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  1. Article ; Online: Imaging incidental adrenal lesions.

    Sahdev, Anju

    The British journal of radiology

    2022  Volume 96, Issue 1142, Page(s) 20220281

    Abstract: Incidental adrenal masses are among the most common incidental lesions detected on cross-sectional imaging. The majority are benign lesions, adenomas and myelolipomas being the most common. Simple cross-sectional imaging techniques using CT and MRI ... ...

    Abstract Incidental adrenal masses are among the most common incidental lesions detected on cross-sectional imaging. The majority are benign lesions, adenomas and myelolipomas being the most common. Simple cross-sectional imaging techniques using CT and MRI permit the characterization of over 80%, thereby requiring no further imaging. The remaining lesions are considered indeterminate. These lesions consist of benign and malignant lesions sharing imaging features. Further imaging and management of these indeterminate lesions should be guided by close collaboration between different specialists in an MDT setting. Advanced imaging options include dedicated adrenal scintigraphy, positron emission tomography CT, biopsy and surveillance. Biochemical and hormonal evaluation is also important to identify hyperfunctioning adrenal lesions. This review focuses on imaging features of benign and malignant adrenal masses used for characterization and suggests an imaging pathway for indeterminate adrenal masses.
    MeSH term(s) Humans ; Adrenal Gland Neoplasms/diagnostic imaging ; Adrenal Gland Neoplasms/pathology ; Tomography, X-Ray Computed/methods ; Adenoma ; Magnetic Resonance Imaging ; Biopsy
    Language English
    Publishing date 2022-05-20
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2982-8
    ISSN 1748-880X ; 0007-1285
    ISSN (online) 1748-880X
    ISSN 0007-1285
    DOI 10.1259/bjr.20220281
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Recommendations for the management of adrenal incidentalomas: what is pertinent for radiologists?

    Sahdev, Anju

    The British journal of radiology

    2017  Volume 90, Issue 1072, Page(s) 20160627

    Abstract: Adrenal incidentalomas are unsuspected, asymptomatic adrenal masses detected on imaging. Most are non-functioning benign adrenocortical adenomas but can represent other benign lesions or lesions requiring therapeutic intervention including adrenocortical ...

    Abstract Adrenal incidentalomas are unsuspected, asymptomatic adrenal masses detected on imaging. Most are non-functioning benign adrenocortical adenomas but can represent other benign lesions or lesions requiring therapeutic intervention including adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis. This review summarizes and highlights radiological recommendations within the recently issued guidelines for the management of adrenal incidentalomas from the European Society of Endocrinology Clinical Practice in collaboration with the European Network for Study of Adrenal Tumours. Four pre-defined clinical questions were addressed in the guidelines and two have specific relevance and implications for radiologists: (1) how to assess risk of malignancy on imaging and (2) what follow-up is indicated if an adrenal incidentaloma is not surgically removed? The guidelines also include recommendations for frequently encountered special circumstances, including bilateral incidentalomas, incidentalomas in patients with extra-adrenal malignancy and in the young and elderly patients. This review highlights radiological recommendations within the guidelines and evidence used for formulating the guidelines.
    MeSH term(s) Adrenal Gland Neoplasms/diagnostic imaging ; Adrenal Glands/diagnostic imaging ; Diagnostic Imaging/methods ; Europe ; Humans ; Incidental Findings ; Practice Guidelines as Topic ; Societies, Medical
    Language English
    Publishing date 2017-02-09
    Publishing country England
    Document type Journal Article ; Practice Guideline
    ZDB-ID 2982-8
    ISSN 1748-880X ; 0007-1285
    ISSN (online) 1748-880X
    ISSN 0007-1285
    DOI 10.1259/bjr.20160627
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: CT in ovarian cancer staging: how to review and report with emphasis on abdominal and pelvic disease for surgical planning.

    Sahdev, Anju

    Cancer imaging : the official publication of the International Cancer Imaging Society

    2016  Volume 16, Issue 1, Page(s) 19

    Abstract: CT of the abdomen and pelvis is the first line imaging modality for staging, selecting treatment options and assessing disease response in ovarian cancer. The staging CT provides disease distribution, disease burden and is the imaging surrogate for ... ...

    Abstract CT of the abdomen and pelvis is the first line imaging modality for staging, selecting treatment options and assessing disease response in ovarian cancer. The staging CT provides disease distribution, disease burden and is the imaging surrogate for surgico-pathological FIGO staging. Optimal cyto-reductive surgery offers patients' the best chance for disease control or cure, but sub-optimal resection confers no advantage over chemotherapy and adversely increases the risk of post surgical complications. Although there is extensive literature comparing performance of CT against laparoscopy and surgery, for the staging abdominal and pelvic CT, there are currently no accepted guidelines for interpretation or routinely used minimum data set templates for reporting these complex CT scans often with extensive radiological findings. This review provides a systematic approach for identifying the important radiological findings and highlighting important sites of disease within the abdomen and pelvis, which may alter or preclude surgery at presentation or after adjuvant chemotherapy. The distribution of sites and volume of disease can be used to categorize patients as suitable, probably suitable or not suitable for optimal cyto-reductive surgery. This categorization can potentially assist oncological surgeons and oncologists as a semi objective assessment tool useful for selecting patient treatment, streamlining multi disciplinary discussion and improving the reproducibility and correlation of CT with surgical findings. The review also highlights sites of disease and complications of ovarian cancer which should be included as part of the radiological report as these may require additional surgical input from non gynaecological surgeons or influence treatment selection.
    MeSH term(s) Abdomen/diagnostic imaging ; Female ; Humans ; Neoplasm Invasiveness/diagnostic imaging ; Neoplasm Staging/standards ; Ovarian Neoplasms/diagnostic imaging ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/surgery ; Pelvis/diagnostic imaging ; Preoperative Care ; Reproducibility of Results ; Tomography, X-Ray Computed/methods ; Tomography, X-Ray Computed/standards
    Language English
    Publishing date 2016-08-02
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1470-7330
    ISSN (online) 1470-7330
    DOI 10.1186/s40644-016-0076-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Cervical tumors.

    Sahdev, Anju

    Seminars in ultrasound, CT, and MR

    2010  Volume 31, Issue 5, Page(s) 399–413

    Abstract: Imaging the cervix for benign and malignant disease can be achieved using transvaginal ultrasound, computed tomography (CT), magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography. The best established role of imaging is in ... ...

    Abstract Imaging the cervix for benign and malignant disease can be achieved using transvaginal ultrasound, computed tomography (CT), magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography. The best established role of imaging is in cervical carcinoma where magnetic resonance imaging, CT and increasingly positron emission tomography-CT are the most frequently used imaging modalities. These have a role in staging, treatment selection, recurrent disease, and imaging complications of treatment. Histopathological diagnosis of cervical disorders cannot be made on the basis of imaging alone but certain imaging features may provide an indication as to the underlying diagnosis. We describe the imaging features of some malignant tumor subtypes in which a preoperative diagnosis may alter management. Benign lesions of the cervix are usually detected incidentally or during investigations for dysfunctional vaginal bleeding. We describe the imaging features of the commonly encountered benign cervical lesions.
    MeSH term(s) Cervix Uteri/diagnostic imaging ; Cervix Uteri/pathology ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging/methods ; Neoplasm Recurrence, Local/diagnosis ; Neoplasm Staging ; Positron-Emission Tomography/methods ; Radiopharmaceuticals ; Radiotherapy Planning, Computer-Assisted/methods ; Tomography, X-Ray Computed/methods ; Uterine Cervical Diseases/diagnosis ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/pathology
    Chemical Substances Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2010-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1353113-x
    ISSN 1558-5034 ; 0887-2171
    ISSN (online) 1558-5034
    ISSN 0887-2171
    DOI 10.1053/j.sult.2010.07.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The role of

    Narayanan, Priya / Sahdev, Anju

    The British journal of radiology

    2017  Volume 90, Issue 1079, Page(s) 20170283

    Abstract: fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography ( ...

    Abstract [fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography (
    MeSH term(s) Adult ; Aged ; Endometrial Neoplasms/diagnostic imaging ; Female ; Fluorodeoxyglucose F18 ; Humans ; Middle Aged ; Ovarian Neoplasms/diagnostic imaging ; Positron Emission Tomography Computed Tomography/methods ; Radiopharmaceuticals ; Uterine Cervical Neoplasms/diagnostic imaging
    Chemical Substances Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2017-08-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2982-8
    ISSN 1748-880X ; 0007-1285
    ISSN (online) 1748-880X
    ISSN 0007-1285
    DOI 10.1259/bjr.20170283
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Imaging investigation of postmenopausal bleeding.

    Sahdev, Anju

    BMJ (Clinical research ed.)

    2009  Volume 338, Page(s) a2787

    MeSH term(s) Aged ; Diagnosis, Differential ; Endometrial Hyperplasia/diagnostic imaging ; Endometrial Neoplasms/diagnostic imaging ; Female ; Humans ; Polyps/ultrastructure ; Postmenopause ; Ultrasonography ; Uterine Hemorrhage/diagnostic imaging
    Language English
    Publishing date 2009-01-07
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.a2787
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Radiomics for Renal Cell Carcinoma: Predicting Outcomes from Immunotherapy and Targeted Therapies-A Narrative Review.

    Rallis, Kathrine S / Kleeman, Sam O / Grant, Michael / Ordidge, Katherine L / Sahdev, Anju / Powles, Thomas

    European urology focus

    2021  Volume 7, Issue 4, Page(s) 717–721

    Abstract: T-cell immunotherapy and molecular targeted therapies have become standard-of-care treatments for renal cell carcinoma (RCC). There is a need to develop robust biomarkers that predict patient outcomes to targeted therapies to personalise treatment. In ... ...

    Abstract T-cell immunotherapy and molecular targeted therapies have become standard-of-care treatments for renal cell carcinoma (RCC). There is a need to develop robust biomarkers that predict patient outcomes to targeted therapies to personalise treatment. In recent years, quantitative analysis of imaging features, termed radiomics, has been used to extract tumour features. This narrative mini review summarises the evidence for radiomics prediction of immunotherapy and molecular targeted therapy outcomes in RCC. Radiomics may predict survival, treatment response, and disease progression in RCC treated with tyrosine kinase inhibitors (eg, sunitinib) and immune checkpoint inhibitors (eg, nivolumab). Further validation is necessary in large-scale studies. PATIENT SUMMARY: We summarise evidence on the ability of features extracted from CT (computed tomography) scans to predict patient outcomes from new treatments for kidney cancer. Although these features can predict treatment outcomes for patients, including survival, treatment response, and cancer progression, further research is necessary before this technology can be applied clinically.
    MeSH term(s) Carcinoma, Renal Cell/diagnostic imaging ; Carcinoma, Renal Cell/therapy ; Humans ; Immunotherapy ; Kidney Neoplasms/diagnostic imaging ; Kidney Neoplasms/pathology ; Kidney Neoplasms/therapy ; Nivolumab ; Tomography, X-Ray Computed/methods
    Chemical Substances Nivolumab (31YO63LBSN)
    Language English
    Publishing date 2021-05-11
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 2405-4569
    ISSN (online) 2405-4569
    DOI 10.1016/j.euf.2021.04.024
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Diffusion-weighted imaging and dynamic contrast-enhanced MRI in assessing response and recurrent disease in gynaecological malignancies.

    Hameeduddin, Ayshea / Sahdev, Anju

    Cancer imaging : the official publication of the International Cancer Imaging Society

    2015  Volume 15, Page(s) 3

    Abstract: Magnetic resonance imaging (MRI) has an established role in imaging pelvic gynaecological malignancies. It is routinely used in staging endometrial and cervical cancer, characterizing adnexal masses, selecting optimal treatment, monitoring treatment and ... ...

    Abstract Magnetic resonance imaging (MRI) has an established role in imaging pelvic gynaecological malignancies. It is routinely used in staging endometrial and cervical cancer, characterizing adnexal masses, selecting optimal treatment, monitoring treatment and detecting recurrent disease. MRI has also been shown to have an excellent performance and an evolving role in surveillance of patients after chemoradiotherapy in cervical cancer, post-trachelectomy, detecting early recurrence and planning exenterative surgery in isolated central recurrences in both cervical and endometrial cancer and in young patients on surveillance for medically managed endometrial cancer. However, conventional MRI still has limitations when the morphological appearance of early recurrent or residual disease overlaps with normal pelvic anatomy or treatment effects in the pelvis. In particular, after chemoradiotherapy for cervical cancer, distinguishing between radiotherapy changes and residual or early recurrent disease within the cervix or the vaginal vault can be challenging on conventional MRI alone. Therefore, there is an emerging need for functional imaging to overcome these limitations. The purpose of this paper is to discuss the emerging functional MRI techniques and their applications in predicting treatment response, detecting residual disease and early recurrent disease to optimize the treatment options available using diffusion-weighted imaging and dynamic contrast enhancement particularly in cervical and endometrial cancer.
    MeSH term(s) Cytoreduction Surgical Procedures ; Diffusion Magnetic Resonance Imaging ; Endometrial Neoplasms/diagnosis ; Female ; Genital Neoplasms, Female/diagnosis ; Genital Neoplasms, Female/mortality ; Genital Neoplasms, Female/radiotherapy ; Genital Neoplasms, Female/surgery ; Humans ; Image Enhancement/methods ; Magnetic Resonance Imaging/methods ; Neoplasm Recurrence, Local/diagnosis ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/surgery ; Therapeutics ; Uterine Cervical Neoplasms/diagnosis
    Language English
    Publishing date 2015-03-15
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1470-7330
    ISSN (online) 1470-7330
    DOI 10.1186/s40644-015-0037-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Re: the prevalence of incidentally detected adrenal enlargement on CT. A reply.

    Tang, Yen Zhi / Sahdev, Anju

    Clinical radiology

    2014  Volume 69, Issue 6, Page(s) 658–659

    MeSH term(s) Adrenal Glands/diagnostic imaging ; Female ; Humans ; Male ; Tomography, X-Ray Computed
    Language English
    Publishing date 2014-06
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 391227-9
    ISSN 1365-229X ; 0009-9260
    ISSN (online) 1365-229X
    ISSN 0009-9260
    DOI 10.1016/j.crad.2014.02.002
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  10. Article ; Online: European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors.

    Fassnacht, Martin / Tsagarakis, Stylianos / Terzolo, Massimo / Tabarin, Antoine / Sahdev, Anju / Newell-Price, John / Pelsma, Iris / Marina, Ljiljana / Lorenz, Kerstin / Bancos, Irina / Arlt, Wiebke / Dekkers, Olaf M

    European journal of endocrinology

    2023  Volume 189, Issue 1, Page(s) G1–G42

    Abstract: Adrenal incidentalomas are adrenal masses detected on imaging performed for reasons other than suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas but may also require therapeutic intervention ... ...

    Abstract Adrenal incidentalomas are adrenal masses detected on imaging performed for reasons other than suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas but may also require therapeutic intervention including that for adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma, or metastases. Here, we provide a revision of the first international, interdisciplinary guidelines on incidentalomas. We followed the Grading of Recommendations Assessment, Development and Evaluation system and updated systematic reviews on 4 predefined clinical questions crucial for the management of incidentalomas: (1) How to assess risk of malignancy?; (2) How to define and manage mild autonomous cortisol secretion?; (3) Who should have surgical treatment and how should it be performed?; and (4) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected Recommendations: (1) Each adrenal mass requires dedicated adrenal imaging. Recent advances now allow discrimination between risk categories: Homogeneous lesions with Hounsfield unit (HU) ≤ 10 on unenhanced CT are benign and do not require any additional imaging independent of size. All other patients should be discussed in a multidisciplinary expert meeting, but only lesions >4 cm that are inhomogeneous or have HU >20 have sufficiently high risk of malignancy that surgery will be the usual management of choice. (2) Every patient needs a thorough clinical and endocrine work-up to exclude hormone excess including the measurement of plasma or urinary metanephrines and a 1-mg overnight dexamethasone suppression test (applying a cutoff value of serum cortisol ≤50 nmol/L [≤1.8 µg/dL]). Recent studies have provided evidence that most patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post dexamethasone >50 nmol/L (>1.8 µg/dL) harbor increased risk of morbidity and mortality. For this condition, we propose the term "mild autonomous cortisol secretion" (MACS). (3) All patients with MACS should be screened for potential cortisol-related comorbidities that are potentially attributably to cortisol (eg, hypertension and type 2 diabetes mellitus), to ensure these are appropriately treated. (4) In patients with MACS who also have relevant comorbidities surgical treatment should be considered in an individualized approach. (5) The appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health, and patient preference. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. (6) Surgery is not usually indicated in patients with an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. Furthermore, we offer recommendations for the follow-up of nonoperated patients, management of patients with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses, and for young and elderly patients with adrenal incidentalomas. Finally, we suggest 10 important research questions for the future.
    MeSH term(s) Aged ; Humans ; Adrenal Gland Neoplasms/diagnosis ; Adrenal Gland Neoplasms/therapy ; Adrenal Gland Neoplasms/pathology ; Dexamethasone ; Diabetes Mellitus, Type 2 ; Hydrocortisone
    Chemical Substances Dexamethasone (7S5I7G3JQL) ; Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2023-06-15
    Publishing country England
    Document type Journal Article ; Practice Guideline
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1093/ejendo/lvad066
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