5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;47:604-620.

Distinctive MR imaging features of GAS were infiltrating mass of endophytic growth, location in the upper cervical canal, and association with tiny cysts. This characteristic appearance can be a clue for the evaluation of extent of tumor based on MR imaging.

Historically, cancer treatment has emphasized measures for the “cure” regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of Magnetic Resonance Imaging (MRI) in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.

PURPOSE To determine if radiomic measures of tumor heterogeneity derived from baseline contrast-enhanced computed tomography (CE-CT) are associated with durable clinical benefit and time to off-treatment in patients with recurrent ovarian cancer (OC) enrolled in prospective immunotherapeutic trials. MATERIALS AND METHODS This retrospective study included 75 patients with recurrent OC who were enrolled in prospective immunotherapeutic trials (n = 74) or treated off-label (n = 1) and had baseline CE-CT scans. Disease burden (total tumor volume, number of disease sites), radiomic measures of intertumor heterogeneity (cluster-site entropy, cluster-site dissimilarity), and intratumor heterogeneity of the largest lesion (Haralick texture features) were computed. Associations of clinical, conventional imaging, and radiomic measures with durable clinical benefit and time to off-treatment were examined. RESULTS In univariable analysis, fewer disease sites, lower intertumor heterogeneity (lower cluster-site entropy, lower cluster-site dissimilarity), and lower intratumor heterogeneity of the largest lesion (higher energy) were significantly associated with durable clinical benefit ( P ≤ .031). More disease sites, presence of pleural disease and/or distant metastases, higher intertumor heterogeneity (higher cluster-site entropy, higher cluster-site dissimilarity), and higher intratumor heterogeneity of the largest lesion (higher Contrastlargest-lesion) were significantly associated with shorter time to off-treatment ( P ≤ .034). In multivariable analysis, higher Energylargest-lesion (indicator of lower intratumor heterogeneity; P = .006; odds ratio, 1.41) and fewer disease sites ( P = .003; odds ratio, 1.64) remained significant indicators of durable clinical benefit (multivariable model C-index, 0.821). Higher cluster-site dissimilarity (indicator of higher intertumor heterogeneity) was a modest but single independent indicator of shorter time to off-treatment ( P = .004; hazard ratio, 1.19; C-index, 0.6). CONCLUSION Fewer disease sites and lower intra- and intertumor heterogeneity modeled from the baseline CE-CT may indicate better response of OC to immunotherapy.

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Purpose:To evaluate the feasibility of computed diffusion weighted imaging (DWI) in cervical cancer and investigate the optimal b-value using computed DWI.Methods:The present retrospective study involved 85 patients with cervical cancer in the International Federation of Gynecology and Obstetrics (FIGO) stage IB, IIA or IIB. DWI was obtained with b-values of 0, 100, 500 and 1000 s/mm2. Computed DWI with b-values of 800, 1000, 1300, 1600 and 2000 s/mm2 (cDWI800, cDWI1000, cDWI1300, cDWI1600, cDWI2000) were generated from all measured DWI (mDWI) data. Qualitatively, computed DWI was evaluated in terms of tumor conspicuity, signal suppression of the fat in the imaged area and total image quality by two radiologists independently with reference to mDWI with b-value of 1000 s/mm2. The b-value at which the signal of the endocervical canal was suppressed was recorded. Quantitatively, the signal intensities of tumor, myometrium, endocervical canal, endometrium, and gluteal subcutaneous fat were measured and represented as contrast ratios (CR).Results:Regarding tumor conspicuity and total image quality, significantly higher scores were obtained at cDWI1300 and cDWI1600 compared to the others (post-hoc comparison, P < 0.001), except for the total image quality between cDWI1000 and cDWI1600 in one reader. Signal suppression of the fat was the worst at cDWI2000. The signal intensity of the endocervical canal was suppressed in 24/27 cases on cDWI1600 and in 26/27 cases on cDWI2000. The CRs of tumor to myometrium, cervix, and endometrium increased with higher b-values, while the CRs of tumor to fat decreased and were statistically significant (post-hoc comparison, P < 0.001).Conclusion:Computed DWI with the b-values of 1300 and 1600 would be suitable for the evaluation of cervical cancer due to good tumor conspicuity.

Early TVRR, Ve, and the change of Ve could be useful predictors for the treatment effectiveness of NACT. These parameters could help to modify strategy in the early stage of NACT and to choose individualized treatment to avoid the delay of radical treatment, even when NACT is ineffective.