Browsing by Author "Cunha, Teresa Margarida"
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- Absence of the infra-renal segment of the inferior vena cavaPublication . Oliveira, C.; Vinhais, S.; Cunha, Teresa Margarida
- Added value of diffusion-weighted MRI in detection of cervical cancer recurrence compared with morphologic and dynamic contrast-enhanced MRI sequencesPublication . Lucas, Rita; Dias, João Lopes; Cunha, Teresa MargaridaPURPOSE We aimed to evaluate the added value of diffusion-weighted imaging (DWI) to standard magnetic resonance imaging (MRI) for detecting post-treatment cervical cancer recurrence. The detection accuracy of T2-weighted (T2W) images was compared with that of T2W MRI combined with either dynamic contrast-enhanced (DCE) MRI or DWI. METHODS Thirty-eight women with clinically suspected uterine cervical cancer recurrence more than six months after treatment completion were examined with 1.5 Tesla MRI including T2W, DCE, and DWI sequences. Disease was confirmed histologically and correlated with MRI findings. The diagnostic performance of T2W imaging and its combination with either DCE or DWI were analyzed. Sensitivity, positive predictive value, and accuracy were calculated. RESULTS Thirty-six women had histologically proven recurrence. The accuracy for recurrence detection was 80% with T2W/DCE MRI and 92.1% with T2W/DWI. The addition of DCE sequences did not significantly improve the diagnostic ability of T2W imaging, and this sequence combination misclassified two patients as falsely positive and seven as falsely negative. The T2W/DWI combination revealed a positive predictive value of 100% and only three false negatives. CONCLUSION The addition of DWI to T2W sequences considerably improved the diagnostic ability of MRI. Our results support the inclusion of DWI in the initial MRI protocol for the detection of cervical cancer recurrence, leaving DCE sequences as an option for uncertain cases.
- Adnexal masses: benign ovarian lesions and characterization - benign ovarian massesPublication . Schlattau, Alexander; Cunha, Teresa Margarida; Forstner, RosemarieIncidental adnexal masses are commonly identified in radiologists’ daily practice. Most of them are benign ovarian lesions of no concern. However, sometimes defining the origin of a pelvic mass may be challenging, especially on ultrasound alone. Moreover, ultrasound not always allows the distinction between a benign and a malignant adnexal tumor. Most of sonographically indeterminate adnexal masses turn out to be common benign entities that can be readily diagnosed by magnetic resonance imaging. The clinical impact of predicting the likelihood of malignancy is crucial for proper patient management. The first part of this chapter will cover the technical magnetic resonance imaging aspects of ovarian lesions characterization as well as the imaging features that allow the radiologist to correctly define the anatomic origin of a pelvic mass. Next, the authors will go through different benign ovarian entities and through the different histologic types of benign ovarian tumors. Finally the functional ovarian tumors and the ovarian tumors in children, adolescents, young females, and pregnant women will be covered.
- Algoritmo de abordagem das lesões anexiais indeterminadas na ecografiaPublication . Lourenço, Cândida; Palma, Sónia; Cunha, Teresa MargaridaO esclarecimento do órgão de origem, ou principalmente da natureza benigna ou maligna de um tumor anexial ecograficamente indeterminado surge com frequência na prática clínica e obriga a uma investigação complementar da sua natureza de modo a evitar cirurgias inúteis, sem deixar de diagnosticar precocemente a patologia maligna. Neste trabalho apresentamos um algoritmo de diagnóstico por Ressonância Magnética (RM), que recentemente foi proposto pela European Society of Urogenital Radiology (ESUR), o qual permite um diagnóstico preciso dos casos indeterminados à ecografia e uma intervenção responsável na abordagem clínica destas doentes.
- An uncommon adnexal tumourPublication . Antunes, Dulce; Cunha, Teresa Margarida
- Aspectos imagiológicos da patologia benigna do miométrioPublication . Simões, Marta; Cunha, Teresa MargaridaOs leiomiomas são a patologia tumoral ginecológica com maior incidência, apresentando características imagiológicas bem documentadas na literatura. Dificuldades diagnósticas ocorrem, em regra, com o marcado aumento das dimensões dos leiomiomas resultando em diversos tipos de degenerescência. De entre estas, a de tipo hialina constitui a mais frequentemente observada, ocorrendo em cerca de 60% dos casos. As degenerescências de tipo mixóide, quística e hemorrágica são encontradas mais raramente. A presença de edema pode prever o desenvolvimento de fenómenos de degenerescência sendo, no entanto, um achado histopatológico comum, encontrado em cerca de 50% dos casos de leiomiomas. O diagnóstico diferencial dos leiomiomas inclui a adenomiose, situação clínica que afecta mulheres na fase pré-menopáusica. A Ressonância Magnética assume especial importância no seu diagnóstico, localização e distinção tendo impacto na orientação da doente ao permitir uma adequada abordagem terapêutica.
- Assessing of depth of myometrial invasion and preoperative staging of endometrial cancer: the added value of diffusion-weighted imaging and dynamic contrast-enhanced MRI sequencesPublication . Alves, Inês; Ramalho, Madalena; Cunha, Teresa MargaridaPurpose: To compare T2-weighted image (T2WI) vs dynamic contrastenhanced magnetic resonance imaging (DCE-MRI) vs diffusion-weighted imaging (DWI) for the evaluation of depth of myometrial invasion and preoperative overall staging of endometrial cancer. Methods and Materials: This retrospective study included forty-four women with endometrial cancer who underwent 1.5 Tesla pelvic MRI as part of their initial preoperative staging. T2WI, DCE-MRI, and DWI sequences were obtained. Retrospectively, two radiologists performed a consensus interpretation of all images interpreted the depth of myometrial invasion, overall stage, and presence of pitfalls. Surgical histology was available for each case and was the gold standard for comparison. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each method were assessed. Results: Respective diagnostic accuracy, sensitivity, specificity, PPV and NPV in assessing the depth of myometrial invasion were: T2WI 61%, 58%, 64%, 55% and 67%; DCE-MRI 86%, 84%, 88%, 84% and 88%; DWI 95%, 95%, 96%, 95% and 96%. DWI correctly staged more patients (41/44) than DCEMRI (34/44) and T2WI (22/44) (P<0.05). For overall cancer staging, κ values were 0.29 with T2WI, 0.59 with DCE-MRI, and 0.89 with DWI. Conclusion: DWI considerably improved the diagnostic sensitivity and accuracy of MRI compared to DCE-MRI and T2WI in assessing both depth of myometrial invasion and overall staging in endometrial cancer.
- Atypical presentation of a cervical cancerPublication . Delgado, Lara; Cunha, Teresa Margarida
- Avaliação radiológica da ressecabilidade no carcinoma do ovárioPublication . Valentim, Maria Helena; Quadrado, Joana; Cunha, Teresa MargaridaO carcinoma do ovário é na maioria das vezes diagnosticado num estádio avançado. Nos últimos anos a quimioterapia neoadjuvante tem emergido como uma terapêutica alternativa para os casos de doença avançada em que não é possível uma adequada remoção cirúrgica dos implantes tumorais, sendo a cirurgia cito-redutora adiada para uma segunda fase. A Radiologia tem vindo a assumir um papel importante na selecção destas doentes, com definição de critérios de irressecabilidade avaliados por Tomografia Computorizada e que se relacionam sobretudo com a localização e dimensão dos implantes.
- Avaliação radiológica do carcinoma do ovárioPublication . Horta, Mariana; Cunha, Teresa Margarida