Critical evaluation of the specificity of MRI and TVUS for differentiation of malignant from benign adnexal lesions

Abstract

The aim of our work was to study the specificity of MRI in comparison with transvaginal US for differentiation of malignant from benign adnexal lesions. A total of 67 patients with clinically suspicious adnexal lesions were evaluated by MRI. Transaxial and coronal images were acquired using T1-weighted sequences before and following IV contrast and T2-weighted sequences. In all patients transvaginal ultrasound examinations (TVUS) were performed. For both imaging modalities each lesion was classified separately as either benign or malignant according to previously published criteria. Pathologic findings were available in 65 cases. Both MRI and TVUS correctly classified the 12 malignant lesions (sensitivity 100 %). Specificity (MRI: 78.2 %, TVUS: 65.5 %) and accuracy (MRI: 82 %, TVUS: 71.6 %) were higher with MRI than with TVUS, but differences were statistically not significant (p = 0.18 and p = 0.20, chi-square test). There was agreement/disagreement between findings of MRI and US in 52/15 lesions. The macroscopic criteria for malignancy are unspecific and result in a limitation of the specificity of both MRI and TVUS. The MRI technique is a valuable adjunct to TVUS by enabling further clarification of adnexal tumors with equivocal complex or solid vaginal sonographic findings.

Comparative evaluation of multidetector CT and MR imaging in the differentiation of adnexal masses

“…But, although the reported sensitivities of the technique are high (85-100%), the specificities are variable (50-100%) [12,37,38]. Both US and MRI are equally sensitive in the evaluation of the intratumoral structure of ovarian masses, but MRI was proved more specific and accurate [39][40][41][42]. MR imaging is known to provide increased resolution for imaging of gynecologic diseases [43][44][45][46].…”

Imaging Key to Diagnose Adnexal Masses- Mri With Histopathological Correlation

“…Granulosa cell tumours are usually benign; however, they maybe malignant as well granulosa cell tumours appear mostly as both cystic and solid masses. 18,19 A rapidly growing endometrioma along with multilocularity, presence of mural nodules with enhancement after gadolinium administration and association with endometrial hyperplasia should raise the suspicion of malignancy probably endometrioid or clear cell carcinoma. 11,13 Stomach, colon, breast, lung and contralateral ovary are the most frequent neoplasms to metastasise to the ovaries.…”

“…10,23,24 Both US and MRI are equally sensitive in the evaluation of the intratumoral structure of ovarian masses, but MRI was proved more specific and accurate. 18,[25][26][27] Ultrasound is the first imaging study performed in the evaluation of suspected ovarian lesion. A combination of grey scale and Doppler features obtained with transabdominal and/or transvaginal scanning used for the investigation of ovarian lesions.…”

Prolactin Receptor–Mediated Internalization of Imaging Agents Detects Epithelial Ovarian Cancer with Enhanced Sensitivity and Specificity

“…Moreover, the current practice of MR imaging of the pelvis following intravenous injection of the gadolinium contrast agent, Magnevist TM often poorly distinguishes whether an observed mass contains benign or malignant tissue (11), further confounding efforts to diagnose and treat the disease (3). Here we have demonstrated proof-of-concept for a new, targeted molecular imaging approach for OvCa based upon upregulation of the PRLR and its capacity to mediate ligand-induced endocytosis.…”

“…gadolinium-chelates) (9), solid tumors become contrast-enhanced relative to surrounding tissue due to their altered vascular anatomy causing increased permeability (10). However, the diagnosis of malignant OvCa using gadolinium enhanced MRI still lacks sufficient specificity (11) to distinguish healthy from cancerous tissue, resulting in many unnecessary surgeries for a presumptive malignancy (3) and lacks the sensitivity (12) to detect small, early tumors. One potential strategy to improve sensitivity and specificity involves the development of targeted molecular probes - imaging agents conjugated to ligands that bind specifically to receptors that are over-expressed on cancer cells (13).…”