Magnetic resonance relaxometry improves the accuracy of conventional MRI in the diagnosis of endometriosis‑associated ovarian cancer: A case report

Abstract

Endometriosis is a precancerous condition for endometriosis-associated ovarian cancer (EAOC). In the present study, conventional magnetic resonance imaging (MRI) and MR relaxometry were used to examine a case of clear cell carcinoma that arose in a pre-existing right-sided benign ovarian endometrioma (OE). The 42-year-old nulliparous woman suspected of EOAC, as assessed by conventional MRI, requested fertility-sparing surgery such as laparoscopic endometrioma cystectomy. Furthermore, the MR transverse relaxation rate (R2) was determined using a single-voxel, multi-echo MR sequence using a 3 Tesla-MR system. An R2 value <12.1 s -1 was indicative of malignancy, as described in previous studies. In the present study, MR relaxometry identified an R2 value of 7.98 s -1 in the right cyst, which suggested the malignant transformation of benign OE. Based on these findings, fertility-sparing surgery was contraindicated. In conclusion, MR relaxometry may represent a new clinical approach as an adjunctive modality for the diagnosis of EAOC. When patients exhibiting a pelvic mass suspected of EAOC desire fertility-sparing treatment options, MR relaxometry can facilitate the selection of conservative management.

Clinicopathological characteristics, molecular features and novel diagnostic strategies for the detection of malignant transformation of endometriosis (Review)

“…Novel imaging modalities (e.g., MR relaxometry) and biomarkers (e.g., TFPI2) are promising technologies. MR relaxometry offers the possibility of early diagnosis as changes in iron levels can be quantified quickly and non-invasively (70)(71)(72)(73). Compared with conventional diagnostic imaging, MR relaxometry more accurately detects malignant transformation; however, there is limited data on its use.…”

“…R2 values highly correlated with iron concentrations, allowing for the rapid and non-invasive differentiation of endometriotic cysts from EAOC preoperatively, with a sensitivity of 86% and a specificity of 94% (70). MR relaxometry is a promising alternative for the early detection of malignant transformation of endometriosis (71)(72)(73). Additionally, real-time in vivo imaging methods used for the diagnosis of malignant transformation of endometriosis include electronic absorption spectroscopy and near infrared approach in addition to MR transverse relaxometry (74).…”

New insights about endometriosis-associated ovarian cancer: pathogenesis, risk factors, prediction and diagnosis and treatment

“…proposed a model that integrates the marker value HE4 and the ADNEX, resulting in increased the discriminatory ability and sensitivity for distinguishing benign from malignant ovarian tumors ( 127 ). The application of transvaginal near-infrared (NIR) imaging might provide diagnostic insights into the malignant advancement of endometriosis and could potentially yield further clinical ramifications, and the incorporation of MR relaxation measurements facilitates the identification of conservative therapeutic approaches ( 128 , 129 ). A pioneering composite optical ultrasound system, employing near infrared guidance and transvaginal ultrasound, is proposed for the purpose of noninvasively quantifying fluid hemoglobin (Hb) levels.…”

BUDA‐MESMERISE: Rapid acquisition and unsupervised parameter estimation for T1, T2, M0, B0, and B1 maps

“…Quantification of the biophysical parameters from acquired signals enables advanced characterization of the tissue, which improves clinical diagnosis and informs longitudinal studies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Estimation of these biophysical parameters typically requires multiple measurements with various scan settings such as TI, TE, TR, and FA. [17][18][19][20] The excessive imaging time required to make multiple acquisitions hampers the clinical application and translation of quantitative imaging.…”

“…In MRI, signal intensity can be formulated in terms of biophysical parameters, such as longitudinal T 1 relaxation, transverse T 2 relaxation, and proton density (PD); and imaging parameters such as TE, TR, and flip angle (FA). Quantification of the biophysical parameters from acquired signals enables advanced characterization of the tissue, which improves clinical diagnosis and informs longitudinal studies 1–16 …”