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Abstract The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers, and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling, and planning of surgical treatment strategies.

To assess the sensitivity and specificity of MRI criteria in the differentiation between malignant peripheral nerve sheath tumors (MPNST) and non-neurogenic malignant soft-tissue tumors (MSTT). MRI examinations of 105 patients with pathologically proven malignant soft-tissue lesions (35 MPNST and 70 MSTT) were retrospectively reviewed, the reviewers being unaware of the pathological diagnosis. Using a standardized protocol, the tumors were evaluated for multiple parameters regarding morphology and appearance on different sequences before and after gadolinium contrast administration (location, distribution, delineation, homogeneity, size, shape, relationship to bone and neurovascular bundle, intralesional hemorrhage, necrosis, perilesional edema, lymphangitis and signal intensities). Results were compared using a chi-square or Fisher's exact test. MRI findings suggestive of MPNST (p<0,05) were intermuscular distribution, location on the course of a large nerve, nodular morphology, and overall non-homogeneity on T1-weighted images, T2-weighted images and T1-weighted images after gadolinium contrast injection. MRI findings in favor of MSTT were intramuscular distribution, ill-delineated appearance of more than 20% of the lesion's circumference, and presence of intralesional blood vessels, perilesional edema and lymphangitis. There is no significant difference for degree and pattern of enhancement after gadolinium contrast injection, nor for presence of bone involvement or cystic or necrotic areas. MRI provides several features that contribute to the differentiation between MPNST and non-neurogenic malignant soft-tissue tumors. MRI findings suggestive of MPNST should be helpful to pathologists in the strategy for further examination.

Background: Prior studies have shown that a standardized pulmonary vein isolation (PVI) workflow guided by a single ablation index (AI) value and a maximum interlesion distance (ILD) between corresponding ablation tags is associated with high single-procedure 1-year clinical success. Improvement in 1-year success may translate to lower cardiovascular healthcare utilization. Purpose: To evaluate the effect of a standardized AI workflow in PAF ablation on cardiovascular healthcare utilization. Methods: Patients were ablated for PAF in a prospective non-randomized clinical study across 17 European centres. Ablations followed a standard AI workflow (AI targets: 400 posterior, 550 anterior, ILD ≤6 mm) utilizing a contact force catheter, location stability settings of 2-3 mm for 3-5 s, 3 g force, and 25% force over time. Cardioversions and overnight cardiovascular hospitalizations were recorded for the 12-month periods pre- and post-ablation. Results: A total of 329 patients were eligible and ablated with AI guidance (age 61 ± 10 years, 60.8% male, CHA2DS2-VASc 1.6 ± 1.4). Cardiovascular hospitalizations were reduced by 42% (99 to 57, p=0.0015) and cardioversions were reduced by 62% (77 to 29, p<0.0001) after ablation (Figure). The 57 post-ablation cardiovascular hospitalizations included 35 repeat ablations in 33 subjects (10%). Conclusion: A standardized workflow incorporating AI guidance with a maximum ILD for PAF ablation resulted in a substantial reduction in cardiovascular hospitalization in the 12 months following ablation compared to the 12 months prior. [Image Omitted]