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

Bernardin, Livia; Dilks, Philip; Liyanage, Sidath H.; Miquel, Marc E.; Sahdev, Anju; Rockall, Andrea

doi:10.1007/s00330-011-2331-z

Cited by 85 publications

(72 citation statements)

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“…In theory, the EA was higher in malignant than in borderline tumors and higher in borderline tumors than in benign tumors, which was confirmed by several studies [9, 10, 13, 14]. However, our study showed that the mean EA of malignant tumors was slightly lower than in borderline tumors and higher than in benign tumors (267.4 ± 86.2 vs. 269.3 ± 70.0 and 220.2 ± 90.5) ( P > 0.05), which was not in accordance with previous studies [9, 10, 13, 14]. Therefore, further work needs to be done to verify our present findings.…”

Section: Discussionsupporting

confidence: 66%

The value of dynamic contrast–enhanced MRI in characterizing complex ovarian tumors

Qiang

et al. 2017

J Ovarian Res

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BackgroundThe study aimed to investigate the utility of dynamic contrast enhanced MRI (DCE-MRI) in the differentiation of malignant, borderline, and benign complex ovarian tumors.MethodsDCE-MRI data of 102 consecutive complex ovarian tumors (benign 15, borderline 16, and malignant 71), confirmed by surgery and histopathology, were analyzed retrospectively. The patterns (I, II, and III) of time-signal intensity curve (TIC) and three semi-quantitative parameters, including enhancement amplitude (EA), maximal slope (MS), and time of half rising (THR), were evaluated and compared among benign, borderline, and malignant ovarian tumors. The types of TIC were compared by Pearson Chi-square χ 2 between malignant and benign, borderline tumors. The mean values of EA, MS, and THR were compared using one-way ANOVA or nonparametric Kruskal-Wallis test.ResultsFifty-nine of 71 (83%) malignant tumors showed a type-III TIC; 9 of 16 (56%) borderline tumors showed a type-II TIC, and 10 of 15 (67%) benign tumors showed a type-II TIC, with a statistically significant difference between malignant and benign tumors (P < 0.001) and between malignant and borderline tumors (P < 0.001). MS was significantly higher in malignant tumors than in benign tumors and in borderline than in benign tumors (P < 0.001, P = 0.013, respectively). THR was significantly lower in malignant tumors than in benign tumors and in borderline than in benign tumors (P < 0.001, P = 0.007, respectively). There was no statistically significant difference between malignant and borderline tumors in MS and THR (P = 0.19, 0.153) or among malignant, borderline, and benign tumors in EA (all P > 0.05).ConclusionsDCE-MRI is helpful for characterizing complex ovarian tumors; however, semi-quantitative parameters perform poorly when distinguishing malignant from borderline tumors.

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Section: Discussionsupporting

confidence: 66%

The value of dynamic contrast–enhanced MRI in characterizing complex ovarian tumors

Qiang

et al. 2017

J Ovarian Res

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“…58 of these lesions were previously published at our institute (St Bartholomew's Hospital, London, UK), but their myometrium was not assessed. 2 The age range was 19-75 years with a mean age of 50.5 years. The size of the lesions ranged from 2 to 28 cm.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

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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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“…Dinamik kontrastlı MRG'de; malign over kitlelerinin (60. sn'de) benign lezyonlardan daha çok kontrast tuttuğu ve %91 doğruluk değeri olduğu gösterilmiştir [20]. Diğer bir teknikte zaman-intensite eğrilerine göre; tip 1, pik olmadan tedrici artış (benign), tip 2, önce erken kontrast tutulumu ve takiben plato (borderline-sınır tümörler), tip 3 myometriuma göre hızlı, erken kontrast tutulumu ve takiben 'washout', (invaziv over tümörleri) için tipik bulunmuştur [21].…”

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Over Tümörlerinde Görüntüleme

Pekindil¹

2015

Trd Sem

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Over tümörleri patolojik olarak epitelial (seröz, müsinöz, endometrioid, clear cell, Brenner), germ hücreli (Teratom, disgerminom, endodermal sinüs tümörü, embriyoner hücreli karsinom, koriokarsinom), seks-kord stromal tümörler (Granülosa, fibrotekoma, sklerozan stromal tümör, Sertoli-Leydig hücreli tümör, steroid hücre ve diğer) ve metastatik tümörler olmak üzere 4 ana grupta irdelenebilir. Over kitlelerinin değerlendirilmesinde ultrasonografi (US), bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) kullanılmakta olup, burada tanısal etkinlikleri ve bulguları anlatılacaktır.Yaklaşım: Kadın pelvisinde bir kitle tespit edildiğinde 3 soruya cevap verilmesi gerekir: 1. Gerçekten kitle mi? yalancı ya da normal görüntü mü? En bilineni US'de rektum gazının teratom zannedilmesi, ya da gaz zannedilerek atlanmasıdır. Fonksiyonel over kistleri de patoloji zannedilebilir. 2. Kitle adneksiyal mi değil mi? Overlerin ayrı-intakt görülmesi over dışı kitle lehine olmakla birlikte, büyük kitlelerde özellikle postmenopoz küçük overin görülmesi sorun olabilir. Ovarial venin seyrinin bulunarak pelvik kitleye girdiğinin gösterilmesi de kitlenin over kaynaklı olduğunu belirlemede yardımcı (pedikül işareti) olabilir (Resim 1) [1,2]. Ayrıca subseröz-saplı myomlar, T2 A hipointens fibrom gibi solid over kitleleri ile karışabilece-ğinden ayrımda ara yüz damar işaretinin MRG ve Doppler US bakıda gösterilmesi myom lehinedir (Resim 2). 3. Adneksiyel ise malign ya da benign mi? Önce US sonra da gerekirse MRG ile değerlendirilir. Malign ise BT ya da MRG ile evrelemeye ilişkin sorulara yanıt aranır.Ultrasonografi: Pratikte adneksiyel kitle şüpheli olgulara öncelikle pelvik US yapılır. Transvajinal US'nin sınırlı görüş alanı ve derinlik gibi dezavantajları nedeniyle, adneksiyel kitlenin iç yapısını ve küçük kitleleri daha iyi saptamak gibi avantajlarına rağmen, pelvik US'ye tercih edilip edilmeyeceği konusu net değildir. Transvajinal US ile adneksiyel kitlenin duvar, septa ve iç yapısı ile ekojenitesine dayanan skorlama sistemi ile benign-malign over kitle ayrımında duyarlılık %100, özgüllük %83 olarak belirlenmiştir [3]. US ile morfolojik analiz yaparak over tümörlerinde maligniteyi belirlemede %85-97 duyarlılık, %56-95 öz-

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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

Abstract: Semi-quantitative DCE-MRI threshold criteria are effective for predicting ovarian malignancy. The surgical approach may be altered depending on DCE-MRI threshold criteria analysis. Borderline tumours demonstrate significant overlap with benign lesions using DCE-MRI threshold criteria.

Cited by 85 publications

References 24 publications

The value of dynamic contrast–enhanced MRI in characterizing complex ovarian tumors

The value of dynamic contrast–enhanced MRI in characterizing complex ovarian tumors

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

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