Apparent diffusion coefficients measured using different regions of interest in differentiating borderline from malignant ovarian tumors

Lu, Jing; Pi, Shan; Feng, Hua; Zhang, Guo Fu; Qiang, Jin Wei

doi:10.1177/0284185118805272

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…Although we did not aim to make a differentiation between borderline and malignant tumors, a more detailed analysis of the signal could potentially show differences between those tumors which could also be scientifically relevant as well as of translational clinical benefit. In the current literature, there are few studies that address this topic and which are focused mostly on DWI parameters [26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Non-contrast MRI can accurately characterize adnexal masses: a retrospective study

et al. 2021

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Objective To determine the accuracy of interpretation of a non-contrast MRI protocol in characterizing adnexal masses. Methods and materials Two hundred ninety-one patients (350 adnexal masses) who underwent gynecological MRI at our institution between the 1st of January 2008 and the 31st of December 2018 were reviewed. A random subset (102 patients with 121 masses) was chosen to evaluate the reproducibility and repeatability of readers’ assessments. Readers evaluated non-contrast MRI scans retrospectively, assigned a 5-point score for the risk of malignancy and gave a specific diagnosis. The reference standard for the diagnosis was histopathology or at least one-year imaging follow-up. Diagnostic accuracy of the non-contrast MRI score was calculated. Inter- and intra-reader agreement was analyzed with Cohen’s kappa statistics. Results There were 53/350 (15.1%) malignant lesions in the whole cohort and 20/121 (16.5%) malignant lesions in the random subset. Good agreement between readers was found for the non-contrast MRI score (к = 0.73, 95% confidence interval [CI] 0.58–0.86) whilst the intra-reader agreement was excellent (к = 0.81, 95% CI 0.70–0.88). The non-contrast MRI score value of ≥ 4 was associated with malignancy with a sensitivity of 84.9%, a specificity of 95.9%, an accuracy of 94.2% and a positive likelihood ratio of 21 (area under the receiver operating curve 0.93, 95% CI 0.90–0.96). Conclusion Adnexal mass characterization on MRI without the administration of contrast medium has a high accuracy and excellent inter- and intra-reader agreement. Our results suggest that non-contrast studies may offer a reasonable diagnostic alternative when the administration of intravenous contrast medium is not possible. Key Points • A non-contrast pelvic MRI protocol may allow the characterization of adnexal masses with high accuracy. • The non-contrast MRI score may be used in clinical practice for differentiating benign from malignant adnexal lesions when the lack of intravenous contrast medium precludes analysis with the O–RADS MRI score.

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Section: Discussionmentioning

confidence: 99%

Non-contrast MRI can accurately characterize adnexal masses: a retrospective study

et al. 2021

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“…Quantitative analysis of ADC maps in OC has previously shown promise in diagnostic and prognostic assessments, as well as in predicting NACT treatment response [ 17 , 23 , 26 – 29 ]. However, the integration of ADC measurements into clinical practice requires further research to define the most robust method for performing quantitative analyses in terms of performance and reproducibility, and to determine the optimal cut-off values for ADC change [ 18 , 25 , 30 ]. We retrospectively enrolled 23 patients with OC to examine whether the possible increase of ADC values could predict the response to NACT treatment.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy induces an elevation of tumour apparent diffusion coefficient values in patients with ovarian cancer

et al. 2023

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Objectives Multiparametric magnetic resonance imaging (mMRI) is the modality of choice in the imaging of ovarian cancer (OC). We aimed to investigate the feasibility of different types of regions of interest (ROIs) in the measurement of apparent diffusion coefficient (ADC) values of diffusion-weighted imaging in OC patients treated with neoadjuvant chemotherapy (NACT). Methods We retrospectively enrolled 23 consecutive patients with advanced OC who had undergone NACT and mMRI. Seventeen of them had been imaged before and after NACT. Two observers independently measured the ADC values in both ovaries and in the metastatic mass by drawing on a single slice of (1) freehand large ROIs (L-ROIs) covering the solid parts of the whole tumour and (2) three small round ROIs (S-ROIs). The side of the primary ovarian tumour was defined. We evaluated the interobserver reproducibility and statistical significance of the change in tumoural pre- and post-NACT ADC values. Each patient’s disease was defined as platinum-sensitive, semi-sensitive, or resistant. The patients were deemed either responders or non-responders. Results The interobserver reproducibility of the L-ROI and S-ROI measurements ranged from good to excellent (ICC range: 0.71–0.99). The mean ADC values were significantly higher after NACT in the primary tumour (L-ROI p < 0.001, S-ROIs p < 0.01), and the increase after NACT was associated with sensitivity to platinum-based chemotherapy. The changes in the ADC values of the omental mass were associated with a response to NACT. Conclusion The mean ADC values of the primary tumour increased significantly after NACT in the OC patients, and the amount of increase in omental mass was associated with the response to platinum-based NACT. Our study indicates that quantitative analysis of ADC values with a single slice and a whole tumour ROI placement is a reproducible method that has a potential role in the evaluation of NACT response in patients with OC. Trial registration Retrospectively registered (institutional permission code: 5302501; date of the permission: 31.7.2020).

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“…Preoperative recognition would enable strategies to retain fertility, e.g., cystectomies, ovarian stroma preservation, and unilateral salpingo-oophorectomy, therefore, DW-MRI has been explored as a potential clinical tool ( Figure 2 ). Various authors have investigated sophisticated ways to assess tiny solid components [ 39 , 40 , 41 ] including whole solid tumor histogram analysis models, diffusion kurtosis modelling, intravoxel incoherent motion models, or different non-Gaussian diffusion models. He et al excluded tumors with solid components smaller than 10 mm and carefully avoided hemorrhagic, necrotic, and cystic components and reported that diffusion kurtosis metrics (DKp10) yielded a sensitivity of 86% and an accuracy of 87% at a cut-off ADC value of 1.406 × 10 −3 mm 2 /s [ 42 ].…”

Section: Dw-mri For Differentiating Benign From Malignant Adnexal Massesmentioning

confidence: 99%

Diffusion-Weighted Magnetic Resonance Imaging in Ovarian Cancer: Exploiting Strengths and Understanding Limitations

Gagliardi

Adejolu

deSouza

2022

JCM

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Detection, characterization, staging, and response assessment are key steps in the imaging pathway of ovarian cancer. The most common type, high grade serous ovarian cancer, often presents late, so that accurate disease staging and response assessment are required through imaging in order to improve patient management. Currently, computerized tomography (CT) is the most common method for these tasks, but due to its poor soft-tissue contrast, it is unable to quantify early response within lesions before shrinkage is observed by size criteria. Therefore, quantifiable techniques, such as diffusion-weighted magnetic resonance imaging (DW-MRI), which generates high contrast between tumor and healthy tissue, are increasingly being explored. This article discusses the basis of diffusion-weighted contrast and the technical issues that must be addressed in order to achieve optimal implementation and robust quantifiable diffusion-weighted metrics in the abdomen and pelvis. The role of DW-MRI in characterizing adnexal masses in order to distinguish benign from malignant disease, and to differentiate borderline from frankly invasive malignancy is discussed, emphasizing the importance of morphological imaging over diffusion-weighted metrics in this regard. Its key role in disease staging and predicting resectability in comparison to CT is addressed, including its valuable use as a biomarker for following response within individual lesions, where early changes in the apparent diffusion coefficient in peritoneal metastases may be detected. Finally, the task of implementing DW-MRI into clinical trials in order to validate this biomarker for clinical use are discussed, along with the trials that include it within their protocols.

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Apparent diffusion coefficients measured using different regions of interest in differentiating borderline from malignant ovarian tumors

Cited by 5 publications

References 26 publications

Non-contrast MRI can accurately characterize adnexal masses: a retrospective study

Non-contrast MRI can accurately characterize adnexal masses: a retrospective study

Neoadjuvant chemotherapy induces an elevation of tumour apparent diffusion coefficient values in patients with ovarian cancer

Diffusion-Weighted Magnetic Resonance Imaging in Ovarian Cancer: Exploiting Strengths and Understanding Limitations

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