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

Abstract

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.

Dynamic Contrast - Enhanced Magnetic Resonance Imaging : A Useful Tool for Characterization and Assessment of Ovarian Masses

“…Some malignant tumors, such as mucinous adenocarcinoma, may appear to be hypovascular, whereas some benign tumors such as thecoma or sclerosing stromal tumor, show abundant vascularity (20) . The EA was higher in malignant than in borderline tumors and higher in borderline tumors than in benign tumors (21) Whereas benign tumors have fewer and relatively mature vessels, which show no obvious change in permeability and microcirculation.…”

MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review

“…Another sequence that might contribute to the specificity of MR imaging is based on the process of angiogenesis, which is characteristic of and essential to nearly all malignant tumours [11,12]. DCE MR attempts to differentiate between benign, borderline and malignant masses by attributing them to one of the three TICs as obtained by DCE.…”

“…The characteristics of the included studies (18 'adult' [11,12,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and 16 'paediatric' studies [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]) are provided in Table 1. The mean age of patients included was 10.8 years in the paediatric and 46.9 years in the adult studies.…”

“…Nine studies investigated the value of DCE-MRI in the differential diagnosis of ovarian masses [11,12,22,23,25,28,[30][31][32]. Data on the TICs and semi-quantitative DCE parameters are depicted in Table 5, as well as diagnostic performance of this sequence and accompanying TICs.…”

“…This investigation is based on enhancement patterns, expressed as time-intensity curves (TICs), of which three different types are acknowledged. Type I displays a gradual, continuous rise in signal intensity; type II shows a moderate rise in signal intensity followed by a plateau; and type III is characterised as early washout [11,12]. In adults, several studies have evaluated the diagnostic value of MR imaging in differentiating between malignant and benign neoplasms and characterising the specific nature of ovarian masses.…”