Browsing by Author "Forstner, Rosemarie"
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- 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.
- ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an updatePublication . Forstner, Rosemarie; Thomassin-Naggara, Isabelle; Cunha, Teresa Margarida; Kinkel, Karen; Masselli, Gabriele; Huch, Rahel Kubik; Spencer, John; Rockall, AndreaAn update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques is provided. An algorithmic approach using sagittal T2 and a set of transaxial T1 and T2WI allows categorization of adnexal masses in one of the following three types according to its predominant signal characteristics. T1 'bright' masses due to fat or blood content can be simply and effectively determined using a combination of T1W, T2W and FST1W imaging. When there is concern for a solid component within such a mass, it requires additional assessment as for a complex cystic or cystic-solid mass. For low T2 solid adnexal masses, DWI is now recommended. Such masses with low DWI signal on high b value image (e.g. > b 1000 s/mm2 ) can be regarded as benign. Any other solid adnexal mass, displaying intermediate or high DWI signal, requires further assessment by contrast-enhanced (CE)T1W imaging, ideally with DCE MR, where a type 3 curve is highly predictive of malignancy. For complex cystic or cystic-solid masses, both DWI and CET1W—preferably DCE MRI—is recommended. Characteristic enhancement curves of solid components can discriminate between lesions that are highly likely malignant and highly likely benign.
- Female pelvis: genital organsPublication . Forstner, Rosemarie; Cunha, Teresa MargaridaGynecologic cancers account for 10–15 % of female malignancies, but the genital organs may also be affected in pelvic irradiation of other organs and in systemic treatment. Depending on cancer type and stage, surgery, radiotherapy, and chemotherapy are treatment options. Advances in therapy result in markedly improved survival rates in pelvic malignancies. In these patients treatmentrelated side effects are more common than recurrence, but their differentiation may be challenging. This is why it is pivotal that the radiologist is aware of the type of treatment and the spectrum of normal posttreatment fi ndings, pitfalls, and complications. Postirradiation sequelae may complicate the early phase but may also occur with a latency of many years. Side effects of targeted agents differ from those of classical cytotoxic agents, and particularly in the latter ovarian function may be impaired.
- Update on imaging of ovarian cancerPublication . Forstner, Rosemarie; Meissnitzer, Matthias; Cunha, Teresa MargaridaThis review will make familiar with new concepts in ovarian cancer and their impact on radiological practice. Disseminated peritoneal spread and ascites are typical of the most common (70–80 %) cancer type, highgrade serous ovarian cancer. Other cancer subtypes differ in origin, precursors, and imaging features. Expert sonography allows excellent risk assessment in adnexal masses. Owing to its high specificity, complementary MRI improves characterization of indeterminate lesions. Major changes in the new FIGO staging classification include fusion of fallopian tube and primary ovarian cancer and the subcategory stage IIIA1 for retroperitoneal lymph node metastases only. Inguinal lymph nodes, cardiophrenic lymph nodes, and umbilical metastases are classified as distant metastases (stage IVB). In multidisciplinary conferences (MDC), CT has been used to predict the success of cytoreductive surgery. Resectability criteria have to be specified and agreed on in MDC. Limitations in detection of metastases may be overcome using advanced MRI techniques.