Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass?

Dilks, Philip; Narayanan, Priya; Reznek, Rodney H.; Sahdev, Anju; Rockall, Andrea

doi:10.1007/s00330-010-1795-6

Cited by 47 publications

(42 citation statements)

References 27 publications

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“…Our previous preliminary study suggested the potential of using threshold criteria based on maximum tumour signal intensity (SI max ) and maximum tumour/psoas muscle signal intensity ratio (SI max ratio) [25]. In the present study, analysing a larger population, we have confirmed that these parameters are significantly different in benign and borderline/invasive malignant groups.…”

Section: Discussionsupporting

confidence: 90%

“…Studies have postulated a relationship between early enhancement of solid tumour components and malignancy [4,23,24] and a correlation with tumour angiogenesis biomarkers [2]. A preliminary study performed at our institution supports the use of threshold criteria based on the semi-quantitative evaluation of early tumour enhancement as an independent predictor of malignancy in a complex ovarian mass [25].…”

Section: Introductionmentioning

confidence: 92%

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Effectiveness of semi-quantitative multiphase dynamic contrast-enhanced MRI as a predictor of malignancy in complex adnexal masses: radiological and pathological correlation

et al. 2011

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 92%

Effectiveness of semi-quantitative multiphase dynamic contrast-enhanced MRI as a predictor of malignancy in complex adnexal masses: radiological and pathological correlation

et al. 2011

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“…Two European centres have done pioneering work on DCE MRI of complex adnexal lesions [15–20]. It is well known that factors related to tumour biological processes, such as VEGFR-2 expression and pericyte coverage index (PCI), are related to maximum uptake of gadolinium by the tumour [18].…”

Section: New Imaging Techniquesmentioning

confidence: 99%

“…Using semi-quantitative multiphase contrast-enhanced MRI, the predominant finding by both groups was that in adnexal masses where solid components demonstrate a rapid rate and high level of enhancement, there is a very high likelihood of malignancy, whereas a slow rate and low level of enhancement is associated with a high likelihood of a benign lesion [15–17, 20]. …”

Section: New Imaging Techniquesmentioning

confidence: 99%

ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update

Forstner

Thomassin‐Naggara

Cunha³

et al. 2016

Eur Radiol

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An update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques is provided. An algorithmic approach using sagittal T2 and a set of transaxial T1 and T2WI allows categorization of adnexal masses in one of the following three types according to its predominant signal characteristics. T1 'bright' masses due to fat or blood content can be simply and effectively determined using a combination of T1W, T2W and FST1W imaging. When there is concern for a solid component within such a mass, it requires additional assessment as for a complex cystic or cystic-solid mass. For low T2 solid adnexal masses, DWI is now recommended. Such masses with low DWI signal on high b value image (e.g. > b 1000 s/mm2) can be regarded as benign. Any other solid adnexal mass, displaying intermediate or high DWI signal, requires further assessment by contrast-enhanced (CE)T1W imaging, ideally with DCE MR, where a type 3 curve is highly predictive of malignancy. For complex cystic or cystic-solid masses, both DWI and CET1W—preferably DCE MRI—is recommended. Characteristic enhancement curves of solid components can discriminate between lesions that are highly likely malignant and highly likely benign.Key Points• MRI is a useful complementary imaging technique for assessing sonographically indeterminate masses. • Categorization allows confident diagnosis in the majority of adnexal masses. • Type 3 contrast enhancement curve is a strong indicator of malignancy. • In sonographically indeterminate masses, complementary MRI assists in triaging patient management. Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4600-3) contains supplementary material, which is available to authorized users.

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“…Time-intensity curves and descriptive DCE parameters of their enhancing solid components have aided differentiation of benign from borderline/ malignant lesions. [1][2][3][4][5][6] However, semi-quantitative assessment of DCE, which is based on signal enhancement, is altered by cardiac flow rate, arterial blood pressure and contrast agent dose. To overcome this, internal references have been suggested to provide lesion-to-internal (lesion-internal reference) ratios.…”

mentioning

confidence: 99%

Use of an internal reference in semi-quantitative dynamic contrast-enhanced MRI (DCE MRI) of indeterminate adnexal masses

Tang

Benardin²,

Booth³

et al. 2014

BJR

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Objective: Semi-quantitative dynamic contrast-enhanced MRI (DCE MRI) has proven useful in discriminating benign from borderline/malignant adnexal lesions. Our aim was to assess if the use of a lesion-to-internal-reference ratio improved the performance in characterizing adnexal masses and which internal reference was suitable. Methods: Semi-quantitative DCE MRI images of 71 indeterminate adnexal lesions were retrospectively reviewed. A region of interest was manually drawn onto the enhancing solid component, psoas muscle and normal outer myometrium. The DCE parameters were evaluated, and the lesion-to-internal-reference ratios were calculated. Results: When the wash in rate of the lesion was higher than that of the myometrium, 97% specificity and 12% sensitivity for borderline/malignancy was reached. When the maximum relative enhancement and maximum absolute enhancement (SI max ) of the lesion was less than those of the psoas, 100% specificity for benignity was achieved. The highest area under the curve (AUC) (0.807) was achieved using a SI max lesion-myometrium ratio. A slightly lower AUC (0.799) was achieved using a SI max lesion-psoas ratio, but the psoas muscle was more frequently measurable in the same slice as the lesion ROI. Although the AUC was higher, when using ratios instead of individual DCE values, this was not significantly different. Conclusion: DCE MRI has added diagnostic value in the assessment of adnexal lesions, and the use of internal references enables high specificity for malignancy and benignity. Lesion-internal-reference ratios have no added diagnostic value over DCE values alone. Advances in knowledge: Both psoas muscle and myometrium are suitable internal references in the DCE assessment of adnexal lesions enabling high specificity for malignancy and benignity.MRI has an excellent performance in characterizing adnexal masses. An overlap remains on conventional MRI as both benign and borderline/malignant pathologies can demonstrate wall thickening, septa and enhancing solid components. Therefore, a proportion of adnexal masses remains indeterminate after ultrasound and conventional MRI. Semi-quantitative dynamic contrast-enhanced MRI (DCE MRI) has previously been investigated in the assessment of indeterminate adnexal lesions. Time-intensity curves and descriptive DCE parameters of their enhancing solid components have aided differentiation of benign from borderline/ malignant lesions. [1][2][3][4][5][6] However, semi-quantitative assessment of DCE, which is based on signal enhancement, is altered by cardiac flow rate, arterial blood pressure and contrast agent dose. To overcome this, internal references have been suggested to provide lesion-to-internal (lesion-internal reference) ratios. A ratio adjusts for the above confounding factors allowing greater reproducibility. The myometrium and psoas muscles have previously been individually assessed in separate studies, including our own, as internal reference tissues.1-3 Our study is the first to use both internal references in the same co...

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Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass?

Abstract: Threshold criteria established in this preliminary study using quantitative DCE-MRI provide an accurate method for the prediction of malignancy, particularly in preoperative indeterminate cases.

Cited by 47 publications

References 27 publications

Effectiveness of semi-quantitative multiphase dynamic contrast-enhanced MRI as a predictor of malignancy in complex adnexal masses: radiological and pathological correlation

Effectiveness of semi-quantitative multiphase dynamic contrast-enhanced MRI as a predictor of malignancy in complex adnexal masses: radiological and pathological correlation

ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update

Use of an internal reference in semi-quantitative dynamic contrast-enhanced MRI (DCE MRI) of indeterminate adnexal masses

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