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Objectives: To prospectively assess an innovative computer-aided diagnostic technology that quantifies characteristic features of backscattered ultrasound and theoretically allows transvaginal sonography (TVS) to discriminate benign from malignant adnexal masses.Methods: Women (n = 264) scheduled for surgical removal of at least one ovary in five centres were included. Preoperative three-dimensional (3D)-TVS was performed and the voxel data were analysed by the new technology. The findings at 3D-TVS, serum CA125 levels and the TVS-based diagnosis were compared with histology. Cancer was deemed present when invasive or borderline cancerous processes were observed histologically.Results: Among 375 removed ovaries, 141 cancers (83 adenocarcinomas, 24 borderline, 16 cases of carcinomatosis, nine of metastases and nine others) and 234 non-cancerous ovaries (107 normal, 127 benign tumours) were histologically diagnosed. The new computer-aided technology correctly identified 138/141 malignant lesions and 206/234 non-malignant tissues (98% sensitivity, 88% specificity). There were no false-negative results among the 47 FIGO stage I/II ovarian lesions. Standard TVS and CA125 had sensitivities/specificities of 94%/66% and 89%/75%, respectively. Combining standard TVS and the new technology in parallel significantly improved TVS specificity from 66% to 92% (p < 0.0001).Conclusions: Computer-aided quantification of backscattered ultrasound is a highly sensitive for the diagnosis of malignant ovarian masses. [ABSTRACT FROM AUTHOR]

Objective: We studied the repeatability and the relative intra-scan variability across acquisition protocols in CT using phantom and unenhanced abdominal series., Methods: We used 17 CT scans from the Credence Cartridge Radiomics Phantom database and 20 unenhanced multi-site non-pathologic abdominal patient series for which we measured spleen and liver tissues. We performed multiple measurements in extracting 9 radiomics features. We defined a "tandem" as the measurement of a given tissue (or material) by a given radiomics. For each tandem, we assessed the proportion of the variability attributable to repetitions, acquisition protocols, material, or patient. We analyzed the distribution of the intra-scan correlation between pairs of tandems and checked the impact of correlation coefficient greater than 0.90 in comparing paired and unpaired differences., Results: The repeatability of radiomics features depends on the measured material; 56% of tandems were highly repeatable. Histogram-derived radiomics were generally less repeatable. Nearly 60% of relative radiomics measurements had a correlation coefficient higher than 0.90 allowing paired measurements to improve reliability in detecting the difference between two materials. The analysis of liver and spleen tissues showed that measurement variability was negligible with respect to other variabilities. As for phantom data, we found that gray level zone length matrix (GLZLM)-derived radiomics and gray level co-occurrence matrix (GLCM)-derived radiomics were the most correlating features. For these features, relative intra-scan measurements improved the detection of different materials or tissues., Conclusions: We identified radiomics features for which the intra-scan measurements between tissues are linearly correlated. This property represents an opportunity to improve tissue characterization and inter-site harmonization., Key Points: • The repeatability of radiomics features on CT depends on the measured material or tissue. • Some tandems of radiomics features/tissues are linearly affected by the variability of acquisition protocols on CT. • Relative intra-scan measurements are an opportunity for improving quantitative imaging on CT., (© 2021. European Society of Radiology.)

Objectives: Following the craze for radiomic features (RF), their lack of reliability raised the question of the generalizability of classification models. Inter-site harmonization of images therefore becomes a central issue. We compared RF harmonization processing designed to detect liver diseases in CT images., Methods: We retrospectively analyzed 76 multi-center portal CT series of non-diseased (NDL) and diseased liver (DL) patients. In each series, we positioned volumes of interest in spleen and liver, then extracted 9 RF (histogram and texture). We evaluated two RF harmonization approaches. First, in each series, we computed the Z-score of liver measurements based on those computed in the spleen. Second, we evaluated the ComBat method according to each imaging center; parameters were computed in the spleen and applied to the liver. We compared RF distributions and classification performances before/after harmonization. We classified NDL versus spleen and versus DL tissues., Results: The RF distributions were all different between liver and spleen (p < 0.05). The Z-score harmonization outperformed for the detection of liver versus spleen: AUC = 93.1% (p < 0.001). For the detection of DL versus NDL, in a case/control setting, we found no differences between the harmonizations: mean AUC = 73.6% (p = 0.49). Using the whole datasets, the performances were improved using ComBat (p = 0.05) AUC = 82.4% and degraded with Z-score AUC = 67.4% (p = 0.008)., Conclusions: Data harmonization requires to first focus on data structuring to not degrade the performances of subsequent classifications. Liver tissue classification after harmonization of spleen-based RF is a promising strategy for improving the detection of DL tissue., Key Points: • Variability of acquisition parameter makes radiomics of CT features non-reproducible. • Data harmonization can help circumvent the inter-site variability of acquisition protocols. • Inter-site harmonization must be carefully implemented and requires designing consistent data sets., (© 2021. European Society of Radiology.)

Objectives: Early tumor shrinkage (ETS) has been reported to be associated with survival of metastatic colorectal cancer (mCRC) patients. Our aim was to analyze long-term tumor-size evolution, according to early mCRC best responses during the first-line therapy, to evaluate first best response-survival links., Methods: Sixty-five patients with unresectable mCRCs, treated between 2010 and 2015, were included retrospectively in this descriptive monocenter study and grouped according to their RECIST 1.1 first-line best responses: progressive disease (PD fl ), stable disease with tumor-size evolution between 0 and + 19% (SD fl +) or 0 and - 29% (SD fl -), and partial responders (PRs), who were classed PR with ETS (ETS fl ) or without (PR fl ). Tumor-size evolution and best tumor responses to each chemotherapy line were analyzed., Results: Tumor loads of ETS fl or PR fl mCRCs tended to remain inferior to their initial values: 60% of patients died with target lesion sums below baseline. For first-line SD fl + or PD fl mCRCs, rapid tumor load increases continued during successive lines: > 80% died with target lesion sums above baseline. ETS fl mCRCs responded better to subsequent lines (37.5% second-line PR), whereas PD fl mCRCs remained refractory to other therapies (0% second- and third-line PR). Overall survival rates were significantly (p = 0.03) longer for the ETS fl group (29.9 [95% CI: 12.6-47.1] months) and shorter for the PD fl group (17.1 [95% CI: 1.5-37.5] months)., Conclusion: Tumors responding to first-line chemotherapy also responded better to subsequent lines, whereas PD fl mCRCs remained refractory, which may explain the better survival associated with ETS fl ., Key Points: • Early shrinking tumors under first-line chemotherapy responded better to subsequent lines, maintaining low tumor loads, potentially explaining the link between early tumor shrinkage and overall survival of metastatic colorectal cancer (mCRC) patients. • mCRCs progressing under first-line chemotherapy remained refractory to other therapies and their tumor loads increased rapidly. • Even outside a clinical trial, an early first CT scan reevaluation with RECIST criteria 8 weeks after starting first-line therapy is crucial to determine long-term mCRC evolution.

Purpose: To assess the added value of the dynamic contrast-enhanced sequence (DCE) to combination T2-weighted imaging (T2w) + diffusion-weighted imaging (DWI) in detecting prostate cancer (PCa) recurrence after HIFU (high-intensity focused ultrasound)., Methods: Forty-five males with clinical and biological suspected PCa recurrence were retrospectively selected. All underwent multi-parametric MRI (mpMRI) before biopsies. Two readers independently assigned a Likert score of cancer likelihood on T2w + DWI + DCE and T2w + DWI images. Prostatic biopsies were taken as the gold standard., Results: Recurrent PCa was identified at biopsy for 37 patients (82%). Areas under the receiver-operating curve of T2w + DWI and T2w + DWI + DCE imaging were not significantly different for both readers. Using a Likert score ≥ 3 for the PCa diagnosis threshold, sensitivity at the lobe level for the (1) senior and (2) junior reader for T2w +DWI +DCE sensitivity was (1) 0.97 and (2) 0.94 vs. (1) 0.94 and (2) 0.97 for T2w + DWI., Conclusion: Accuracy of mpMRI was not significantly improved by adding DCE to T2w + DWI. Sensitivity was high for T2w + DWI + DCE and T2w + DWI with no significant difference for either the junior or senior reader., Key Points: • MpMRI has the capability to detect PCa recurrence in post-HIFU monitoring. • The sensitivity of T2w and DWI for detecting PCa recurrence was not improved by DCE. • Readers with different degrees of experience did not improve their performance with DCE.

Aim: To assess anatomic changes on computed tomography (CT) after neoadjuvant FOLFIRINOX (5-fluorouracil/leucovorin/irinotecan/oxaliplatin) chemotherapy for secondary resected borderline resectable (BR) and locally advanced (LA) pancreatic adenocarcinoma and their accuracy to predict resectability and pathological response., Methods: Thirty-six patients with secondary resected BR/LA pancreatic adenocarcinoma after neoadjuvant FOLFIRINOX chemotherapy (± chemoradiotherapy) were retrospectively included. Two radiologists reviewed baseline and pre-surgical CTs in consensus. NCCN (National Comprehensive Cancer Network) classification, largest axis, product of the three axes (P3A), and arterial/venous involvement were studied and compared to pathological response and resection status and to disease-free survival (DFS)., Results: Thirty-one patients had R0 resection, including only six exhibiting a downstaging according to the NCCN classification. After treatment, the largest axis and P3A decreased (P < 0.0001). The pre-surgical largest axis and P3A were smaller in case of R0 resection (P = 0.019/P = 0.021). The largest axis/P3A variations were higher in case of complete pathological response (P = 0.011/P = 0.016). A decrease of the arterial/venous involvement was not able to predict R0 or ypT0N0 (P > 0.05). Progression of the vascular involvement was seen in two (5 %) patients and led to a shorter DFS., Conclusion: In BR/LA pancreatic adenocarcinoma after the neoadjuvant FOLFIRINOX regimen (± chemoradiotherapy), significant tumour size decreases were observed on CT. However, CT staging was not predictive of resectability and pathological response., Key Points: • Significant tumour size decreases were observed on CT after FOLFIRINOX (± chemoradiotherapy). • CT is not able to predict R0 resection accurately after FOLFIRINOX (± chemoradiotherapy). • CT is not able to predict complete response accurately after FOLFIRINOX (± chemoradiotherapy). • Even with a stable NCCN classification, BR/LA pancreatic adenocarcinoma could have R0 resection.

Objectives: To assess the contrast-enhanced ultrasound (CEUS) frequencies of centrifugal enhancement, spoke-wheel sign and central scar in focal nodular hyperplasia (FNH) as a function of lesion size., Methods: Ninety-four FNHs were retrospectively reviewed to assess their largest diameter and enhancement pattern, including centrifugal enhancement from one central artery, spoke-wheel sign, diffuse or centripetal enhancement, central scar and late-phase washout., Results: Mean FNH-lesion size was 3.7 ± 2.1 cm. Only 43.6 % of FNHs had centrifugal enhancement, with a spoke-wheel pattern (23.4 %) or without (20.2 %), while 56.4 % showed diffuse or centripetal enhancement. Centrifugal enhancement was observed in 73.9 % of FNHs ≤3.1 cm and 14.6 % of FNHs >3.1 cm (P < 10(-4)). Size and frequency of centrifugal enhancement were negatively correlated (r = -0.57, P < 10(-4)). The spoke-wheel pattern was also seen more frequently in smaller (37 %) than in larger FNHs (10.4 %) (P < 10(-3)). Late-phase washout was described in 5.3 % of FNHs and was not size-dependent. Lesions with a central scar were larger than those without, respectively, 5.7 ± 1.7 and 3.6 ± 2.0 cm (P = 0.012)., Conclusions: Typical centrifugal enhancement yielding a confident FNH diagnosis is seen significantly more frequently when the lesion is ≤3.1 cm., Key Points: • CEUS yields confident diagnoses of FNHs ≤3.1 cm • The larger the FNH, the lower the diagnostic sensitivity of CEUS • Final diagnosis of FNHs >3.1 cm should be obtained with MRI not CEUS.

Objectives: To describe the early patterns of liver lesions successfully treated with radiofrequency ablation (RFA) or cryoablation (CA) and their changes over time., Methods: Twenty-two RFA-treated and 17 CA-treated patients underwent CEUS from week 1 to year 3 post-ablation. Patterns, margins and volumes of RF-induced and cryolesions were evaluated and compared over time., Results: After contrast enhancement, shortly after ablation, undefined margins with persistent enhancing small vessels penetrating >2 mm into the treated zone were significantly more frequent after CA (67 %) than RFA (22 %) (P < 0.02). During the arterial phase, a thin, enhancing marginal rim was seen during week 1 (T1) in around 28 % of RF lesions, while 75 % of cryolesions had thick enhancing rims (P < 0.02). The mean RF-induced lesion volume, maximum at T1 (44.1 ± 37.5 ml), shrank slowly over time, remaining clearly visible at 1 year (8.3 ± 7.4 ml). Cryolesions shrank faster (P = 0.009), from an average of 16.6 ± 7.1 ml at T1 to 1.7 ± 1.3 ml 1-year post-ablation., Conclusion: RF-induced and cryolesions differ, particularly their margins and shrinkage rates. Knowing these differences allows avoidance of incomplete treatment or falsely diagnosed recurrence, especially after CA., Key Points: • Contrast-enhanced ultrasound (CEUS) provides new follow-up information following hepatic radiological inyervention. • CEUS provides good visualisation of vascular modifications after thermoablation. • RFA-induced lesions and cryoablated lesions differ. • Knowledge about RF and cryolesion patterns is essential for correct CEUS follow-up. • Cryolesions have thicker peripheral inflammatory reactions and shrink faster than RFA-induced lesions.

Objective: To evaluate morphological and perfusion changes in liver metastases of neuroendocrine tumours by contrast-enhanced ultrasound (CEUS) after transarterial embolisation with bead block (TAE) or trans-arterial chemoembolisation with doxorubicin-eluting beads (DEB-TACE)., Methods: In this retrospective study, seven patients underwent TAE, and ten underwent DEB-TACE using beads of the same size. At 1 day before embolisation, 2 days, 1 month and 3 months after the procedure, a destruction-replenishment study using CEUS was performed with a microbubble-enhancing contrast material on a reference tumour. Relative blood flow (rBF) and relative blood volume (rBV) were obtained from the ratio of values obtained in the tumour and in adjacent liver parenchyma. Morphological parameters such as the tumour's major diameter and the viable tumour's major diameter were also measured. A parameter combining functional and morphological data, the tumour vitality index (TVI), was studied. The Wilcoxon rank-sum test and Fisher's test were used to compare treatment groups., Results: At 3 months rBF, rBV and TVI were significantly lower (P = 0.005, P = 0.04 and P = 0.03) for the group with doxorubicin. No difference in morphological parameters was found throughout the follow-up., Conclusions: One parameter, TVI, could evaluate the morphological and functional response to treatments.

Imaging is key in the accurate monitoring of response to cancer therapies targeting tumour vascularity to inhibit its growth and dissemination. Dynamic contrast enhanced ultrasound (DCE ultrasound) is a quantitative method with the advantage of being non-invasive, widely available, portable, cost effective, highly sensitive and reproducible using agents that are truly intravascular. Under the auspices of the initiative of the Experimental Cancer Medicine Centre Imaging Network, bringing together experts from the UK, Europe and North America for a 2-day workshop in May 2010, this consensus paper aims to provide guidance on the use of DCE ultrasound in the measurement of tumour vascular support in clinical trials. Key Points • DCE ultrasound can quantify and extract specific blood flow parameters, such as flow velocity, relative vascular volume and relative blood flow rate. • DCE ultrasound can be performed repeatedly and is therefore ideally suited for pharmacokinetic and pharmacodynamic studies evaluating vascular-targeted drugs. • DCE ultrasound provides a reproducible method of assessing the vascular effects of therapy in pre-clinical and early clinical trials, which is easily translatable into routine clinical practice.

This article updates the description of an anatomical variation of the liver, in which the gallbladder is adjacent to the ligamentum teres, that was described until now as "right-sided ligamentum teres and right umbilical portion of the portal vein". A study of eight patients showing this anatomical variation has led to a new archetypal anatomical description of the hepatic and portal veins, using multidetector-row computed tomography (MDCT) with three-dimensional (3D) volume-rendering (VR) reconstructions. While 2D axial imaging gave the same information, MDCT imaging with VR reconstructions provided a clear 3D visualization of this anatomical variation. Typical features can be described as follows: (1) juxtaposition of the ligamentum teres and the gallbladder; (2) typical portal vein branching with a right posterior branch, a left posterior branch and a main medial branch that terminates in the ligamentum teres; (3) two main hepatic veins and a hypotrophied medial hepatic vein. We think, based on the direct comparison of anatomical findings and knowledge of chronological embryological development, that this abnormality results from the defective development of the central part of the liver and not from the persistence of the right rather than the left umbilical vein. Because of the presence of only one medial plane, containing both the gallbladder and the ligamentum teres, we propose renaming it "fusion of hepatic planes".

The aim of this study was to correlate sonographic abnormalities of the rotator cuff with clinical findings in veteran tennis players. One hundred fifty individuals playing competition-level tennis, aged from 35 to 77 years (mean age 55 years), underwent physical and US examinations of their shoulders. The US abnormalities found in the dominant shoulder were compared with those observed in the non-dominant shoulder and in different subsets of players defined by the absence or presence of former and/or current pain. Tears of the long head of the biceps tendon were seen only in dominant shoulders ( n=8), and tears (23 complete and 20 partial) of the supraspinatus tendon were observed in 43 dominant vs 16 (3 complete and 13 partial) contralateral shoulders ( p<0.001). Subscapularis tendon calcifications were depicted in 23 dominant vs 12 contralateral shoulders ( p<0.05). Seventy players had no pain, 49 had former-but-not-current pain, and 31 had current pain. Abnormal thickening (>2 mm) and effusion of the subacromial-subdeltoid bursa and complete tear of the supraspinatus tendon were more frequent in the latter two groups ( p<0.001 and p<0.05), respectively. Although 90% of the players with a complete supraspinatus tear had experienced former pain, no relationship was found between current pain and the presence of a supraspinatus tear or tendon calcification. The rotator cuff may present important asymptomatic lesions, such as complete tears of the supraspinatus tendon or calcifications, that do not prevent the playing competitive tennis. The only US abnormality associated with pain was subacromial-subdeltoid bursa effusion.

The purpose of our study was to evaluate the ability of superparamagnetic iron oxide (SPIO)-enhanced MR imaging to detect liver fibrosis in patients with chronic liver disease and to compare the findings with histopathological data. Sixty-seven patients with chronic hepatitis ( n=58) or focal nodular hyperplasia (FNH; n=9) were studied using a 1.5-T MR system. The protocol included proton density-weighted, T2-weighted spin-echo (SE) and fast SE (FSE) sequences before and after SPIO administration and T2*-weighted gradient-recalled-echo (GRE) sequences after SPIO. Pre- and post-contrast T2-weighted and T2*-weighted sequences were retrospectively evaluated by three independent observers for evidence of non-tumor hypersignal intensities. Three liver patterns were considered: thick reticulations; thin reticulations; and/or multiple areas of hypersignal intensities. Unenhanced or enhanced patterns were compared with histopathological specimens, which had been obtained by percutaneous biopsy of the right lobe within a maximum of 12 months of MR examination. Liver fibrosis was histologically graded using a five-level scale (F0-F4), according to the METAVIR classification. Histopathology demonstrated significant fibrosis (F2-F4) in 57 patients, non-significant fibrosis in 1 patient (F1), and normal liver surrounding FNH in 9 patients (F0). After SPIO administration, at least one pattern of non-tumor hypersignal intensities was seen in 43 (76%) of the 57 patients with F>/=2 with good agreement (kappa=0.68) compared with 2 (20%) of the 10 F0/1 patients ( p<0.01). Attenuated non-homogeneous liver-signal intensities with persistent thick reticulations, thin reticulations, or multiple areas of hypersignals were observed in, respectively, 30, 52, and 56% of patients with F>/=2 with moderate agreement (kappa=0.51). Before SPIO, MR images were positive in 21 of 57 (37%) F>/=2 and zero F0/1 patients. Post-contrast proton-density-weighted and T2*-weighted GRE were the most sensitive sequences for detecting non-tumor hypersignal intensities. In patients with chronic liver diseases, SPIO-enhanced MR imaging exhibits non-tumor hypersignal intensities indicative of liver fibrosis by decreasing the signal from the non-fibrotic areas where Kupffer cells are present.