1. To learn the MRI technique for imaging the peritoneum in advanced ovarian cancer.
2. To learn the appearances of WB-MRI in metastatic ovarian cancer.
3. To be aware of the pitfalls to interpretation.
By their ability to evaluate distant nodal or visceral metastatic disease spread, computed tomography (CT), Fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) and magnetic resonance imaging (MRI) have an increasingly important role in the management of gynaecological cancers. MRI has established its clinical importance by its superior contrast resolution and ability to extract morphological and functional information, beneficial for tumour detection, characterisation, staging and response assessment. The single most important prognostic factor in ovarian cancer is complete tumour resection at debulking surgery. In patients suspected for ovarian cancer, imaging workup has a major role in depicting metastases in order to assess resectability. CT tends to underestimate peritoneal disease extent; a problem that is not adequately solved by FDG-PET/CT. Recent technological progress has enabled time efficient whole-body MRI (WB-MRI) integrating diffusion-weighted imaging (DWI); the latter allows for the depiction of millimetric tumour deposits. In recent studies, WB-MRI/DWI has shown greater accuracy for a comprehensive presurgical depiction of peritoneal metastases over CT or FDG-PET/CT, while WB-MRI/DWI has shown similar accuracy to FDG-PET/CT for depicting distant metastases and lymphadenopathies. Important for surgical planning, MRI has shown better sensitivity over conventional imaging for detecting involvement of surgically critical tumour sites including mesenteric root infiltration small bowel and colon carcinomatosis and unresectable distant metastases. This presentation will discuss sequence optimisation, DWI anatomy, physiological signal and artefacts, the appearance of tumoral lesions in relation to their size and correlation of WB-MRI/DWI findings to surgical criteria that determine complete resection.
1. To learn the indications for use of hybrid imaging in cervix and endometrial cancer.
2. To know the strengths and weaknesses of the technique.
3. To be familiar with the role of hybrid imaging in patient prognosis.
1. To learn about the concept and technique of texture analysis.
2. To be familiar with the key associations of biology and texture features.
3. To be familiar with the potential added value of texture analysis in image interpretation.
Tumour heterogeneity in metastatic gynaecological cancer and especially advanced ovarian cancer has been reported at the histological and genetic levels and found to be associated with adverse clinical outcomes. Classic tumour evaluation using standard CT or MRI techniques does not account for the intra- or inter-tumoural heterogeneity in advanced ovarian cancer with peritoneal carcinomatosis. As such, computational approaches in assessing tumour heterogeneity have been proposed using radiomics and radiogenomics to capitalise the whole tumour heterogeneity as opposed to single biopsy sampling. As part of radiomics, texture analysis which includes the extraction of multiple data from the images has been proposed recently to evaluate advanced ovarian tumour heterogeneity. The preliminary data suggests that it can unravel tumour heterogeneity and predict response to treatment both conventional and immunotherapy.