Adnexal Masses: Development and Preliminary Validation of an MR Imaging Scoring System

Thomassin‐Naggara, Isabelle; Aubert, Emilie; Rockall, Andrea; Jalaguier-Coudray, Aurélie; Rouzier, Roman; Daraı̈, Émile; Bazot, Marc

doi:10.1148/radiol.13121161

Cited by 185 publications

(195 citation statements)

References 34 publications

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“…Duvarında kalsifikasyon saptanabilir. MRG'de T1A da düşük-orta intensitede, T2A'da yüksek intensitede pür kist şeklinde olur, bazen küçük milimetrik papiller projeksiyonlar ve sıklıkla ince septa saptanabilir (Resim 6, 7) [14,16,17,25]. ise T1A kesitlerde daha hiperintens, T2A kesitlerde daha hipointens değişken intensitede buzlu cam-vitray görünümünde sinyal gös-terirler (Resim 12).…”

Section: Epiteliyal Tümörlerunclassified

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Over Tümörlerinde Görüntüleme

Pekindil¹

2015

Trd Sem

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Over tümörleri patolojik olarak epitelial (seröz, müsinöz, endometrioid, clear cell, Brenner), germ hücreli (Teratom, disgerminom, endodermal sinüs tümörü, embriyoner hücreli karsinom, koriokarsinom), seks-kord stromal tümörler (Granülosa, fibrotekoma, sklerozan stromal tümör, Sertoli-Leydig hücreli tümör, steroid hücre ve diğer) ve metastatik tümörler olmak üzere 4 ana grupta irdelenebilir. Over kitlelerinin değerlendirilmesinde ultrasonografi (US), bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) kullanılmakta olup, burada tanısal etkinlikleri ve bulguları anlatılacaktır.Yaklaşım: Kadın pelvisinde bir kitle tespit edildiğinde 3 soruya cevap verilmesi gerekir: 1. Gerçekten kitle mi? yalancı ya da normal görüntü mü? En bilineni US'de rektum gazının teratom zannedilmesi, ya da gaz zannedilerek atlanmasıdır. Fonksiyonel over kistleri de patoloji zannedilebilir. 2. Kitle adneksiyal mi değil mi? Overlerin ayrı-intakt görülmesi over dışı kitle lehine olmakla birlikte, büyük kitlelerde özellikle postmenopoz küçük overin görülmesi sorun olabilir. Ovarial venin seyrinin bulunarak pelvik kitleye girdiğinin gösterilmesi de kitlenin over kaynaklı olduğunu belirlemede yardımcı (pedikül işareti) olabilir (Resim 1) [1,2]. Ayrıca subseröz-saplı myomlar, T2 A hipointens fibrom gibi solid over kitleleri ile karışabilece-ğinden ayrımda ara yüz damar işaretinin MRG ve Doppler US bakıda gösterilmesi myom lehinedir (Resim 2). 3. Adneksiyel ise malign ya da benign mi? Önce US sonra da gerekirse MRG ile değerlendirilir. Malign ise BT ya da MRG ile evrelemeye ilişkin sorulara yanıt aranır.Ultrasonografi: Pratikte adneksiyel kitle şüpheli olgulara öncelikle pelvik US yapılır. Transvajinal US'nin sınırlı görüş alanı ve derinlik gibi dezavantajları nedeniyle, adneksiyel kitlenin iç yapısını ve küçük kitleleri daha iyi saptamak gibi avantajlarına rağmen, pelvik US'ye tercih edilip edilmeyeceği konusu net değildir. Transvajinal US ile adneksiyel kitlenin duvar, septa ve iç yapısı ile ekojenitesine dayanan skorlama sistemi ile benign-malign over kitle ayrımında duyarlılık %100, özgüllük %83 olarak belirlenmiştir [3]. US ile morfolojik analiz yaparak over tümörlerinde maligniteyi belirlemede %85-97 duyarlılık, %56-95 öz-

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Section: Epiteliyal Tümörlerunclassified

“…Ancak çalışmalar, evrelemede diğer yöntem-lerden üstün olduğunu göstermemekte olup, MRG'nin daha iyi olduğunu belirten çalışma-lar mevcuttur [2,11,14]. [14][15][16][17].…”

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Over Tümörlerinde Görüntüleme

Pekindil¹

2015

Trd Sem

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“…MRI examinations were performed after thorough pelvic examination. We included all women with adnexal masses for whom histologic results were available or who had been followed for at least 1 year (until February 2017), as proposed by Thomassin-Naggara et al (17). We also included women discharged from our oncology facility due to benign clinical findings, such as functional cysts, endometrioma or hydrosalpinx, and those whose adnexal masses had disappeared on follow-up examinations.…”

Section: Patientsmentioning

confidence: 99%

“…Gadolinium chelate (Omniscan, 0.2 mL/kg body weight; GE Healthcare®) was administered at a rate of 3.5 mL/s using a power injector (Medrad), followed by a 10 mL infusion of normal saline. In the postprocessing of images, regions of interest (ROI) were selected and qualitative criteria were performed for diffusion-weighted restriction, as proposed by Thomassin-Naggara et al (17), avoiding areas of necrosis. The postprocessing of the dynamic study included the absolute signal and the relative enhancement to build the dynamic curves.…”

Section: Mri Protocol and Evaluationmentioning

confidence: 99%

“…In an attempt to standardize imaging evaluation and reporting and to facilitate communication between gynecologists and radiologists, Thomassin-Naggara et al (17) published the MRI scoring system for adnexal lesions (ADNEX MR scoring system) in 2013. This protocol has a structure similar to that of the Breast Imaging Report Data System (BI-RADS™), with a sensitivity of 93.5% and specificity of 96.6% in the detection of malignant adnexal masses (17). However, one of the main parts of the protocol is the acquisition and post-processing of perfusion-weighted magnetic resonance images obtained by using a dynamic contrast-enhanced T1-weighted gradient-echo sequence.…”

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Untitled

2014

Diagn Interv Radiol

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PURPOSEWe aimed to evaluate the ADNEX MR scoring system for the prediction of adnexal mass malignancy, using a simplified magnetic resonance imaging (MRI) protocol. METHODSIn this prospective study, 200 patients with 237 adnexal masses underwent MRI between February 2014 and February 2016 and were followed until February 2017. Two radiologists calculated ADNEX MR scores using an MRI protocol with a simplified dynamic study, not a high temporal resolution study, as originally proposed. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the area under the receiver operating characteristic curve were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >12 months of follow-up. RESULTSOf 237 lesions, 79 (33.3%) were malignant. The ADNEX MR scoring system, using a simplified MRI protocol, showed 94.9% (95% confidence interval [CI], 87.5%-98.6%) sensitivity and 97.5% (95% CI, 93.6%-99.3%) specificity in malignancy prediction; it was thus highly accurate, like the original system. The level of interobserver agreement on simplified scoring was high (κ = 0.91). CONCLUSIONIn a tertiary cancer center, the ADNEX MR scoring system, even based on a simplified MRI protocol, performed well in the prediction of malignant adnexal masses. This scoring system may enable the standardization of MRI reporting on adnexal masses, thereby improving communication between radiologists and gynecologists.You may cite this article as: Pereira PN, Sarian LO, Yoshida A, et al. Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses. Diagn Interv Radiol 2018; 24:63-71. A dnexal masses are frequent findings in pelvic and abdominal imaging studies, such as those conducted with ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) (1). Preoperative evaluation of these lesions and determination of the risk of malignancy are critical to define treatment. A lesion with a low risk of malignancy can be followed or treated with minimally invasive surgery performed by a general gynecologist. When the risk of malignancy is significant, the patient should be referred to a tertiary center for treatment by a multidisciplinary team that includes an oncologic gynecologist (2, 3).Every year, about 240 000 women worldwide are diagnosed with ovarian cancer. The 5-year survival rate is less than 45%, and ovarian cancer is responsible for about 150 000 deaths annually. Thus, it is the seventh most common cancer and the eighth most common cause of cancer death among women (4).US is the first-line modality for the assessment of suspected adnexal masses, with very accurate results (5). However, US examination yields indeterminate findings in approximately 20% of adnexal masses (6-8). Exophytic and large tumors, fatty components, clots that mimic vegetation, and fibrous tumors have morphologic characteristics that are difficult to interpret with US. Other imaging methods (e...

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