Cystic female pelvic lesions, whether of ovarian or non-ovarian origin, are prevalent in routine clinical practice, with the majority originating from gynaecological (ovarian) structures, ranging from functional cysts to malignant ovarian tumours. Despite the fact that we encounter these lesions in the course of our routine clinical work, arriving at an accurate diagnosis can often prove challenging due to the overlap of imaging appearances. Ultrasound is the primary imaging modality for the evaluation of most cystic female pelvic lesions, while MRI serves as a problem-solving tool. In cases that are more complex or equivocal, pelvic MRI proved to be particularly useful due to its superior soft tissue resolution, multiplanar imaging capability and non-invasive nature. In order to make an accurate diagnosis, it is crucial to have a comprehensive understanding of pelvic topographic anatomy, be familiar with possible differential diagnoses and include all relevant clinical data. The classification of ovarian cystic lesions was undertaken using the O-RADS MRI risk stratification system, which provides standardised language for communication between radiologists and clinicians. The objective of this review is to illustrate the spectrum of typical MRI characteristics of different cystic female lesions of both ovarian and non-ovarian origin, with the emphasis on differential diagnoses. The review includes tables with MRI appearances on T2, T1, DWI sequences and postcontrast tomograms. To facilitate the learning process, schematic representations of MRI appearances of ovarian lesions have been incorporated. MRI diagnosis of various ovarian and non-ovarian cystic female pelvic lesions and their differential diagnosis.

The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to formulate recommendations on the imaging modalities and minimal technical requirements for abdominopelvic imaging in the follow-up of adult patients treated for testicular germ-cell tumors (TGCT). The SPIWG members performed an extensive literature search, reviewed the current clinical practice, and reached a consensus based on the opinions of experts in the field. Recurrence in patients treated for TGCT mainly occurs in retroperitoneal lymph nodes (LNs). Abdominopelvic CT and MRI are equivalent assessing retroperitoneal LNs. MRI has the advantage of avoiding radiation exposure, and moreover, diffusion-weighted images (DWI) may increase the detection rates without the need for contrast administration. In patients treated for stage I TGCT, the ESUR-SPIWG recommends MRI over CT for the detection of retroperitoneal LNs during the follow-up after treatment. CT, however, remains the follow-up imaging of choice in patients with advanced disease. When MRI is used, the recommended minimal requirements are at least one high-quality anatomical sequence (T1-WI or T2-WI) in axial and coronal planes, and DWI in the same axial plane, ≤ 4 mm contiguous slices from the diaphragm to the perineum. When CT is used, the recommended minimal requirement is a standard-dose contrast-enhanced CT in the portal-venous phase, scanned from the diaphragm to the perineum. In this paper, the ESUR-SPIWG provides recommendations on the imaging modalities and minimal technical requirements for abdominopelvic imaging in the follow-up of adult patients treated for TGCT. Question There are no recommendations on the preferred imaging modality or scan sequences required for abdominopelvic imaging in the follow-up after treatment for testicular cancers. Findings The European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) provides recommendations for abdominopelvic imaging in follow-up after treatment for testicular cancers. Clinical relevance Recurrence of testicular germ-cell tumors mainly occurs in retroperitoneal lymph nodes. Both CT and MRI provide similar morphological assessments, but radiation exposure can be avoided by using MRI instead of CT.

Objectives: To investigate the impact of compressed sensing - sensitivity encoding (CS-SENSE) acceleration factor on the diagnostic performance of magnetic resonance imaging (MRI) within standard female pelvis protocol in patients with endometrial cancer. Methods: T2-weighted turbo spin echo (TSE) sequence from standard female pelvic MRI protocol was chosen due to its long acquisition time and essential role in the evaluation of morphological characteristics of the female pelvic anatomical structures. Fully sampled reference scans and multiple prospectively 2x to 5x under-sampled CS-SENSE scans were acquired. Retrospectively, under-sampled scans were compared to fully sampled scans and visually assessed for image quality and diagnostic quality by two independent radiologists dedicated to urogenital imaging with different experience levels. Results: Images obtained with CS-SENSE accelerated acquisition were of diagnostically acceptable quality at up to 3x acceleration for T2 TSE in both axial and sagittal planes (with an acquisition time reduction of 64 %). Among all evaluated uterine structures, the junctional zone proved to be most sensitive to the influence of the acceleration factor. Statistical analysis showed statistically significant differences between image interpretation qualities between two radiologists of different experience levels (p < 0.05). Conclusion: CS-SENSE accelerated T2 TSE sequence of the female pelvis shows image quality similar to that of conventional acquisitions with reduced acquisition time. CS-SENSE can moderately reduce scan time, providing many benefits without losing the image quality.

Background/Aim. Breast cancer is a leading global health concern. Contrast-enhanced mammography (CEM) presents a promising advancement in early breast cancer detection, excelling in sensitivity, specificity, and cost-effectiveness. The aim of the study was to assess the overall diagnostic efficacy of CEM in breast cancer screening, particularly in distinguishing benign from malignant lesions in dense breasts. Methods. A two-year retrospective study was conducted at the Center for Radiology, including a total of 279 women undergoing CEM following standard mammography. Results. CEM demonstrated high sensitivity (92.4%), specificity (75.1%), and a noteworthy negative predictive value of 97.0%, significantly reducing unnecessary biopsies. Conclusion. CEM is a valuable screening tool, offering enhanced diagnostic capabilities and the potential to reduce the number of unnecessary biopsies. It is particularly beneficial for patients with dense breasts or inconclusive traditional mammography results.

Background/Objectives: Chronic spontaneous urticaria (CSU) is an immune-mediated skin disorder, with increasing evidence suggesting its association with autoimmune thyroid diseases. The presence of antithyroid antibodies (anti-TPO and anti-TG) and autoimmune thyroid disease indicates shared immunological mechanisms in the pathogenesis of both conditions. This study examines the prevalence of autoimmune thyroid changes in patients with CSU. Methods: The study was conducted as a combined retrospective-prospective observational analysis. It included 43 patients with CSU and 50 healthy participants in the control group. Thyroid hormone levels (TSH, T3, T4), anti-TPO and anti-TG antibodies, as well as ultrasound characteristics of the thyroid gland, were analyzed. Results: In patients with CSU, a higher prevalence of hypothyroidism (27.9% vs. 4% in the control group), hypertension, asthma, and diabetes were observed. Elevated levels of anti-TPO antibodies were found in 51.2% of CSU patients, compared to only 6% in the control group (p < 0.001). Similarly, anti-TG antibodies were increased in 41.9% of CSU patients, compared to 4% in the control group. Additionally, ultrasound analysis revealed significant differences in thyroid morphology, with a heterogeneous structure observed in 72.1% of CSU patients, compared to only 14% in the control group (p < 0.001). Nodular changes were present in 34.88% of CSU patients, whereas the prevalence in the control group was only 6% (p < 0.001). Conclusions: Our results confirm a significant association between CSU and autoimmune thyroid diseases, including a high prevalence of anti-TPO and anti-TG antibodies, hypothyroidism, diffuse heterogeneity, and nodular changes. Additionally, elevated T3 hormone levels were common among CSU patients, while T4 levels did not differ significantly from those in the control group.

The analysis of works of art (artifacts) requires non-destructive techniques that offer both morphological and material characterization. In this study, we show how Dual Energy Computed Tomography (DECT) could be used to characterize natural pigments ( e. g ., lead white, red lead, cinnabar, red ochre, etc.) in the painting layer of an18th-century icon. Image acquisition was performed on a clinical single-energy multi-slice CT scanner using four different X-ray tube potentials at 80, 100, 120, and 140 kV. Energy dispersive X-ray fluorescence (EDXRF) analysis was performed to validate material characterization results obtained from DECT. The optimal pair of X-ray tube potentials was found to be 80 and 120 kV, considering the maximum separation of the four regions of interest in two-dimensional Hounsfield units (HU) histogram space. Using lead white and cinnabar as a decomposition basis, maps of lead-based and mercury-based pigments were created from the dual energy (80 and 120 kV) CT scans using the material decomposition method. The obtained results were successfully validated against EDXRF measurements. The material maps were then used to analyse red pigments, i.e., distinguish red ochre and cinnabar pigments and exclude the presence of red lead from selected regions within the icon. The examination of the icon showed the new potential of the presented technique to provide valuable material composition information for the conservation and preservation study of artifacts while maintaining their integrity. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Diagnostic imaging of peritoneal metastases in ovarian and colorectal cancer remains pivotal in selecting the most appropriate treatment and balancing clinical benefit with treatment-related morbidity and mortality. To address the challenges related to diagnostic imaging and detecting and reporting peritoneal metastatic spread, a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Society of Urogenital Radiology (ESUR), Peritoneal Surface Oncology Group International (PSOGI), and European Association of Nuclear Medicine (EANM). A targeted literature search was performed and consensus recommendations were proposed using Delphi questionnaires and a five-point Likert scale. A total of three Delphi rounds were performed. Consensus was reached on the position of diagnostic imaging for assessment of operability, treatment response monitoring, and follow-up of peritoneal metastases, optimal imaging modality and their technical imaging requirements depending on the indication and how to optimise communication of imaging results by the report and multidisciplinary board discussion. The complete list of recommendations is provided. These expert consensus statements aim to guide appropriate indications, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients. Question Staging peritoneal metastases (PM) helps to guide clinical decision-making for colorectal and ovarian cancer patients. How can we optimise the use of imaging techniques to assess PM? Findings Imaging plays a crucial role in the detection, operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in colorectal and ovarian cancer patients. Clinical relevance These expert consensus statements aim to guide appropriate indication, acquisition, interpretation, and reporting of imaging for operability assessment, treatment response monitoring, and follow-up of peritoneal metastases in ovarian and colorectal cancer patients.

The paper presents the results of the multi-analytical study of the painting on a panel from the icon collection of the Gallery of Matica srpska museum in Novi Sad, Serbia. It is part of the research aiming to set the methodology for the museum’s database on artistic materials and techniques present in the collection. Computer tomography (CT) scanning was used to understand the structure of the wooden panel support. Ultraviolet (UV) and infrared (IC) imaging, as well as visible (VIS) macro photography, were used to study the paint layer, both the original part and restoration treatments, as well as the coat of varnish. Energy dispersive X-ray fluorescence (EDXRF) and Fourier-transform infrared (FTIR) spectroscopy revealed the pigments, binders, and metal leaf, defining the artistic technique. Optical microscopy (OM) and scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) were used to disclose the stratigraphy and composition of layers in the artwork. The multi-analytical approach confirmed that protein-based binder, gilding, silver leaf, and traditional pigments were used. The data gathered from this research are important for studying the artistic materials and techniques in icon production and defining the methodology setting for the museum collection’s databases as the reference material.

IntroductionMagnetic resonance imaging (MRI) with its innovative techniques, such as diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC), increases the diagnostic accuracy in distinguishing between malignant and benign lesions of the endometrium. The aim of the study was MRI differentiation between malignant and benign endometrial lesions and correlation with histopathological findings with a special emphasis on quantitative analysis. An additional aim was to correlate the ADC values and histological tumor grades.MethodsThe prospective study included 119 female patients with or without vaginal bleeding and pathological values of endometrial thickness, who underwent MRI examinations. According to MRI reports the patients were divided into 45 suspicious malignant and 74 suspicious benign endometrial lesions. The radiological diagnosis was compared to the histopathological evaluation, which confirmed 37 malignant lesions while the rest were benign.ResultsThe mean ADC value for malignant lesions was 0.761 ± 0.13×10−3 mm2/s and for benign lesions was 1.318 ± 0.20×10−3 mm2/s. The ADC values for malignant lesions were expectedly lower than those of benign lesions (p<0.001). The ADC cut-off value was 1.007×10−3 mm2/s with a sensitivity of 100%, specificity of 92.7%, a positive predictive value of 60.3%, and a negative predictive value of 100%. In comparison with the histopathological findings, the sensitivity of MRI was 100%, specificity 90.2%, positive predictive value was 82.2%, and negative predictive value was 100%. Observing the histological grades 1, 2, and 3 of endometrial carcinoma, no statistically significant differences of mean ADC values were found. The mean ADC values for histological tumor grades 1,2 and 3 were 0.803 ± 0.13×10−3 mm2/s, 0.754 ± 0.12×10−3 mm2/s and 0.728 ± 0.13×10−3 mm2/s, respectively.ConclusionDWI and ADC values represent clinically useful tools for the differentiation between malignant and benign endometrial lesions with high sensitivity and good specificity, but the results failed to demonstrate their usefulness in differentiating histological grades of endometrial cancer.

Background/Aim. Functional imaging, including diffusion-weighted magnetic resonance imaging (DWI MRI) and apparent diffusion coefficient (ADC) map, provides promising results in discrimination benign from malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. The aim of the study was to assess diagnostic performances of DWI in differentiation between benign and malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. Methods. The prospective clinical study was conducted at the Clinical Center of Vojvodina, Serbia, from 2013 to 2016, comprising 80 patients with malignant gynecological tumors. Preoperatively, all patients underwent MRI examination, followed by standard surgical treatment with complete pelvic and/or inguinal lymphadenectomy. A combination of ADC value criteria and size-based criteria yields MRI the following diagnostic performances in discrimination between benign and malignant lymph nodes: sensitivity 95%, specificity 92%, overall accuracy 92.5%, positive predictive value 46%, and negative predictive value 99.6%. Histopathological examination of surgically removed material and lymph nodes separated in pelvic and inguinal anatomic groups was performed after the surgery. Results. A total of 2,320 lymph nodes were mapped and histopathologically examined in 80 patients included in the study. Metastases in lymph nodes were histopathologically confirmed in 28 (35%) patients. Measured ADC values were significantly lower in metastatic (mean ? standard deviation (SD), ADC: 0.8725 ? 10-3 ? 0.0125 ? 10-3 mm2/s) than benign lymph nodes (mean ? SD, ADC: 1.116 ? 10-3 ? 0.1848 ? 10-3 mm2/s; p = 0.001). If ADC value of 0.860 ? 10-3 mm2/s was determined as a cut-off value for discrimination between benign and malignant lymph nodes, DWI sensitivity was 89%, specificity 85%, and overall accuracy was 86%, positive predictive values 30%, and negative predictive value 99%. Conclusion. DWI MRI sequence is a fast, simple, non-invasive method that aids significantly to MRI diagnostic performances in dis-crimination between benign and malignant pelvic and inguinal lymph nodes.

Objective The aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging staging guidelines for vulvar cancer and to propose standardised MRI protocols and reporting. Methods The guidelines recommended from the ESUR in this article resulted from a questionnaire analysis regarding imaging staging of vulvar cancer that was answered by all members of the Female Pelvic Imaging Working Group. Only the answers with an agreement equal to or more than 80% were considered. Additionally, the literature was reviewed to complement and further support our conclusions. Results The critical review of the literature and consensus obtained among experts allows for recommendations regarding imaging staging guidelines, patient preparation, MRI protocol, and a structured MRI report. Conclusions Standardising image acquisition techniques and MRI interpretation reduces ambiguity and ultimately improves the contribution of radiology to the staging and management of patients with vulvar cancer. Moreover, structured reporting assists with the communication of clinically relevant information to the referring physician.

Imaging evaluation is an essential part of treatment planning for patients with ovarian cancer. Variation in the terminology used for describing ovarian cancer on computed tomography (CT) and magnetic resonance (MR) imaging can lead to ambiguity and inconsistency in clinical radiology reports. The aim of this collaborative project between Society of Abdominal Radiology (SAR) Uterine and Ovarian Cancer (UOC) Disease-focused Panel (DFP) and the European Society of Uroradiology (ESUR) Female Pelvic Imaging (FPI) Working Group was to develop an ovarian cancer reporting lexicon for CT and MR imaging. Twenty-one members of the SAR UOC DFP and ESUR FPI working group, one radiology clinical fellow, and two gynecologic oncology surgeons formed the Ovarian Cancer Reporting Lexicon Committee. Two attending radiologist members of the committee prepared a preliminary list of imaging terms that was sent as an online survey to 173 radiologists and gynecologic oncologic physicians, of whom 67 responded to the survey. The committee reviewed these responses to create a final consensus list of lexicon terms. An ovarian cancer reporting lexicon was created for CT and MR Imaging. This consensus-based lexicon has 6 major categories of terms: general, adnexal lesion-specific, peritoneal carcinomatosis-specific, lymph node-specific, metastatic disease -specific, and fluid-specific. : This lexicon for CT and MR imaging evaluation of ovarian cancer patients has the capacity to improve the clarity and consistency of reporting disease sites seen on imaging. • This reporting lexicon for CT and MR imaging provides a list of consensus-based, standardized terms and definitions for reporting sites of ovarian cancer on imaging at initial diagnosis or follow-up. • Use of standardized terms and morphologic imaging descriptors can help improve interdisciplinary communication of disease extent and facilitate optimal patient management. • The radiologists should identify and communicate areas of disease, including difficult to resect or potentially unresectable disease that may limit the ability to achieve optimal resection.

Acute pelvic pain (APP) requires urgent medical evaluation and treatment. Differential diagnosis of APP is broad, including a variety of gynecologic and non-gynecologic/ urinary, gastrointestinal, vascular and other entities. Close anatomical and physiological relations of pelvic structures, together with similar clinical presentation of different disorders and overlapping of symptoms, especially in the emergency background, make the proper diagnosis of APP challenging. Imaging plays a crucial role in the fast and precise diagnosis of APP. Ultrasonography is the first-line imaging modality, often accompanied by CT, while MRI is utilized in specific cases, using short, tailored protocols. Recognizing the cause of APP in females is a challenging task, due to the wide spectrum of possible origin and overlap of their imaging features. Therefore, the radiologist has to be familiar with the possible causes of APP, and, relying on clinical presentation, together with laboratory findings, choose the best imaging strategy in order to establish a fast and accurate diagnosis.

PURPOSE:To investigate the impact of compressed sensing - sensitivity encoding (CS-SENSE) acceleration factor on the diagnostic quality of magnetic resonance images within standard brain protocol. METHODS:Three routine clinical neuroimaging sequences were chosen for this study due to their long acquisition time: T2-weighted turbo spin echo (TSE), fluid - attenuated inversion recovery (FLAIR), and 3D time of flight (TOF). Fully sampled reference scans and multiple prospectively 2x to 5x undersampled CS scans were acquired. Retrospectively, undersampled scans were compared to fully sampled scans and visually assessed for image quality and diagnostic quality by three independent radiologists. RESULTS:Images obtained with CS-SENSE accelerated acquisition were of diagnostically acceptable quality at up to 3x acceleration for T2 TSE (average qualitative score 3.53 on a 4-point scale, with the acquisition time reduction of 64%), up to 2x for FLAIR (average qualitative score 3.27, with the acquisition time reduction of 43%) and 4x acceleration for 3D TOF sequence (average qualitative score 3.13, with the acquisition time reduction of 73%). There were no substantial differences between the readers' diagnostic quality scores (p > 0.05). CONCLUSIONS:CS-SENSE accelerated T2 TSE, FLAIR, and 3D TOF sequences of the brain show image quality similar to that of conventional acquisitions with reduced acquisition time. CS-SENSE can moderately reduce scan time, providing many benefits without losing the image quality.

A 28-year-old patient was admitted to radiology department due to a painless left-sided extra scrotal lump and discomfort in the ipsilateral lower inguinal region. Scrotal ultrasound revealed an oval circumscribed soft tissue mass, located in the proximity of the distal part of spermatic cord, without visible flow at Color Doppler. Scrotal MRI depicted T2 hyperintense, T1 hypo- to isointense oval mass with diffusion restriction and no fat suppression, surrounded by T1/T2 hypointense rim, located close to the spermatic cord. Additionally, MRI revealed coma-shaped T1 iso-/T2 hypointense related to the testicle formation. Following the intravenous administration of gadolinium-based contrast agent, both previously described structures enhanced. Taking into account that malignancy could be the potential complication of polyorchidism our patient was operated and histopathology confirmed supernumerary testicle with cribriform epididymal hyperplasia.

Imaging plays a crucial role in the evaluation of scrotal trauma. Among the imaging modalities, greyscale ultrasound and Colour Doppler ultrasound (CDUS) are the primary techniques with the selective utilisation of advanced techniques such as contrast-enhanced ultrasound (CEUS) and elastography. Despite ultrasound being the mainstay of imaging scrotal trauma, its diagnostic performance is not fully established. Considering these difficulties and their impact on clinical practice, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) established an expert task force to review the current literature and consolidate their expertise on examination standards and imaging appearances of various entities in scrotal trauma. This paper provides the position statements agreed on by the task force with the aim of providing guidance for the use of imaging especially multiparametric US in scrotal trauma. Key Points • Greyscale and Colour Doppler ultrasound are the mainstay of imaging in patients with scrotal trauma. • Contrast-enhanced ultrasound and elastography are the advanced techniques useful as a problem-solving modality in equivocal cases. • This paper summarises the position statements of the ESUR-SPIWG on the appropriate utilisation of multiparametric ultrasound and other imaging modalities in the evaluation of scrotal trauma.

Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.

MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis.

High prevalence, peculiar etiopathogenesis, and ineffective therapies have contributed to the fact that genital warts are one of the most challenging issues in modern medicine. This prospective study was aimed at determining the clinical efficacy of combination therapy with 0.5% podophyllotoxin solution and liquid nitrogen cryotherapy in the local treatment of genital warts in men. One hundred and ten consecutive male patients with genital warts were randomly assigned to two groups. The control group consisted of two subgroups: 30 patients treated with podophyllotoxin and 30 patients treated with cryotherapy. The experimental group included 50 patients treated with combination therapy. The therapy continued until complete regression, but not longer than six weeks. Analysis of the average increase in the number of cleared warts compared to week zero found a significant clinical improvement in the group treated with a combination therapy in relation to the group treated with podophyllotoxin at the end of each of the six weeks and in comparison with the group treated with cryotherapy at the end of each of the first three weeks. After discontinuation of therapy, a significantly lower recurrence rate and appearance of new condylomas was observed at the end of the third month in the group treated with a combination therapy compared with each group treated with monotherapy, and at the end of the sixth month compared with patients treated with cryotherapy. The combination of podophyllotoxin and cryotherapy showed a significantly higher efficacy in the treatment of genital warts in comparison with monotherapy with podophyllotoxin after 6 weeks of treatment (P<0.001), with considerably lower recurrence and appearance of new warts compared with cryotherapy during the 6 months after therapy (P<0.005).