OBJECTIVE:To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC). METHODS:Twenty-one experts, members of the female pelvis imaging ESUR subcommittee from 19 institutions, replied to 2 rounds of questionnaires regarding imaging techniques and structured reporting used for pre-treatment evaluation of OC patients. The results of the survey were presented to the other authors during the group's annual meeting. The lexicon was aligned with the Society of American Radiology (SAR)-ESUR lexicon; a first draft was circulated, and then comments and suggestions from the other authors were incorporated. RESULTS:Evaluation of disease extent at diagnosis should be performed by chest, abdominal, and pelvic CT. The radiological report should map the disease with specific mention of sites that may preclude optimal cytoreductive surgery. For suspected recurrence, CT and [18F]FDG PET-CT are both valid options. MRI can be considered in experienced centres, as an alternative to CT, considering the high costs and the need for higher expertise in reporting. CONCLUSIONS:CT is the imaging modality of choice for preoperative evaluation and follow-up in OC patients. A structured radiological report, including specific mention of sites that may preclude optimal debulking, is of value for patient management. KEY POINTS:Question Guidelines were last published for ovarian cancer (OC) imaging in 2010; here, guidance on imaging techniques and reporting, incorporating advances in the field, are provided. Findings Structured reports should map out sites of disease, highlighting sites that limit cytoreduction. For suspected recurrence, CT and 18FDG PET-CT are options, and MRI can be considered. Clinical relevance Imaging evaluation of OC patients at initial diagnosis (mainly based on CT), using a structured report that considers surgical needs is valuable in treatment selection and planning.
To summarize the key updates introduced in the 2023 International Federation of Gynecology and Obstetrics (FIGO) classification for endometrial cancer (EC), and to highlight the role of MRI in aligning with these changes for improved staging and patient management. A review of the updated 2023 FIGO classification, which integrates molecular profiling and histopathological criteria, was conducted. Additionally, the revised European Society of Urogenital Radiology (ESUR) MRI recommendations were analyzed to assess their alignment with the new FIGO framework, focusing on their role in evaluating myometrial invasion (MI) and cervical stromal involvement. The updated FIGO classification incorporates molecular data to refine risk stratification and staging accuracy. MRI continues to play a pivotal role in distinguishing between stages, mapping disease extent, and guiding surgical planning. The updated ESUR recommendations emphasize standardized MRI protocols, particularly the use of multiphase contrast-enhanced imaging, to improve diagnostic confidence in assessing MI. The integration of molecular classification into FIGO staging, supported by standardized and advanced MRI protocols as recommended by ESUR, enhances the management of endometrial cancer. Question The 2023 FIGO update integrates molecular profiling into endometrial cancer staging, requiring MRI adaptations to improve accuracy in assessing disease extent, including myometrial invasion. Findings Updated ESUR MRI guidelines emphasize multiphase contrast-enhanced imaging, structured reporting, and integration with FIGO 2023 classification, enhancing diagnostic precision for staging and treatment planning. Clinical relevance Standardized MRI protocols aligned with FIGO 2023 system improve endometrial cancer staging, guiding optimal surgical and therapeutic strategies, reducing diagnostic variability, and enhancing patient outcomes through individualized risk stratification and personalized treatment.
Introduction: Atrial Fibrillation (AF) is detected in nearly 30% of patients undergoing cardiac monitoring after ischemic stroke. Studies investigating predictors of AF showed mixed results. In this study, we aim to identify predictors of AF on insertable cardiac monitors (ICMs) and compare rates between cryptogenic stroke patients and controls. Methods: The ANT icoagulation A nd St R oke Re C urrence in A T rial F I brillation Dete C ted A fter Stroke (ANTARCTICA) study is an individual patient data meta-analysis of prospective observational studies of cryptogenic ischemic stroke and control patients (non-cryptogenic ischemic stroke and non-ischemic stroke) who underwent an ICM implantation. The search included prospective observational studies and randomized controlled trials of patients with non-cardioembolic ischemic stroke or transient ischemic attack or non-ischemic stroke controls who underwent prolonged cardiac monitoring with an ICM after the index event. We performed multiple imputations to derive missing covariates such as left atrial volume index. We used multivariable multi-level logistic regression models to identify clinical, imaging, and echocardiographic factors associated with AF detection. We compared AF rates and charecterisctis between cryptogenic stroke and controls. Results: We identified 14 studies (2 RCTs and 12 observational) that included 2036 patients (1562 cryptogenic stroke and 474 non-cryptogenic stroke and non stroke controls); AF was detected in 30.7% of cryptogenic stroke patients and 29.1% of non-cryptogenic stroke patients. In multivariable logistic regression analyses, factors associated with AF were age (OR per year increase 1.05 95% CI 1.04-1.06), left atrial volume index (OR per unit increase 1.03 95% CI 1.02-1.05), and cryptogenic stroke (adjusted OR 1.89, 95% CI 1.20-2.98, p = 0.006). When compared to controls, the time to AF detection was significantly shorter in cryptogenic stroke (median 65 days vs. 169 days, p < 0.001) and AF duration was non-significantly longer (median 90 minutes vs. 120 minutes, p = 0.144). Results remained unchanged when the control group was limited to patients with non-cryptogenic ischemic stroke. Conclusions: In this large, individual patient data meta-analysis of patients undergoing ICM, there is increased detection and burden of AF after cryptogenic stroke compared to controls, suggesting a likely pathogenicity of device-detected AF in cryptogenic stroke.
Nanoparticles can acquire a protein corona defining their biological identity. Corona functions were not yet considered for cell-derived extracellular vesicles (EVs). Here we demonstrate that nanosized EVs from therapy-grade human placental-expanded (PLX) stromal cells are surrounded by an imageable and functional protein corona when enriched with permissive technology. Scalable EV separation from cell-secreted soluble factors via tangential flow-filtration and subtractive tandem mass-tag proteomics revealed significant enrichment of predominantly immunomodulatory and proangiogenic proteins. Western blot, calcein-based flow cytometry, super-resolution and electron microscopy verified EV identity. PLX-EVs protected corona proteins from protease digestion. EVs significantly ameliorated human skin regeneration and angiogenesis in vivo, induced differential signaling in immune cells, and dose-dependently inhibited T cell proliferation in vitro. Corona removal by size-exclusion or ultracentrifugation abrogated angiogenesis. Re-establishing an artificial corona by cloaking EVs with defined proangiogenic proteins served as a proof-of-concept. Understanding EV corona formation will improve rational EV-inspired nanotherapy design.
