Diffusion-weighted MRI of epithelial ovarian cancers: Correlation of apparent diffusion coefficient values with histologic grade and surgical stage

Oh, Jiwon; Rha, Sung Eun; Oh, Soon Nam; Park, Michael Yong; Byun, Jae Young; Lee, Ahwon

doi:10.1016/j.ejrad.2015.01.005

Cited by 29 publications

(20 citation statements)

References 30 publications

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“…Analysis of ADCs has shown promise in increasing the precision of diagnosis, prognosis assessment, and predicting the therapeutic response in different cancers [ 13 , 14 , 17 , 23 ], paralleling the results in preclinical studies [ 24 ]. In our cohort, ADCs measured with WLsp-ROI were lower in poorly differentiated primary tumours, an observation consistent with early studies [ 11 , 18 ]. Grade is a significant predictor of OC outcome [ 2 , 25 ].…”

Section: Discussionsupporting

confidence: 92%

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Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI

et al. 2017

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ObjectivesWe aimed to investigate whether apparent diffusion coefficients (ADCs) measured by 3.0T diffusion-weighted magnetic resonance imaging (DWI) associate with histological aggressiveness of ovarian cancer (OC) or predict the clinical outcome. This prospective study enrolled 40 patients with primary OC, treated 2011-2014.MethodsDWI was performed prior to surgery. Two observers used whole lesion single plane region of interest (WLsp-ROI) and five small ROIs (S-ROI) to analyze ADCs. Samples from tumours and metastases were collected during surgery. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) were used to measure the expression of vascular endothelial growth factor (VEGF) and its receptors.ResultsThe interobserver reliability of ADC measurements was excellent for primary tumours ICC 0.912 (WLsp-ROI). Low ADCs significantly associated with poorly differentiated OC (WLsp-ROI P = 0.035). In primary tumours, lower ADCs significantly associated with high Ki-67 (P = 0.001) and low VEGF (P = 0.001) expression. In metastases, lower ADCs (WLsp-ROI) significantly correlated with low VEGF receptors mRNA levels. ADCs had predictive value; 3-year overall survival was poorer in patients with lower ADCs (WLsp-ROI P = 0.023, S-ROI P = 0.038).ConclusionReduced ADCs are associated with histological severity and worse outcome in OC. ADCs measured with WLsp-ROI may serve as a prognostic biomarker of OC.Key Points• Reduced ADCs correlate with prognostic markers: poor differentiation and high Ki-67 expression • ADCs also significantly correlated with VEGF protein expression in primary tumours • Lower ADC values are associated with poorer survival in ovarian cancer • Whole lesion single plane-ROI ADCs may be used as a prognostic biomarker in OC

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Section: Discussionsupporting

confidence: 92%

“…ADCs are affected by tissue cellularity, fluid viscosity, membrane permeability, macromolecular structures, and blood flow [ 15 ]. Due to high cellularity, malignancies are associated with lower ADCs [ 11 , 12 , 16 – 19 ]. However, no standardized measurement protocols or cut-off values are available for ADC measurements in OC.…”

Section: Introductionmentioning

confidence: 99%

Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI

et al. 2017

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“…We lack complete clinical information that would allow us to fully model these scenarios but suggest that timely MR imaging in such patients could play a role in minimizing unnecessary surgical interventions for benign but sonographically indeterminate cysts. Preoperative MR imaging in the subset of six sonographically indeterminate ovarian cancers would have been highly likely to support a malignant diagnosis (17)(18)(19) and could potentially have contributed surgically relevant information, such as contralateral ovarian and/or nodal involvement. Diagnostic capacity and availability of high-quality pelvic MR imaging have improved since 2010.…”

Section: Sru Ratingsmentioning

confidence: 99%

Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines

Maturen¹,

Blaty²,

Wasnik³

et al. 2017

Radiology

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Purpose To evaluate the performance of the 2010 Society of Radiologists in Ultrasound (SRU) consensus guidelines in the risk stratification of symptomatic and asymptomatic adnexal cysts. Materials and Methods An institutional review board-approved retrospective review was performed, including adnexal cysts detected with ultrasonography (US) with surgical diagnosis or at least 2 years of imaging or clinical follow-up, from January to June 2011. SRU management recommendations were scored as 0, no follow-up; 1, US follow-up; 2, magnetic resonance (MR) imaging follow-up; and 3, surgical evaluation. Distribution of outcomes (nonneoplastic cyst, benign neoplasm, malignant neoplasm) was compared in each rating group by using the Cochran-Armitage trend test. Where SRU guidelines allow more than one management option, they were classified as being interpreted in either a "surgically focused" environment, with limited MR imaging availability, or an "MR-capable" center, where MR imaging is selected whenever it is an option. Predictors of neoplasms and malignancy were evaluated by using multivariate logistic regression. Results A total of 570 cysts in 500 women aged 18-90 years (mean, 42 years) were included. There were 475 (83.3%) nonneoplastic cysts, 77 (13.5%) benign neoplasms, and 18 (3.2%) malignant neoplasms. Of the 500 women, 161 (32.2%) were asymptomatic. In the surgically focused interpretation of guidelines, proportions of any neoplasm and malignant neoplasm, respectively, were 1% and 0% in SRU 0, 17% and 1% in SRU 1, 48% and 0% in SRU 2, and 48% and 16% in SRU 3 (P < .0001 for both trends). In the interpretation of SRU guidelines with MR imaging when it was an option, proportions of any neoplasm and malignant neoplasm, respectively, were 1% and 0% in SRU 0, 17% and 1% in SRU 1, 38% and 5% in SRU 2, and 81% and 52% in SRU 3 (P < .0001, both trends) and 82 (89.1%) fewer benign cysts would have gone directly to surgical evaluation. In multivariate regression, SRU rating predicted both any neoplasm (odds ratio, 2.58; P < .0001) and malignant neoplasm (odds ratio, 4.94; P = .005). Conclusion SRU consensus guidelines effectively stratified the risk of neoplasia and malignancy. Selecting MR imaging when it is an option in the guidelines would have reduced the number of benign cysts sent for surgical evaluation. RSNA, 2017.

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“…Thomassin-Naggara et al[74] found that complex solid cystic ovarian lesions with solid components showing restricted diffusion turned out to be malignant. However, restricted diffusion is also seen in benign ovarian lesions like benign cystic teratoma, endometriomas, hemorrhagic ovarian cysts and ovarian cysts with high content of mucin[75,76] (Figure 12). Peritoneal metastases can also be assessed with DWI, presence of which precludes surgery[77].…”

Section: Applications Of Dwi In Oncologymentioning

confidence: 99%

Diffusion magnetic resonance imaging: A molecular imaging tool caught between hope, hype and the real world of “personalized oncology”

Mahajan

Deshpande

Thakur

2017

WJR

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“Personalized oncology” is a multi-disciplinary science, which requires inputs from various streams for optimal patient management. Humongous progress in the treatment modalities available and the increasing need to provide functional information in addition to the morphological data; has led to leaping progress in the field of imaging. Magnetic resonance imaging has undergone tremendous progress with various newer MR techniques providing vital functional information and is becoming the cornerstone of “radiomics/radiogenomics”. Diffusion-weighted imaging is one such technique which capitalizes on the tendency of water protons to diffuse randomly in a given system. This technique has revolutionized oncological imaging, by giving vital qualitative and quantitative information regarding tumor biology which helps in detection, characterization and post treatment surveillance of the lesions and challenging the notion that “one size fits all”. It has been applied at various sites with different clinical experience. We hereby present a brief review of this novel functional imaging tool, with its application in “personalized oncology”.

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Diffusion-weighted MRI of epithelial ovarian cancers: Correlation of apparent diffusion coefficient values with histologic grade and surgical stage

Cited by 29 publications

References 30 publications

Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI

Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI

Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines

Diffusion magnetic resonance imaging: A molecular imaging tool caught between hope, hype and the real world of “personalized oncology”

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