Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T

Abstract

BackgroundPreoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the usefulness of apparent diffusion coefficients (ADC) for characterizing complex solid and cystic adnexal masses.MethodsOne-hundred and 91 patients underwent diffusion-weighted (DW) magnetic resonance (MR) imaging of 202 ovarian masses. The mean ADC value of the solid components was measured and assessed for each ovarian mass. Differences in ADC between ovarian masses were tested using the Student’s t-test. The receiver operating characteristic (ROC) was used to assess the ability of ADC to differentiate between benign and malignant complex adnexal masses.ResultsEighty-five patients were premenopausal, and 106 were postmenopausal. Seventy-four of the 202 ovarian masses were benign and 128 were malignant. There was a significant difference between the mean ADC values of benign and malignant ovarian masses (p < 0.05). However, there were no significant differences in ADC values between fibrothecomas, Brenner tumors and malignant ovarian masses. The ROC analysis indicated that a cutoff ADC value of 1.20 x10-3 mm2/s may be the optimal one for differentiating between benign and malignant tumors.ConclusionsA high signal intensity within the solid component on T2WI was less frequently in benign than in malignant adnexal masses. The combination of DW imaging with ADC value measurements and T2-weighted signal characteristics of solid components is useful for differentiating between benign and malignant ovarian masses.

Differentiation of Benign from Malignant Adnexal Masses by Functional 3 Tesla MRI Techniques: Diffusion-Weighted Imaging and Time-Intensity Curves of Dynamic Contrast-Enhanced MRI

“…Furthermore, the mean ADC values were significantly lower in malignant adnexal masses. Our results are consistent with the previous studies by Takeuchi et al (2010), Li et al (2012) and Zhang et al (2012) that suggested ADC value as a useful measurement for differentiating benign from malignant adnexal masses.…”

“…However, there is considerable overlap between benign and malignant masses in the mentioned parameters (Timmerman et al, 2000;Katayama et al, 2002;Thomassin-Naggara et al, 2009). Researchers in different studies have investigated more recent functional MR techniques such as DCE-MRI, DWI, and its quantitative derivative, ADC in distinguishing benign from malignant adnexal masses (Katayama et al, 2002;Takeuchi et al, 2010;ThomassinNaggara et al, 2011;Li et al, 2012;Zhang et al, 2012). The present study showed that DWI, mean ADC value, and TIC type contribute to differentiating benign from malignant adnexal masses, with TIC type being more accurate than DWI and mean ADC value.…”

“…Some studies showed that ADC value is useful in discriminating benign from malignant masses (Takeuchi et al, 2010;Li et al, 2012;Zhang et al, 2012). Li et al (2012)showed that lower mean ADC values were significantly associated with malignant epithelial ovarian tumors, with a cut-off value of 1.25×10 -3 mm 2 /s.…”

“…There is controversy in the literature regarding the role of the mean ADC value in distinguishing benign from malignant adnexal masses. Some studies showed that ADC value is useful in discriminating benign from malignant masses (Takeuchi et al, 2010;Li et al, 2012;Zhang et al, 2012). But on the contrary, the results of the studies by Thomassin-Naggara et al (2009), Katayama et al (2002), and Fujii et al (2008) demonstrated that ADC measurements did not contribute to differentiating benign from malignant adnexal masses.…”

Diagnostic imaging using positron emission tomography for gynecological malignancy

“…75 MRI provides higher post-test probability to detect ovarian cancer than US or CT. 76,77 Moreover, contrast enhancement or DWI can provide additional value for the characterization of ovarian tumors. 78 The usefulness of 18 F-FDG PET/CT in the differentiation of benign and malignant ovarian tumors is limited. First, normal ovaries can be affected by physiological conditions such as inflammation and the menstrual cycle, as with normal endometrium.…”