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ITMIG Classification of Mediastinal
Compartments and Multidisciplinary
Approach to Mediastinal Masses
Autor: Brett W. Carter, MD, Marcelo F. Benveniste, MD, Rachna Madan, MD, Myrna C. Godoy, MD, PhD, Patricia M. de Groot, MD, Mylene T. , ruong, MD, Melissa L. Rosado-de-Christenson, MD, Edith M. Marom, MD
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Division of the mediastinum into specific compartments is beneficial
for a number of reasons, including generation of a focused
differential diagnosis for mediastinal masses identified on imaging
examinations, assistance in planning for biopsies and surgical
procedures, and facilitation of communication between clinicians
in a multidisciplinary setting. Several classification schemes for
the mediastinum have been created and used to varying degrees
in clinical practice. Most radiology classifications have been based
on arbitrary landmarks outlined on the lateral chest radiograph. A
new scheme based on cross-sectional imaging, principally multidetector
computed tomography (CT), has been developed by the
International Thymic Malignancy Interest Group (ITMIG) and
accepted as a new standard. This clinical division scheme defines
unique prevascular, visceral, and paravertebral compartments
based on boundaries delineated by specific anatomic structures at
multidetector CT. This new definition plays an important role in
identification and characterization of mediastinal abnormalities,
which, although uncommon and encompassing a wide variety of
entities, can often be diagnosed with confidence based on location
and imaging features alone. In other scenarios, a diagnosis may
be suggested when radiologic features are combined with specific
clinical information. In this article, the authors present the new
multidetector CT–based classification of mediastinal compartments
introduced by ITMIG and a structured approach to imaging evaluation
of mediastinal abnormalities.
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Multiparametric magnetic resonance imaging
(MRI) is essential in the evaluation of sonographically
indeterminate adnexal lesions, because it
enables an adequate characterization of these lesions
and their classification based on the degree
of suspicion for malignancy. It also allows the
most accurate therapy and/or follow-up approach,
limiting the associated costs.
The majority of indeterminate adnexal lesions
at ultrasound are benign and its characterization
with MRI avoids unnecessary and inappropriate
surgery. Only a minority of these lesions corresponds
to malignant adnexal disease, and their
proper evaluation by MRI allows timely implementation
of the correct therapeutic approach,
which is the key aspect in the management of
these tumors.
In this article the authors review and illustrate the
MRI characteristics of the sonographically indeterminate
adnexal lesions, which classifies them
attending to their degree of suspicion. The multiparametric
MRI protocol that should be applied
in the study of these tumors is also highlighted.
Key-words:
Adnexal Diseases; Ultrasound; Magnetic
Resonance; Classification.
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