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

Abstract

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...

MR diffusion versus MR perfusion in patients with ovarian tumors; how far could we get?

“…Some authors compared the diagnostic performance of both psoas muscle and myometrium in the DCE assessment of adnexal lesions. They found that both psoas muscles and myometrium are suitable internal references enabling high specificity for malignancy and benignity [20][21][22].…”

Differentiation of Benign from Malignant Adnexal Masses by Dynamic Contrast-Enhanced MRI (DCE-MRI): Quantitative and Semi-quantitative analysis at 3-Tesla MRI

“…In the semi-quantitative analyses, changes of signal intensity is assessed over time and the individual variabilities such as cardiac output, arterial blood pressure and contrast agent dosage are not taken into account (Thomassin-Naggara et al, 2012;Tang et al, 2014). As previously established, among the semi-quantitative parameters, the maximal slope of the time-intensity curve is the most accurate for differentiating benign from malignant adnexal masses (Thomassin-Naggara et al, 2011).…”

Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging for malignant ovarian tumors: a systematic review and meta-analysis

“…Of them, one study investigated both quantitative and semi-quantitative parameters (37). Therefore, 11 articles (37–47) reported semi-quantitative DCE-MRI data for detecting MOTs, while four articles (37,48–50) reported quantitative DCE-MRI data (Table 1). It should be noted that one study included two cases of cancer of the fallopian tubes (48); however, this study was included because the guidelines of the National Comprehensive Cancer Network (NCCN) (3) suggest that the procedure of diagnosis and treatment for fallopian tube cancer and epithelial ovarian cancer are consistent.…”