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Purposes: This study investigates the clinical significance of the anterior parametrical invasion in surgically treated patients with cervical squamous cell carcinoma (SCC)., Methods: We included patients diagnosed with cervical SCC with local lesions classified as T2b, who were treated at our department between January 2006 and December 2020. We evaluated the degree of anterior invasion using pretreatment magnetic resonance imaging and divided patients into three groups: partial, equivocal, and full invasion. The frequency of recurrence within 3 years (early recurrence) and overall prognosis were assessed., Results: There were 12, 24, and 46 cases in the partial equivocal, and full invasion groups, respectively. Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy was the mainstay of treatment across all groups (7, 17, and 27 cases, respectively). Although the frequency of early recurrence tended to be worse in the full group (partial; 2/7 cases, equivocal; 3/17 cases and full; 9/27 cases), all early local recurrence cases in the full group (four cases) responded well to the subsequent treatment. As for overall survival, the full invasion group had the best prognosis among the three groups., Conclusions: In surgical treatment, although full anterior invasion may increase the risk of early local recurrence, it was considered to have little prognostic impact., (© 2024 Japan Society of Obstetrics and Gynecology.)

Purpose: Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhea. However, the MRI features are also similar in both disorders. They are ultimately diagnosed by chromosome testing, but there is a possibility of misdiagnosis if chromosome testing is not performed. This study aimed to identify MRI features that are useful for differentiating CAIS from MRKHS., Method: This multicenter retrospective study included 12 patients with CAIS and 19 patients with MRKHS. Three radiologists blindly evaluated the following features: (1) detection of vagina, (2) detection of nodular and cystic structures in the lateral pelvis; undescended testicles and paratesticular cysts in CAIS and rudimentary uteri and ovaries in MRKHS, (3) their location, (4) number of cysts in the cystic structures, and (5) signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values of the nodular structures. Statistical comparisons were performed using Mann-Whitney U and Fisher's exact tests., Results: Compared with MRKHS, the CAIS group showed significantly detectable vagina, more ventrally located nodular and cystic structures, fewer cysts within the cystic structures, and nodular structures with higher signal intensity on DWI and lower ADC values., Conclusions: MRI features of detectable vagina, location of nodular and cystic structures, number of cysts within the cystic structures, signal intensity on DWI and ADC values of the nodular structures were useful in differentiating CAIS from MRKHS., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Rationale and Objectives: To develop and validate a deep learning (DL) model to automatically diagnose muscle-invasive bladder cancer (MIBC) on MRI with Vision Transformer (ViT)., Materials and Methods: This multicenter retrospective study included patients with BC who reported to two institutions between January 2016 and June 2020 (training dataset) and a third institution between May 2017 and May 2022 (test dataset). The diagnostic model for MIBC and the segmentation model for BC on MRI were developed using the training dataset with 5-fold cross-validation. ViT- and convolutional neural network (CNN)-based diagnostic models were developed and compared for diagnostic performance using the area under the curve (AUC). The performance of the diagnostic model with manual and auto-generated regions of interest (ROI manual and ROI auto , respectively) was validated on the test dataset and compared to that of radiologists (three senior and three junior radiologists) using Vesical Imaging Reporting and Data System scoring., Results: The training and test datasets included 170 and 53 patients, respectively. Mean AUC of the top 10 ViT-based models with 5-fold cross-validation outperformed those of the CNN-based models (0.831 ± 0.003 vs. 0.713 ± 0.007-0.812 ± 0.006, p < .001). The diagnostic model with ROI manual achieved AUC of 0.872 (95 % CI: 0.777, 0.968), which was comparable to that of junior radiologists (AUC = 0.862, 0.873, and 0.930). Semi-automated diagnosis with the diagnostic model with ROI auto achieved AUC of 0.815 (95 % CI: 0.696, 0.935)., Conclusion: The DL model effectively diagnosed MIBC. The ViT-based model outperformed CNN-based models, highlighting its utility in medical image analysis., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yasuhisa Kurata reports financial support was provided by 10.13039/501100001691Japan Society for the Promotion of Science. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objectives: To build preoperative prediction models with and without MRI for regional lymph node metastasis (r-LNM, pelvic and/or para-aortic LNM (PENM/PANM)) and for PANM in endometrial cancer using established risk factors., Methods: In this retrospective two-center study, 364 patients with endometrial cancer were included: 253 in the model development and 111 in the external validation. For r-LNM and PANM, respectively, best subset regression with ten-time fivefold cross validation was conducted using ten established risk factors (4 clinical and 6 imaging factors). Models with the top 10 percentile of area under the curve (AUC) and with the fewest variables in the model development were subjected to the external validation (11 and 4 candidates, respectively, for r-LNM and PANM). Then, the models with the highest AUC were selected as the final models. Models without MRI findings were developed similarly, assuming the cases where MRI was not available., Results: The final r-LNM model consisted of pelvic lymph node (PEN) ≥ 6 mm, deep myometrial invasion (DMI) on MRI, CA125, para-aortic lymph node (PAN) ≥ 6 mm, and biopsy; PANM model consisted of DMI, PAN, PEN, and CA125 (in order of correlation coefficient β values). The AUCs were 0.85 (95%CI: 0.77-0.92) and 0.86 (0.75-0.94) for the external validation, respectively. The model without MRI for r-LNM and PANM showed AUC of 0.79 (0.68-0.89) and 0.87 (0.76-0.96), respectively., Conclusions: The prediction models created by best subset regression with cross validation showed high diagnostic performance for predicting LNM in endometrial cancer, which may avoid unnecessary lymphadenectomies., Clinical Relevance Statement: The prediction risks of lymph node metastasis (LNM) and para-aortic LNM can be easily obtained for all patients with endometrial cancer by inputting the conventional clinical information into our models. They help in the decision-making for optimal lymphadenectomy and personalized treatment., Key Points: •Diagnostic performance of lymph node metastases (LNM) in endometrial cancer is low based on size criteria and can be improved by combining with other clinical information. •The optimized logistic regression model for regional LNM consists of lymph node ≥ 6 mm, deep myometrial invasion, cancer antigen-125, and biopsy, showing high diagnostic performance. •Our model predicts the preoperative risk of LNM, which may avoid unnecessary lymphadenectomies., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

The staging of endometrial cancer is based on the International Federation of Gynecology and Obstetrics (FIGO) staging system according to the examination of surgical specimens, and has revised in 2023, 14 years after its last revision in 2009. Molecular and histological classification has incorporated to new FIGO system reflecting the biological behavior and prognosis of endometrial cancer. Nonetheless, the basic role of imaging modalities including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography, as a preoperative assessment of the tumor extension and also the evaluation points in CT and MRI imaging are not changed, other than several point of local tumor extension. In the field of radiology, it has also undergone remarkable advancement through the rapid progress of computational technology. The application of deep learning reconstruction techniques contributes the benefits of shorter acquisition time or higher quality. Radiomics, which extract various quantitative features from the images, is also expected to have the potential for the quantitative prediction of risk factors such as histological types and lymphovascular space invasion, which is newly included in the new FIGO system. This article reviews the preoperative imaging diagnosis in new FIGO system and recent advances in imaging analysis and their clinical contributions in endometrial cancer. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3., (© 2023 International Society for Magnetic Resonance in Medicine.)

This study aimed to develop a versatile automatic segmentation model of bladder cancer (BC) on MRI using a convolutional neural network and investigate the robustness of radiomics features automatically extracted from apparent diffusion coefficient (ADC) maps. This two-center retrospective study used multi-vendor MR units and included 170 patients with BC, of whom 140 were assigned to training datasets for the modified U-net model with five-fold cross-validation and 30 to test datasets for assessment of segmentation performance and reproducibility of automatically extracted radiomics features. For model input data, diffusion-weighted images with b = 0 and 1000 s/mm 2 , ADC maps, and multi-sequence images (b0-b1000-ADC maps) were used. Segmentation accuracy was compared between ours and existing models. The reproducibility of radiomics features on ADC maps was evaluated using intraclass correlation coefficient. The model with multi-sequence images achieved the highest Dice similarity coefficient (DSC) with five-fold cross-validation (mean DSC = 0.83 and 0.79 for the training and validation datasets, respectively). The median (interquartile range) DSC of the test dataset model was 0.81 (0.70-0.88). Radiomics features extracted from manually and automatically segmented BC exhibited good reproducibility. Thus, our U-net model performed highly accurate segmentation of BC, and radiomics features extracted from the automatic segmentation results exhibited high reproducibility., (© 2023. The Author(s).)

Background: Diagnosis of fetal growth restriction (FGR) entails difficulties with differentiating fetuses not fulfilling their growth potential because of pathologic conditions, such as placental insufficiency, from constitutionally small fetuses. The feasibility of placental MRI for risk stratification among pregnancies diagnosed with FGR remains unexplored., Purpose: To explore quantitative MRI features useful to identify pregnancies with unfavorable outcomes and to assess the diagnostic performance of visual analysis of MRI to detect pregnancies with unfavorable outcomes, among pregnancies diagnosed with FGR., Study Type: Retrospective., Population: Thirteen pregnancies with unfavorable outcomes (preterm emergency cesarean section or intrauterine fetal death) and 11 pregnancies with favorable outcomes performed MRI at gestational weeks 21-36., Field Strength/sequence: A 5-T, half-Fourier-acquired single-shot turbo spin echo (HASTE), spin-echo echo-planar imaging (SE-EPI) and T2 map derived from SE-EPI., Assessment: Placental size on HASTE sequences and T2 mapping-based histogram features were extracted. Three radiologists qualitatively evaluated the visibility of maternal cotyledon on HASTE and SE-EPI sequences with echo times (TEs) = 60, 90, and 120 msec using 3-point Likert scales: 0, absent; 1, equivocal; and 2, present., Statistical Tests: Welch's t-test or Mann-Whitney U test for quantitative features between the favorable and unfavorable outcome groups. Areas under the receiver operating curves (AUCs) of the three readers' visual analyses to detect pregnancies with unfavorable outcomes. A P value of <0.05 was inferred as statistically significant., Results: Placental size (major and minor axis, estimated area of placental bed, and volume of placenta) and T2 mapping-based histogram features (mean, skewness, and kurtosis) were statistically significantly different between the two groups. Visual analysis of HASTE and SE-EPI with TE = 60 msec showed AUCs of 0.80-0.86 to detect pregnancies with unfavorable outcomes., Data Conclusion: Placental size, histogram features, and visual analysis of placental MRI may allow for risk stratification regarding outcomes among pregnancies diagnosed with FGR., Evidence Level: 3 TECHNICAL EFFICACY: Stage 5., (© 2022 International Society for Magnetic Resonance in Medicine.)

Purpose: To compare the diagnostic performance of dynamic contrast-enhanced-MR (DCE-MR) and delayed contrast-enhanced (CE)-MRI added to unenhanced MRI, including diffusion weighted image (DWI) for differentiating malignant adnexal tumors, conducting a retrospective blinded image interpretation study., Methods: Data of 80 patients suspected of having adnexal tumors by ultrasonography between April 2008 and August 2018 were used for the study. All patients had undergone preoperative MRI and surgical resection at our institution. Four radiologists (two specialized in gynecological radiology and two non-specialized) were enrolled for blinded review of the MR images. A 3-point scale was used: 0 = benign, 1 = indeterminate, and 2 = malignant. Three imaging sets were reviewed: Set A, unenhanced MRI including DWI; Set B, Set A and delayed CE-T1WI; and Set C, Set A and DCE-MRI. Imaging criteria for benign and malignant tumors were given in earlier reports. The diagnostic performance of the three imaging sets of the four readers was calculated. Their areas under the curve (AUCs) were compared using the DeLong method., Results: Accuracies of Set B were 81%-88%. Those of Set C were 81%-85%. The AUCs of Set B were 0.83 and 0.89. Those of Set C were 0.81-0.86. For two readers, Set A showed lower accuracy and AUC than Set B/Set C (less than 0.80), although those were equivalent in other readers. No significant difference in AUCs was found among the three sequence sets. Intrareader agreement was moderate to almost perfect in Sets A and B, and substantial to almost perfect in Set C., Conclusion: DCE-MR showed no superiority for differentiating malignant adnexal tumors from benign tumors compared to delayed CE-T1WI with conventional MR and DWI.

Polypoid endometriosis is a benign, rare variant of endometriosis that forms polypoid nodules mimicking malignant tumors. For three cases of polypoid endometriosis of female genital organs, this report presents characteristic MR imaging features reflecting the histopathological findings. The solid and microcystic pattern or the multilocular pattern both reflecting dilated endometrial glands, and characteristic morphology of the nodules, multilobulated or polypoid-shaped, were helpful diagnostic clues present in these three cases. Earlier reported MR findings were also recognized, including signal intensity similar to that of the endometrium on T2-weighted image and contrast enhanced T1-weighted image, hypointense rim on T2-weighted image, lack of diffusion restriction, and hyperintense foci on T1-weighted image. Two cases were diagnosed preoperatively based on MR imaging findings as polypoid endometriosis. Fertility-preserving treatment was administered for one patient. Preoperative inference of polypoid endometriosis from MR imaging can avoid overtreatment and lead to fertility preservation., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Endometriosis, a common chronic inflammatory disease in female of reproductive age, is closely related to patient symptoms and fertility. Because of its high contrast resolution and objectivity, MRI can contribute to the early and accurate diagnosis of ovarian endometriotic cysts and deeply infiltrating endometriosis without the need for any invasive procedure or radiation exposure. The ovaries, which are the most frequent site of endometriosis, can be afflicted by multiple related conditions and diseases. For the diagnosis of deeply infiltrating endometriosis and secondary adhesions among pelvic organs, fibrosis around the ectopic endometrial gland is usually found as a T2 hypointense lesion. This review summarizes the MRI findings obtained for ovarian endometriotic cysts and their physiologically and pathologically related conditions. This article also includes the key imaging findings of deeply infiltrating endometriosis., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2022 The Korean Society of Radiology.)

Purpose: To evaluate radiomic machine learning (ML) classifiers based on multiparametric magnetic resonance images (MRI) in pretreatment assessment of endometrial cancer (EC) risk factors and to examine effects on radiologists' interpretation of deep myometrial invasion (dMI)., Methods: This retrospective study examined 200 consecutive patients with EC during January 2004 -March 2017, divided randomly to Discovery (n = 150) and Test (n = 50) datasets. Radiomic features of tumors were extracted from T2-weighted images, apparent diffusion coefficient map, and contrast enhanced T1-weighed images. Using the Discovery dataset, feature selection and hyperparameter tuning for XGBoost were performed. Ten classifiers were built to predict dMI, histological grade, lymphovascular invasion (LVI), and pelvic/paraaortic lymph node metastasis (PLNM/PALNM), respectively. Using the Test dataset, the diagnostic performances of ten classifiers were assessed by the area under the receiver operator characteristic curve (AUC). Next, four radiologists assessed dMI independently using MRI with a Likert scale before and after referring to inference of the ML classifier for the Test dataset. Then, AUCs obtained before and after reference were compared., Results: In the Test dataset, mean AUC of ML classifiers for dMI, histological grade, LVI, PLNM, and PALNM were 0.83, 0.77, 0.81, 0.72, and 0.82. AUCs of all radiologists for dMI (0.83-0.88) were better than or equal to mean AUC of the ML classifier, which showed no statistically significant difference before and after the reference., Conclusion: Radiomic classifiers showed promise for pretreatment assessment of EC risk factors. Radiologists' inferences outperformed the ML classifier for dMI and showed no improvement by review., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the most accurate magnetic resonance (MR) sequence for tumor detection, maximal tumor diameter, and parametrial invasion compared with histopathologic diagnoses., Methods: Fifty-one patients with International Federation of Gynecology and Obstetrics 2018 IB1 to IIB cervical cancer underwent preoperative MR imaging and surgical resection. Two radiologists independently evaluated the tumor detection, parametrial invasion, and tumor size in each of T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Results obtained for squamous cell carcinoma (SCC) and adenocarcinoma were also compared., Results: Neither the tumor detection rate nor parametrial invasion was found to be significantly different among sequences. Tumor size assessment using MR imaging with pathology showed good correlation: r = 0.63-0.72. The adenocarcinoma size tended to be more underestimated than SCC in comparison with the pathologic specimen., Conclusions: Cervical cancer staging by MR images showed no significant difference among T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Adenocarcinoma was prone to be measured as smaller than the pathologic specimen compared with SCC., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this study is to evaluate utility of MRI in differentiation of uterine low-grade endometrial stromal sarcoma (LGESS) from rare leiomyoma variants. This multi-center retrospective study included consecutive 25 patients with uterine LGESS and 42 patients with rare leiomyoma variants who had pretreatment MRI. Two radiologists (R1/R2) independently evaluated MRI features, which were analyzed statistically using Fisher's exact test or Student's t-test. Subsequently, using a five-point Likert scale, the two radiologists evaluated the diagnostic performance of a pre-defined MRI system using features reported as characteristics of LGESS in previous case series: uterine tumor with high signal intensity (SI) on diffusion-weighted images and with either worm-like nodular extension, intra-tumoral low SI bands, or low SI rim on T2-weighted images. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of the two readers' Likert scales were analyzed. Intra-tumoral low SI bands (p < 0.001), cystic/necrotic change (p ≤ 0.02), absence of speckled appearance (p < 0.001) on T2-weighted images, and a low apparent diffusion coefficient value (p ≤ 0.02) were significantly associated with LGESS. The pre-defined MRI system showed very good diagnostic performance: AUC 0.86/0.89, sensitivity 0.95/0.95, and specificity 0.67/0.69 for R1/R2. MRI can be useful to differentiate uterine LGESS from rare leiomyoma variants., (© 2021. The Author(s).)

Purpose: To compare the diagnostic performance of biparametric magnetic resonance imaging (bpMRI) versus multiparametric MRI (mpMRI) for the staging of well-differentiated endometrioid endometrial cancer (EC) in potential candidates for fertility-sparing management., Methods: This multi-center retrospective study included 48 potential candidates for fertility-sparing management (age <46 years, grade 1 endometroid EC) who did not wish to undergo fertility-sparing management and thus underwent definitive surgery. Two readers (R1, R2) independently reviewed bpMRI (T1, T2, and diffusion-weighted imaging) and mpMRI (bpMRI and dynamic contrast-enhanced imaging, DCE) during two separate sessions spaced one month apart for the presence of myometrial invasion (MI), cervical stromal involvement (CSI), malignant adnexal disease (mAD), and pelvic lymphadenopathy (pLNM). Each reader also recorded maximum tumor diameter, tumor volume, and tumor-to-uterine volume ratio (TVR) on T2-weighted imaging. The diagnostic performance of bpMRI and mpMRI was determined for each reader with surgical pathology serving as a gold standard., Results: The area under the receiver operating curve (AUC) for bpMRI versus mpMRI was 0.76/0.78 (R1/R2) versus 0.84/0.83 for MI, 0.79/0.76 versus 0.99/0.80 for CSI, 0.84/0.84 versus 0.84/0.80 for mAD, and 0.82/0.82 for pLMN. The sensitivity and specificity of MRI for detecting tumor spread beyond the endometrium were 71%/77% and 71%/65% for bpMRI (R1/R2) vs. 84%/90% and 71%/65% for mpMRI (R1/R2), respectively. The AUC of maximum tumor diameter, tumor volume, and TVR for MI was 0.71/0.61, 0.73/0.75, and 0.75/0.77 for R1/R2, respectively., Conclusion: MRI had moderate diagnostic performance across potential candidates for fertility-sparing treatment of EC. mpMRI outperformed bpMRI for detecting EC spreading beyond the endometrium., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To evaluate the diagnostic performance of MRI findings for differentiating uterine leiomyoma with intraligamentous growth, or broad ligament fibroid, from subserosal leiomyoma., Methods: This study included 37 patients with surgically confirmed uterine smooth muscle tumors (36 leiomyomas and one smooth muscle tumor of uncertain malignant potential) with intraligamentous growth (IL) and size-matched control of 37 patients with subserosal leiomyoma (SS). Two radiologists independently evaluated eight preoperative MRI findings: tumor shape, degeneration, attachment to uterus, ovary elevation, ureter displacement, bladder deformation, rectal displacement, and separation of round ligament (RL) and uterine artery (UA). The diagnostic values of these findings and interobserver agreement were assessed. Receiver-operating characteristic (ROC) analysis of the number of positive MRI findings for diagnosing IL was performed. Clinical outcomes including surgical method, operation time, intraoperative blood loss, perioperative complications, and postoperative hospital stay of the two groups were compared., Results: Significant differences in tumor shape, attachment to uterus, ovary elevation, ureter displacement, and separation of RL and UA were found between IL and SS. Four of these findings, excluding ureter displacement, showed moderate to substantial interobserver agreement. When two or more of these four findings were positive, sensitivity, specificity, and area under the ROC curve were 91%, 77%, 0.90 in reader 1 and 82%, 89%, 0.91 in reader 2. The operation time was significantly longer for IL than for SS., Conclusion: Tumor shape, attachment to uterus, ovary elevation, and separation of RL and UA are useful MRI findings for differentiating intraligamentous leiomyoma from subserosal leiomyoma., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Endometrial cancer (EC) is the most common gynecological tumor in developed countries, and preoperative risk stratification is essential for personalized medicine. There have been several radiomics studies for noninvasive risk stratification of EC using MRI. Although tumor segmentation is usually necessary for these studies, manual segmentation is not only labor-intensive but may also be subjective. Therefore, our study aimed to perform the automatic segmentation of EC on MRI with a convolutional neural network. The effect of the input image sequence and batch size on the segmentation performance was also investigated. Of 200 patients with EC, 180 patients were used for training the modified U-net model; 20 patients for testing the segmentation performance and the robustness of automatically extracted radiomics features. Using multi-sequence images and larger batch size was effective for improving segmentation accuracy. The mean Dice similarity coefficient, sensitivity, and positive predictive value of our model for the test set were 0.806, 0.816, and 0.834, respectively. The robustness of automatically extracted first-order and shape-based features was high (median ICC = 0.86 and 0.96, respectively). Other high-order features presented moderate-high robustness (median ICC = 0.57-0.93). Our model could automatically segment EC on MRI and extract radiomics features with high reliability., (© 2021. The Author(s).)

To evaluate whether radiomic features from contrast-enhanced computed tomography (CE-CT) can identify DNA mismatch repair deficient (MMR-D) and/or tumor mutational burden-high (TMB-H) endometrial cancers (ECs). Patients who underwent targeted massively parallel sequencing of primary ECs between 2014 and 2018 and preoperative CE-CT were included (n = 150). Molecular subtypes of EC were assigned using DNA polymerase epsilon (POLE) hotspot mutations and immunohistochemistry-based p53 and MMR protein expression. TMB was derived from sequencing, with > 15.5 mutations-per-megabase as a cut-point to define TMB-H tumors. After radiomic feature extraction and selection, radiomic features and clinical variables were processed with the recursive feature elimination random forest classifier. Classification models constructed using the training dataset (n = 105) were then validated on the holdout test dataset (n = 45). Integrated radiomic-clinical classification distinguished MMR-D from copy number (CN)-low-like and CN-high-like ECs with an area under the receiver operating characteristic curve (AUROC) of 0.78 (95% CI 0.58-0.91). The model further differentiated TMB-H from TMB-low (TMB-L) tumors with an AUROC of 0.87 (95% CI 0.73-0.95). Peritumoral-rim radiomic features were most relevant to both classifications (p ≤ 0.044). Radiomic analysis achieved moderate accuracy in identifying MMR-D and TMB-H ECs directly from CE-CT. Radiomics may provide an adjunct tool to molecular profiling, especially given its potential advantage in the setting of intratumor heterogeneity.

Purpose: To evaluate the diagnostic performance of chest CT to differentiate coronavirus disease 2019 (COVID-19) pneumonia in non-high-epidemic area in Japan., Materials and Methods: This retrospective study included 21 patients clinically suspected COVID-19 pneumonia and underwent chest CT more than 3 days after the symptom onset: six patients confirmed COVID-19 pneumonia by real-time reverse-transcription polymerase chain reaction (RT-PCR) and 15 patients proved uninfected. Using a Likert scale and its receiver operating characteristic curve analysis, two radiologists (R1/R2) evaluated the diagnostic performance of the five CT criteria: (1) ground glass opacity (GGO)-predominant lesions, (2) GGO- and peripheral-predominant lesions, (3) bilateral GGO-predominant lesions; (4) bilateral GGO- and peripheral-predominant lesions, and (5) bilateral GGO- and peripheral-predominant lesions without nodules, airway abnormalities, pleural effusion, and mediastinal lymphadenopathy., Results: All patients confirmed COVID-19 pneumonia had bilateral GGO- and peripheral-predominant lesions without airway abnormalities, mediastinal lymphadenopathy, and pleural effusion. The five CT criteria showed moderate to excellent diagnostic performance with area under the curves (AUCs) ranging 0.77-0.88 for R1 and 0.78-0.92 for R2. The criterion (e) showed the highest AUC., Conclusion: Chest CT would play a supplemental role to differentiate COVID-19 pneumonia from other respiratory diseases presenting with similar symptoms in a clinical setting.

Purpose: To determine if the primary treatment approach (primary debulking surgery (PDS) versus neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS)) influences the pattern of first recurrence in patients with completely cytoreduced advanced high-grade serous ovarian carcinoma (HGSOC)., Materials and Methods: This retrospective study included 178 patients with newly diagnosed stage IIIC-IV HGSOC, complete gross resection during PDS (n = 124) or IDS (n = 54) from January 2008-March 2013, and baseline and first recurrence contrast-enhanced computed tomography scans. Clinical characteristics and number of disease sites at baseline were analyzed for associations with time to recurrence. In 135 patients who experienced recurrence, the overlap in disease locations between baseline and recurrence and the number of new disease locations at recurrence were analyzed according to the primary treatment approach., Results: At univariate and multivariate analyses, NACT-IDS was associated with more overlapping locations between baseline and first recurrence (p ≤ 0.003) and fewer recurrences in new anatomic locations (p ≤ 0.043) compared with PDS. The same results were found in a subgroup that received intra-peritoneal adjuvant chemotherapy after either treatment approach. At univariate analysis, patient age, primary treatment approach, adjuvant chemotherapy route, and number of disease locations at baseline were associated with time to recurrence (p ≤ 0.009). At multivariate analysis, older patient age, NACT-IDS, and greater disease locations at baseline remained significant (p ≤ 0.018)., Conclusion: The distribution of disease at the time of first recurrence varied with the choice of primary treatment. Compared to patients treated with PDS, patients who underwent NACT-IDS experienced recurrence more often in the same locations as the original disease., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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 Contrast largest-lesion ) were significantly associated with shorter time to off-treatment ( P ≤ .034). In multivariable analysis, higher Energy largest-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., Competing Interests: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/po/author-center. Dmitriy ZamarinEmployment: Acorda Therapeutics (I) Consulting or Advisory Role: BioMed Valley Discoveries, Merck, PsiOxus Therapeutics, Synlogic, Western Oncolytics, Tesaro, Agenus, Trieza Therapeutics, ACM Biolabs Research Funding: Merck Patents, Royalties, Other Intellectual Property: I hold a patent regarding the use of recombinant Newcastle Disease Virus (NDV) for cancer therapy (Inst) Travel, Accommodations, Expenses: RocheAlexandra SnyderEmployment: Adaptive Biotechnologies, Merck Stock and Other Ownership Interests: Merck Consulting or Advisory Role: Driver Group Research Funding: Bristol-Myers Squibb Travel, Accommodations, Expenses: Genentech, Bristol-Myers SquibbMargaret CallahanEmployment: Bristol-Myers Squibb (I), Celgene (I), Kleo Pharmaceuticals (I), Bristol-Myers Squibb (I) Consulting or Advisory Role: AstraZeneca, Moderna Therapeutics, Merck Research Funding: Bristol-Myers Squibb (Inst) Other Relationship: Clinical Care Options, Potomac Center for Medical EducationEvis SalaHonoraria: Siemens Healthineers Speakers' Bureau: Siemens Healthineers Travel, Accommodations, Expenses: Siemens HealthineersYulia LakhmanStock and Other Ownership Interests: Y-mAbs Therapeutics No other potential conflicts of interest were reported., (© 2019 by American Society of Clinical Oncology.)

Objectives: The aim of this study was to assess the prognostic and incremental value of pretreatment apparent diffusion coefficient (ADC) values of tumors for the prediction of tumor recurrence after complete resection of the tumor in patients with endometrial cancer., Methods: This study enrolled 210 patients with stages IA to IIIC endometrial cancer who had undergone complete resection of the tumor and pretreatment magnetic resonance imaging. The minimum and mean ADC values (ADCmin, ADCmean) of tumors and normalized ADC (nADCmin, nADCmean) were calculated from magnetic resonance imaging. The primary outcome was recurrence-free survival (RFS). Receiver operating characteristic analysis was performed to compare the diagnostic performance of ADC values of 4 types. The Kaplan-Meier method, log-rank tests, and Cox regression were used to explore associations between recurrence and the ADC values with adjustment for clinicopathological factors., Results: In receiver operating characteristic curve analysis, the areas under the curve were significant for ADCmean and nADCmean predicting tumor recurrence but were not significant for ADCmin and nADCmin. Regarding univariate analysis, ADCmean and nADCmean were significantly associated with increased risk of recurrence. Multivariate analysis showed that ADCmean and nADCmean remained independently associated with shorter RFS. In the high-risk group, the RFS of patients with lower ADC values (ADCmean and nADCmean) was significantly shorter than that of patients in the higher ADC value group., Conclusions: Pretreatment tumor ADCmean and nADCmean were important imaging biomarkers for predicting recurrence in patients after complete resection of the tumor. They might improve existing risk stratification.

Background Half-Fourier acquisition single-shot turbo spin-echo (HASTE) imaging is now widely used for placental and fetal imaging because of its rapidity and low sensitivity to fetal movement. If placental dysfunction is also predicted by quantitative value obtained from HASTE image, then it might be beneficial for evaluating placental wellbeing. Purpose To ascertain the most suitable magnetic resonance (MR) signal indexes reflecting placental function using HASTE imaging. Material and Methods This retrospective study included 37 consequent patients who had given informed consent to MR imaging (MRI) examinations. All had undergone MRI examinations between February 2014 and June 2015. First, the correlation between T2-relaxation time of normal placenta and gestational age (GA) was examined. Second, correlation between signal intensity ratios (SIRs) using HASTE imaging and placental T2-relaxation time were assessed. The SIRs were calculated using placental signal intensity (SI) relative to the SI of the amniotic fluid, fetal ocular globes, gastric fluid, bladder, maternal psoas major muscles, and abdominal subcutaneous adipose tissue. Results Among the 37 patients, the correlation between T2-relaxation time of the 25 normal placentas and GA showed a moderately strong correlation (Spearman rho = -0.447, P = 0.0250). The most significant correlation with placental T2-relaxation time was observed with the placental SIR relative to the maternal psoas major muscles (SIR pl./psoas muscle ) (Spearman rho = -0.531, P = 0.0007). Conclusion This study revealed that SIR pl./psoas muscle showed the best correlation to placental T2-relaxation time. Results show that SIR pl./psoas muscle might be optimal as a clinically available quantitative index of placental function.

Objectives: To evaluate the diagnostic performance of quantitative values and MRI findings for differentiating seromucinous borderline tumours (SMBTs) from endometriosis-related malignant ovarian tumours (MT)., Methods: This retrospective study examined 19 lesions from SMBT and 84 lesions from MT. The following quantitative values were evaluated using receiver-operating characteristic analysis: overall and solid portion sizes, fluid signal intensity (SI), degree of contrast-enhancement, and mean and minimum apparent diffusion coefficient (ADC) values of the solid portion. Two radiologists independently evaluated four MRI findings characteristic of SMBT, fluid SI on the T1-weighted image and SI of the solid portion on diffusion-weighted image. The diagnostic values of these findings and interobserver agreement were assessed., Results: For diagnosing SMBT, the mean ADC value of the solid portion showed the greatest area under the curve (0.860) (cut-off value: 1.31 × 10 -3 mm 2 /s, sensitivity: 1.00, specificity: 0.61). The T2-weighted image (T2WI) high SI solid portion was the most useful finding, with high specificity and interobserver agreement (sensitivity, 0.58; specificity, 0.95-0.96, kappa = 0.96), followed by T2WI low SI core (sensitivity, 0.48-0.63; specificity, 0.98, kappa = 0.68)., Conclusion: Mean ADC values of the solid portion, T2WI high SI solid portion, and T2WI low SI core were useful for differentiating SMBT from MT., Key Points: • SMBT is a newly categorised ovarian tumour often associated with endometriosis. • Differentiation of SMBT from endometriosis-related malignant ovarian tumour is clinically important. • Diagnostic performances of quantitative values and MRI findings were evaluated. • Mean ADC value of the solid portion was the most useful value. • "T2WI high SI solid portion" was the most useful MRI finding.

Background Although age-related change of junctional zone (JZ) of the uterus has been known, there has been no previous systematic study of age-related changes of uterine peristalsis that is observed as the wave conduction of the thickest or darkest area within the JZ. Purpose To examine the age-related changes of uterine peristalsis in pre and postmenopausal women using cine magnetic resonance imaging (MRI), and to determine the correlation between peristalsis and JZ on T2-weighted (T2W) imaging. Material and Methods Cine MRI analysis was performed in 64 premenopausal volunteers and in 43 postmenopausal women. The peristaltic frequency, JZ detectability, and JZ thickness were evaluated and compared between the two groups. In the premenopausal group, the correlations between age and each item was examined. In the postmenopausal group, the number of years after menopause was used instead of age. The correlation between peristaltic frequency and JZ detectability or thickness was also analyzed. Results Peristaltic frequency and JZ detectability significantly differed between the two groups, while JZ thickness did not. Peristaltic frequency did not vary significantly with age before menopause and no peristalsis was observed after menopause. JZ detectability did not change significantly with age or number of years after menopause, while JZ thickness significantly increased with age before menopause, but did not vary after menopause. A significant moderate correlation was observed between JZ detectability and peristaltic frequency, but not between JZ thickness and peristaltic frequency. Conclusion Uterine peristalsis frequency did not change significantly according to age, but observed peristalsis on MRI significantly decreased after menopause.

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/mm 2 . Computed DWI with b-values of 800, 1000, 1300, 1600 and 2000 s/mm 2 (cDWI 800 , cDWI 1000 , cDWI 1300 , cDWI 1600 , cDWI 2000 ) 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/mm 2 . 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 cDWI 1300 and cDWI 1600 compared to the others (post-hoc comparison, P < 0.001), except for the total image quality between cDWI 1000 and cDWI 1600 in one reader. Signal suppression of the fat was the worst at cDWI 2000 . The signal intensity of the endocervical canal was suppressed in 24/27 cases on cDWI 1600 and in 26/27 cases on cDWI 2000 . 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.

Purpose: To investigate specific MRI findings for the prompt diagnosis of tubal torsion by reviewing 12 cases., Methods: The MRI findings presenting surgically and pathologically proven isolated tubal torsion were evaluated., Results: Key specific findings, including whirlpool sign and plicae tubaliae, were frequently associated with the diseases and were grouped for three types., Conclusion: Knowledge of specific MRI findings and the types of tubal torsion may lead to a correct and prompt diagnosis, resulting in preservation of fertility., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Pseudomyxoma peritonei (PMP) is a rare disease with neoplastic growth of mucin-secreting cells in the peritoneal cavity, resulting in mucinous ascites. The septum of intra-abdominal fluid collection is a key imaging finding characteristic to PMP. In magnetic resonance imaging (MRI), multi-b value diffusion-weighted imaging (DWI) is a method used to obtain an accurate apparent diffusion coefficient. The clinical utilities of DWI using lower b values as diagnostic imaging are rarely highlighted. This report describes a case of PMP in which DWI using b values of 100 and 500 s/mm(2) exclusively visualized many thick septa with low signal intensity in peritoneal effusion. The septa could not be recognized in DWIs with b values of zero or 1000 s/mm(2), as with ultrasonography, computed tomography, and conventional MRI. A discrepancy between DWI using lower b values and other MRI sequences or imaging modalities indicates a specific capability of DWI using low b values: the ability to visualize septa of intra-abdominal fluid collection much thicker than in real cases. Results for this case suggest that DWI using low b values might present clinical potential for the preoperative diagnosis of PMP.

Introduction: To investigate a simple visual assessment method of placental function using half-Fourier acquisition single-shot turbo spin-echo (HASTE) magnetic resonance imaging (MRI)., Methods: The institutional review board approved this retrospective study of fetal MRI in 48 singleton pregnant women for whom placentas had undergone clinical pathological examinations. Two readers independently assessed the placentas using the HASTE scoring system, particularly emphasizing the visualization of the regular two-tone pattern inside and signal intensity (SI) of placental parenchyma referring to SI of the fetal kidney and liver. After categorization using the HASTE scoring system, the associations between the scores and the presence of pathologically proven placental insufficiency or of low birth weight less than the tenth percentile were examined using chi-square tests. The associations between the HASTE scores and the MRI findings previously reported to suggest placental insufficiency, such as placental thickness and placenta to amniotic fluid SI ratio, were also examined using Student t-tests., Results: The HASTE scores were associated significantly with the presence of pathologically proven placental insufficiency (P = .003 for reader 1; P = .04 reader 2) and birth weight less than the tenth percentile (P = .005 for reader 1; P = .003 for reader 2). The HASTE scores were associated significantly with the placenta thickness (P < .0001 for both readers) and the placenta to the amniotic fluid SI ratio (P < .0001 for both readers)., Discussion: The HASTE scoring system is feasible for use in clinical assessment of placental function and for diagnosing placental insufficiency., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: To determine the optimal inversion time (TI) value of three-dimensional (3D) balanced steady-state free-precession time-spatial labeling inversion pulse (time-SLIP) technique for visualization of the renal artery at 3T MRI, and to assess whether the optimal TI is affected by the subject's age and blood velocity., Materials and Methods: Forty-two healthy volunteers (range 20-67 years) were enrolled in the study and subjected to non-contrast-enhanced renal MR angiography. Five different TI values (1200, 1400, 1600, 1800, and 2000 ms) were selected for evaluation. For quantitative evaluation, the relative signal intensity (SI) of the main renal artery was compared with that of the renal medulla (Vessel-to-Kidney ratio; VKR). Blood velocity of the abdominal aorta was measured using 2D phase contrast technique. For qualitative evaluation, two radiologists scored the depiction of the renal pelvis and the quality of visualization of the renal artery., Results: VKR is the highest at TI = 1600 ms. A strong negative correlation between age and blood velocity was demonstrated. Regarding the qualitative evaluation, the overall image scores of renal arteries were the highest at a TI = 1800 ms for both readers. The optimal TI values in subjects below 50 years of age were 1600 and 1800 ms, whereas in subjects above 50 years of age, the optimal TI value was 1800 ms., Conclusion: The optimal TI value for the visualization of renal arteries using time-SLIP technique at 3T MRI was 1800 ms. Subjects' age affected optimal TI and this is likely due to differences in the blood velocity of the abdominal aorta.

Aim: The aim of this study was to clarify the magnetic resonance (MR) imaging findings, including diffusion-weighted imaging (DWI), of hemorrhagic infarction of ovarian torsion., Material and Methods: Twelve patients presenting surgically confirmed ovarian masses with torsion were independently evaluated by two radiologists about the following MR findings: presence of ascites, uterine deviation, wall thickening on T2 weighted image (WI), recognition of twisted pedicle on T1/T2WI, and presence of wall enhancement of ovarian lesions on Gd-T1WI. The signal intensities on T1WI and DWI were compared with those of the iliopsoas muscle and the nerve root, respectively. These MR findings were statistically compared between cases of ovarian torsion with histopathologically proven hemorrhagic infarction and those without., Results: Pathologically, hemorrhagic infarction of the wall was confirmed in six of twelve cases. Ascites, uterine deviation and twisted pedicle were detected in most cases whether with or without hemorrhagic infarction. The complete absence of wall enhancement was observed in only one case with necrosis. A higher signal intensity of the wall compared to controls was observed in 4/6 and 5/6 cases with infarction on T1WI/DWI, respectively. This was not observed in any cases without infarction. Three out of five cystic lesions with hemorrhagic infarction showed irregular wall thickening on T2WI, and no cystic lesion without hemorrhagic infarction did. Smooth wall thickening was observed in 2/6 cases without hemorrhagic infarction., Conclusion: Pathological hemorrhagic infarction of ovarian torsion was associated with several MR imaging findings, including high signal intensity on T1WI/DWI, and irregular wall thickening on T2WI., (© 2015 Japan Society of Obstetrics and Gynecology.)

Objectives: To assess the prognostic impact of the pretreatment mean apparent diffusion coefficient (ADCmean) values of tumors obtained by diffusion-weighted magnetic resonance imaging. We evaluated the prognostic value of the ADCmean for event-free survival (EFS) and overall survival (OS) among patients with uterine cervical cancer., Methods/materials: We included 171 patients diagnosed as having International Federation of Gynecology and Obstetrics stage Ib to IIIb cervical cancer by pretreatment magnetic resonance imaging scans, regardless of therapeutic methods. In all patients and in patients with squamous cell carcinoma (SCC; n = 123), the optimal cutoff values of the tumor ADCmean for EFS and for OS were determined, respectively. The prognostic significance of the ADCmean was evaluated using univariate and multivariate Cox regression analyses., Results: In the univariate analyses, the ADCmean values were significantly associated with negative effects on EFS both in all patients and in patients with SCC, while not being significantly associated with OS in both groups. In the multivariate analysis, ADCmean was an independent biomarker for EFS (P < 0.05) in patients with SCC along with lymph node metastasis and definitive surgery, whereas ADCmean was not independently significant in EFS in all patients., Conclusions: The pretreatment ADCmean value of the tumor was an independent prognostic factor for EFS in International Federation of Gynecology and Obstetrics stage Ib to III SCC of the uterine cervix.

Dynamic physiological and anatomical changes for delivery may adversely induce various specific non-obstetric complications during pregnancy and puerperal period. These complications can be fatal to both the mother and the fetus, thus a precise and early diagnosis ensued by an early treatment is essential. Along with ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) have assumed an increasing role in the diagnosis. This article aims to discuss the pathophysiology of these complications, the indications for CT and MRI, and the imaging findings.

We report two cases of clinically suspected placental hypocirculation, as per evidenced by specific half-Fourier acquisition single-shot turbo spin-echo (HASTE) magnetic resonance findings of the whole placenta. Patient 1 was a case of fetal growth restriction caused by pregnancy-induced hypertension, while patient 2 experienced a discordant dichorionic diamniotic twin pregnancy with fetal growth restriction complication with a velamentous insertion of the umbilical cord in the smaller twin. In both cases, HASTE images showed noticeably decreased signal intensity with high-intensity signal spots present in the central region of the placenta. In the twin pregnancy case, the low-intensity signal area in the placenta of the smaller twin was much lower compared to that of the larger twin. Pathological findings failed to support or explain these observations. HASTE images might reflect compensatory alternation of the distribution of maternal blood and villus caused by hypocirculation. In conclusion, our results suggest that HASTE imaging might be a useful approach for the visualization of placental hypocirculation., (© 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.)

Objective: We used magnetic resonance (MR) imaging and hormonal levels to evaluate the influence of chemotherapy for cervical cancer on female pelvic reproductive organs., Materials and Methods: We retrospectively evaluated 16 pre- and 11 postmenopausal patients with cervical cancer who underwent neoadjuvant chemotherapy (NACT) and radical surgery. We evaluated morphological changes in the uterus and ovaries by MR imaging both quantitatively and qualitatively, measuring the volume of the uterine body and bilateral ovaries, endometrial thickness, and signal intensity of the myometrium and bilateral ovaries and assessing visibility of the junctional zone and bilateral ovarian follicles. We compared both quantitative and qualitative factors between pre- and post-NACT. Pre- and post-NACT hormonal values of estradiol, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) of 8 patients in the premenopausal group were obtained and analyzed statistically., Results: In the premenopausal group, we observed a statistically significant decrease in all quantitative parameters as well as in the visibility of the left ovarian follicle. In the postmenopausal group, only endometrial thickness changed significantly. Premenopausal patients showed a statistically significant decrease in levels of progesterone, FSH, and LH after chemotherapy., Conclusions: MR demonstrated changes in the uterus and ovaries in premenopausal subjects who underwent chemotherapy that resembled those changes classically reported in physiological postmenopausal subjects. These changes are likely due to ovarian toxicity and secondary hormonal changes. MR imaging might be a valuable tool for obtaining information regarding chemotherapy-induced infertility.

Aim: To assess the use of magnetic resonance imaging (MRI) for prenatal differentiation between complete hydatidiform mole with a twin live fetus (CHMTF) and placental mesenchymal dysplasia (PMD)., Methods: Three CHMTF cases and three PMD cases, from two institutions over a 6-year period, were retrospectively included in this study. Clinical findings including age, pregnancy history, serum hCG level, ultrasonography findings, complications of the mother, outcome of the fetus, and results of chromosomal study of fetus, amniotic fluid and lesion, if possible, were noted. MRI findings were evaluated by two radiologists with respect to the location of the disease (intra- or extra-fetal sac), the presence of multicystic component, and presence of intra- or extra-lesional hemorrhage., Results: In all six cases, the diseases were recognized as multicystic lesions by ultrasonography and MRI. In two of three CHMTF cases, patients continued with the pregnancy, which resulted in spontaneous abortion. In one case of CHMTF, the patient underwent artificial abortion, after which the mole progressed into an invasive mole with lung metastases. All three PMD patients had live births, and two of the three babies had fetal growth restriction. By MRI, CHMTF was located within an extra-fetal sac accompanied by intra- and/or extra-lesional hemorrhage, while PMD was located within the placenta in the fetal sac without hemorrhage., Conclusion: MRI could provide important information about the prenatal differential diagnosis of CHMTF and PMD, based on the pathophysiology and characteristics of the diseases., (© 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.)

Objectives: The purpose of this study was to quantitatively evaluate 3 types of magnetic resonance imaging (MRI) parameters in parallel for the early prediction of neoadjuvant chemotherapy (NACT) effectiveness in cervical cancer-tumor volume parameters, diffusion parameters, and perfusion parameters., Materials and Methods: We prospectively evaluated 13 patients with International Federation of Gynecology and Obstetrics stage IB to IIB cervical squamous cell carcinoma who underwent 3 serial MRI studies, that is, pretreatment, post-first course NACT, and post-second course NACT followed by radical hysterectomy. We obtained tumor volume parameters, diffusion parameters, and dynamic contrast material-enhanced perfusion parameters quantitatively from pretreatment MRI and post-first course MRI. The correlation of these parameters and the eventual tumor volume regression rate (TVRR) obtained from pretreatment MRI and post-second course MRI before surgery were investigated, statistically based on the Pearson correlation coefficient., Results: Thirteen patients had a total of 39 scans. Early TVRR (r = 0.844; P < 0.001), the fractional volume of the tissue extracellular extravascular space (Ve, r = 0.648; P < 0.05), and the change of Ve during the first course of NACT (r = -0.638; P < 0.05) correlated with eventual TVRR., Conclusions: 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.

Adenomyosis is a common gynecologic disease. Pregnancy with adenomyosis is on the increase due to a tendency of delay with first pregnancies and various infertility treatments involved in the process. We encountered decidualized adenomyosis in three patients during pregnancy, who were suspected by magnetic resonance (MR) imaging and were followed monitored post delivery. The MR imaging findings of adenomyosis during pregnancy showed low signal intensity areas with embedded bright foci that expanded to a few mm in diameter on half Fourier single-shot turbo spin-echo images. This finding may reflect decidual change of the stroma within the ectopic endometrium caused during pregnancy. The MR imaging findings of adenomyosis after childbirth showed hemorrhage inside the lesion, which were assumed to be led by rapid decrease in a blood flow to adenomyosis post childbirth.

Massive subchorionic thrombosis is a rare condition, defined as a large thrombus confined to the subchorionic space. It is associated with poor perinatal prognosis. However, prenatal diagnosis by ultrasonography is often difficult. We report a case of massive subchorionic thrombosis developing dermatomyositis after the delivery, followed by magnetic resonance imaging. Moreover, we review other 4 cases assessed with magnetic resonance imaging. Magnetic resonance imaging is very useful for confirmation of diagnosis and follow-up in combination with ultrasonography.