Role of MRI Diffusion Weighted Imaging in Evaluation of Gynecological Pelvic Masses

Abstract

Background: Gynecological Pelvic masses are common problem that are commonly discovered during routine gynecologic or physical examinations. Radiologists routinely evaluate a wide range of pelvic masses during daily practice. Proper management depends on proper preoperative assessment with the help of clinical examination, laboratory tests and different imaging modalities. Radiological evaluation includes ultrasonography (US), computed tomography (CT) and recently magnetic resonance imaging (MRI). Diffusion weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. Objective: This study aimed to evaluate the role of diffusion weighted imaging in the characterization of gynecological pelvic masses and differentiation between benign and malignant tumors. Patients and Methods: This study was performed on 63 patients. All patients had US findings of uterine and adnexal lesions then they underwent conventional MRI with contrast & DWI. Results: DWI is significant promising tool factors for characterization of gynecological tumors and differentiation between benign & malignant lesions with high sensitivity 95% (81%:99% with 95% CI). The sensitivity, specificity and accuracy of detection of the nature of the lesions have been increased after adding of DWI to the conventional imaging. Conclusions: Adding of DWI to the conventional MRI improves the sensitivity and specificity of diagnosis and allows confident diagnosis and differentiation between benign and malignant lesions.

Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Gynecological Masses

“…In the current study, 19 masses were of benign nature (57.6%), while 14 masses were of malignant nature (42.4%). This is in line with the study of Abd-Elmageed et al [20] and El-Sayed et al [18] who showed that benign masses were more prevalent than malignant masses. This was also confirmed in the meatanalysis conducted by Guo et al [23] on 2474 patients and reported higher prevalence of benign masses.…”

“…In the current investigation, the majority of malignant lesions (69.2 percent) exhibited moderate enhancement as nodular and septation enhancement. In consistency with this study findings, the recent Egyptian studies of El-Sayed et al [18], Mansour et al [33], Hamed et al [34] and Abd-Elmageed et al [20] reported that the appearance of benign and malignant lesions was rather similar in T1WI and T2WI, but as regarding contrast enhancement, the gynecological masses showed different pattern of enhancement according being benign or malignant.…”

“…In line with the present study, there was an initial experience in 2004, conducted by Sarty et al (124) 12 cases were examined to assess the viability of ADC measurement for the differential diagnosis of cancer. The conclusion of the research was that ADC measurement, intensity, and texture may identify malignancy in ovarian tumours.In addition, El-Sayed et al [18], Mansour et al [33], Hamed et al [34] and Abd-Elmageed et al [20] reported that although some overlaps were found in the ADC values of benign and malignant lesions, yet the mean ADC value of malignant masses was significantly lower than that of benign, which is similar to current study. Thomassin-Naggara et al [35] evaluated the contribution of DWI in conjunction with morphological criteria to characterize gynecological masses.…”

“…Other lesions were endometrial polyp (6.1%), endometrial hyperplasia (3%), and adenomyosis (3%). Similarly, Abd-Elmageed et al [20] and Sharma et al [19] found that the most prevalent benign tumors were leiomyomas. This is also consistent with the well documented data that uterine leiomyomas are the most prevalent benign pelvic tumor in women.…”

“…DW-MRI can describe tissues in terms of cell organisation and density, microstructure, and microcirculation based on the water diffusion parameters associated with each of these characteristics [19]. [20].…”