Browsing by Author "Guerra, A."
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- European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosisPublication . Bazot, M.; Bharwani, N.; Huchon, C.; Kinkel, K.; Cunha, T. M.; Guerra, A.; Manganaro, L.; Buñesch, L.; Kido, A.; Togashi, K.; Thomassin-Naggara, I.; Rockall, A. G.Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence.
- Magnetic resonance evaluation of adnexal massesPublication . Guerra, A.; Cunha, Teresa Margarida; Félix, A.Background: Accurate evaluation of adnexal masses allows correct surgical procedure, avoiding unnecessary surgery. Purpose: To evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of malignancy of adnexal lesions. Material and Methods: We retrospectively reviewed the pelvic MRI scans of 161 patients with 199 surgically confirmed adnexal masses, between November 1998 and June 2005. The criteria for adnexal malignancy were contrast-enhanced solid lesions, contrastenhanced solid components in mixed lesions (except those with low-signal-intensity solid components on T2-weighted imaging [T2WI]), contrast-enhanced papillary projections in cystic lesions (except those with low-signal-intensity papillary projections on T2WI), or septal thickness ]3 mm. Ascites, peritoneal metastasis, and pelvic adenopathy were also regarded as criteria for malignancy. Results: On MRI evaluation, 97 adnexal lesions were malignant and 102 were nonmalignant. Thirty-two percent of patients with ascites had benign lesions. Histopathologic evaluation of the adnexal lesions showed that 83 were malignant (true positives), 100 were non-malignant (true negatives), and seven were uncertain malignant potential tumors; two were false negative and seven were false positive. The MRI sensitivity and specificity for malignancy were 98% and 93%, respectively. MRI reached an accuracy of 95%, with a positive predictive value of 0.92 and a negative predictive value of 0.98 for malignant adnexal lesions. The kappa coefficient was 0.906, indicating almost perfect agreement between MRI and histological results. Conclusion: MRI is an accurate method for evaluating the malignancy of adnexal lesions.