐of‐care time‐of‐flight (TOF) techniques for nonenhanced magnetic resonance angiography (NEMRA) of the carotid bifurcation and other cervical arteries often provide nondiagnostic image quality due to motion and flow artifacts. Purpose To perform an initial evaluation of an ungated radial quiescent‐interval slice‐selective (QISS) technique for NEMRA of the neck, in comparison with 2D TOF and contrast‐enhanced magnetic resonance angiography (CEMRA). Study Type Retrospective. Population Sixty patients referred for neck MR angiography. Field Strength/Sequence Ungated radial QISS at 3T. Assessment Three radiologists scored image quality of 18 arterial segments using a 4‐point scale (1, nondiagnostic; 2, fair; 3, good; 4, excellent), and two radiologists graded proximal internal carotid stenosis using five categories (<50%, 50–69%, 70–99%, occlusion, nondiagnostic). Statistical Tests Friedman tests with post‐hoc Wilcoxon signed‐rank tests; unweighted Gwet's AC1 statistic; tests for equality of proportions. Results Ungated radial QISS provided image quality that significantly exceeded 2D TOF (mean scores of 2.7 vs. 2.0, 2.7 vs. 2.2, and 2.9 vs. 2.3; P < 0.001, all comparisons), while CEMRA provided the best image quality (mean scores of 3.6, 3.7, and 3.5 for the three reviewers). Interrater agreement of image quality scores was substantial for CEMRA (AC1 = 0.70, P < 0.001), and moderate for QISS (AC1 = 0.43, P < 0.001) and TOF (AC1 = 0.41, P < 0.001). Compared with TOF, QISS NEMRA provided a significantly higher percentage of diagnostic segments for all three reviewers (91.0% vs. 71.7%, 93.5% vs. 72.9%, 95.5% vs. 85.2%; P < 0.0001) and demonstrated better agreement with CEMRA for grading of proximal internal carotid stenosis (AC1 = 0.94 vs. 0.73 for reviewer 1, P < 0.05; AC1 = 0.89 vs. 0.68 for reviewer 2, P < 0.05). Data Conclusion In this initial study, ungated radial QISS significantly outperformed 2D TOF for the evaluation of the neck arteries, with overall better image quality and more diagnostic arterial segments, and improved agreement with CEMRA for grading stenosis of the proximal internal carotid artery. Level of Evidence: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1798–1807.

Peritoneal cancers traditionally have been associated with significant morbidity and universal mortality; however, the management of such cancers has evolved substantially. Advanced treatment options, including cytoreductive surgery and intraperitoneal chemotherapy, are associated with significantly improved long-term patient survival. To ensure that patients benefit from aggressive multimodality treatments, the radiologist plays a pivotal role in the multidisciplinary team to ensure careful patient selection, identifying individuals with resectable disease for whom complete cytoreduction can be achieved.

Increasing maximum diameter of the whole lesion (ground glass and solid component) on CT was significantly associated with invasiveness (p = .003), as was the maximum pathologic specimen diameter (p = .008). Larger diameter of the solid component on CT was also found in lepidic predominant adenocarcinoma compared to minimally invasive adenocarcinoma (median 10.5 vs 2 mm, p = .005). More invasive tumors had higher visual estimated percentage solid component compared to whole lesion measurement on CT (p = .014). CT and pathologic measurements were positively correlated, although only moderately (ρ = .66) for the maximum whole lesion size and fair (ρ = .49) for solid/invasive component maximum measurements. Larger whole lesion size and solid component size of lepidic predominant pattern adenocarcinomas are associated with lesion invasiveness, although radiologic and pathologic lesion measurements are only fair-moderately positively correlated.

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This preliminary analysis of resected ICC suggests associations between CT imaging features and OS and DFS. No association was identified between imaging features and currently known genetic pathways.

PurposeNoncontrast MRA avoids potential risks from gadolinium‐based contrast agents. A 2D noncontrast technique, quiescent interval slice‐selective (QISS), accurately evaluates the peripheral arteries but has limited spatial resolution along the slice direction. We therefore implemented a prototype thin‐slab stack‐of‐stars version (tsSOS‐QISS) with nearly isotropic spatial resolution and tested it in the renal and peripheral arteries of healthy subjects and patients with vascular disease.MethodsThe study was approved by the hospital institutional review board. A total of 16 subjects were scanned at 1.5 T: 7 for imaging of the renal arteries and 9 for imaging of the peripheral arteries. For tsSOS‐QISS of the renal arteries, each slab consisted of about sixteen 1.3‐mm‐thick or 2.0‐mm‐thick slices (interpolated to thirty‐two 0.65‐mm‐thick or 1.0‐mm‐thick 3D partitions) oriented in an oblique axial or oblique coronal view along the length of the target vessel and was acquired in a breath‐hold. For tsSOS‐QISS of the peripheral arteries, 20 axial overlapping thin slabs were typically acquired, each with twelve 1.3‐mm‐thick slices (interpolated to twenty‐four 0.65‐mm‐thick 3D partitions). Image quality, vessel sharpness in multiplanar reconstructions, and normalized SNR were measured.ResultsImage quality and normalized SNR in the renal and peripheral arteries were significantly better compared with 2D QISS acquired at the same spatial resolution, while vessel sharpness was improved in multiplanar reconstructions of the renal arteries.ConclusionThe tsSOS‐QISS technique overcomes a significant limitation of 2D QISS by providing nearly isotropic spatial resolution with improved image quality, normalized SNR, and vessel sharpness in multiplanar reconstructions.