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Published in: World Journal of Surgical Oncology 1/2012

Open Access 01-12-2012 | Research

Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T

Authors: Ping Zhang, Yanfen Cui, Wenhua Li, Gang Ren, Caiting Chu, Xiangru Wu

Published in: World Journal of Surgical Oncology | Issue 1/2012

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Abstract

Background

Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the usefulness of apparent diffusion coefficients (ADC) for characterizing complex solid and cystic adnexal masses.

Methods

One-hundred and 91 patients underwent diffusion-weighted (DW) magnetic resonance (MR) imaging of 202 ovarian masses. The mean ADC value of the solid components was measured and assessed for each ovarian mass. Differences in ADC between ovarian masses were tested using the Student’s t-test. The receiver operating characteristic (ROC) was used to assess the ability of ADC to differentiate between benign and malignant complex adnexal masses.

Results

Eighty-five patients were premenopausal, and 106 were postmenopausal. Seventy-four of the 202 ovarian masses were benign and 128 were malignant. There was a significant difference between the mean ADC values of benign and malignant ovarian masses (p < 0.05). However, there were no significant differences in ADC values between fibrothecomas, Brenner tumors and malignant ovarian masses. The ROC analysis indicated that a cutoff ADC value of 1.20 x10-3 mm2/s may be the optimal one for differentiating between benign and malignant tumors.

Conclusions

A high signal intensity within the solid component on T2WI was less frequently in benign than in malignant adnexal masses. The combination of DW imaging with ADC value measurements and T2-weighted signal characteristics of solid components is useful for differentiating between benign and malignant ovarian masses.
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Literature
1.
go back to reference Medeiros LR, Freitas LB, Rosa DD, Silva FR, Silva LS, Birtencourt LT, Edelweiss MI, Rosa MI: Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review. Am J Obstet Gynecol. 2011, 204 (67): e1-10.PubMed Medeiros LR, Freitas LB, Rosa DD, Silva FR, Silva LS, Birtencourt LT, Edelweiss MI, Rosa MI: Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review. Am J Obstet Gynecol. 2011, 204 (67): e1-10.PubMed
2.
go back to reference Lalwani N, Prasad SR, Vikram R, Shanbhogue AK, Huettner PC, Fasih N: Histologic, molecular, and cytogenetic features of ovarian cancers: implications for diagnosis and treatment. Radiographics. 2011, 31: 625-646. 10.1148/rg.313105066.CrossRefPubMed Lalwani N, Prasad SR, Vikram R, Shanbhogue AK, Huettner PC, Fasih N: Histologic, molecular, and cytogenetic features of ovarian cancers: implications for diagnosis and treatment. Radiographics. 2011, 31: 625-646. 10.1148/rg.313105066.CrossRefPubMed
3.
go back to reference Bazot M, Nassar-Slaba J, Thomassin-Naggara I, Cortez A, Uzan S, Darai E: MR imaging compared with intraoperative frozen-section examination for diagnosis of adnexal tumors; correlation with final histology. Eur Radiol. 2006, 16: 2687-2699. 10.1007/s00330-006-0163-z.CrossRefPubMed Bazot M, Nassar-Slaba J, Thomassin-Naggara I, Cortez A, Uzan S, Darai E: MR imaging compared with intraoperative frozen-section examination for diagnosis of adnexal tumors; correlation with final histology. Eur Radiol. 2006, 16: 2687-2699. 10.1007/s00330-006-0163-z.CrossRefPubMed
4.
go back to reference Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I: Terms, definitions and measurements to describe the sonographic features of adenexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000, 16: 500-505. 10.1046/j.1469-0705.2000.00287.x.CrossRefPubMed Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I: Terms, definitions and measurements to describe the sonographic features of adenexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000, 16: 500-505. 10.1046/j.1469-0705.2000.00287.x.CrossRefPubMed
5.
go back to reference Bazot M, Darai E, Nassar-Slaba J, Lafont C, Thomassin-Naggara I: Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist Tomogr. 2008, 32: 712-723. 10.1097/RCT.0b013e31815881ef.CrossRefPubMed Bazot M, Darai E, Nassar-Slaba J, Lafont C, Thomassin-Naggara I: Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist Tomogr. 2008, 32: 712-723. 10.1097/RCT.0b013e31815881ef.CrossRefPubMed
6.
go back to reference Sohaib SAA, Sahdev A, Trappen PV, Jacobs IJ, Reznek RH: Characterization of adnexal mass lesions on MR imaging. AJR. 2003, 180: 1297-1304.CrossRefPubMed Sohaib SAA, Sahdev A, Trappen PV, Jacobs IJ, Reznek RH: Characterization of adnexal mass lesions on MR imaging. AJR. 2003, 180: 1297-1304.CrossRefPubMed
7.
go back to reference Ghossain MA, Buy JN, Ligneres C, Bazot M, Hassen K, Malbec L, Hugol D, Truc JB, Decroix Y, Poitout P: Epithelial tumors of the ovary: comparison of MR and CT findings. Radiology. 1991, 181: 863-870.CrossRefPubMed Ghossain MA, Buy JN, Ligneres C, Bazot M, Hassen K, Malbec L, Hugol D, Truc JB, Decroix Y, Poitout P: Epithelial tumors of the ovary: comparison of MR and CT findings. Radiology. 1991, 181: 863-870.CrossRefPubMed
8.
go back to reference Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST: CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002, 22: 1305-1325. 10.1148/rg.226025033.CrossRefPubMed Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST: CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002, 22: 1305-1325. 10.1148/rg.226025033.CrossRefPubMed
9.
go back to reference Thomassin-Naggara I, Darai E, Cuenod CA, Rouzier R, Callard P, Bazot M: Dynamic contrast-enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumors. J Magn Reson Imaging. 2008, 28: 111-120. 10.1002/jmri.21377.CrossRefPubMed Thomassin-Naggara I, Darai E, Cuenod CA, Rouzier R, Callard P, Bazot M: Dynamic contrast-enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumors. J Magn Reson Imaging. 2008, 28: 111-120. 10.1002/jmri.21377.CrossRefPubMed
10.
go back to reference Thomassin-Naggara I, Darai E, Cuenod CA, Fournier L, Toussaint I, Marsault C, Fournier L, Tossaint I, Marsault P, Bazot M: Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol. 2009, 19: 1544-1552. 10.1007/s00330-009-1299-4.CrossRefPubMed Thomassin-Naggara I, Darai E, Cuenod CA, Fournier L, Toussaint I, Marsault C, Fournier L, Tossaint I, Marsault P, Bazot M: Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol. 2009, 19: 1544-1552. 10.1007/s00330-009-1299-4.CrossRefPubMed
11.
go back to reference Katayama M, Masui T, Kobayashi S, Ito T, Sakahara H, Nozaki A, Kabasawa H: Diffusion-weighted echo planar imaging of ovarian tumors: is it useful to measure apparent diffusion coefficients?. J Comput Assist Tomogr. 2002, 26: 250-256. 10.1097/00004728-200203000-00015.CrossRefPubMed Katayama M, Masui T, Kobayashi S, Ito T, Sakahara H, Nozaki A, Kabasawa H: Diffusion-weighted echo planar imaging of ovarian tumors: is it useful to measure apparent diffusion coefficients?. J Comput Assist Tomogr. 2002, 26: 250-256. 10.1097/00004728-200203000-00015.CrossRefPubMed
12.
go back to reference Li WH, Chu CT, Cui YF, Zhang P, Zhu MJ: Diffusion-weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components. Abdom Imaging. 2012, 37: 897-903. 10.1007/s00261-011-9814-x.CrossRefPubMed Li WH, Chu CT, Cui YF, Zhang P, Zhu MJ: Diffusion-weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components. Abdom Imaging. 2012, 37: 897-903. 10.1007/s00261-011-9814-x.CrossRefPubMed
13.
go back to reference Moteki T, Ishizaka H: Evaluation of cystic ovarian lesions using apparent diffusion coefficient from turboFLASH MR images. Br J Radiol. 1998, 71: 612-620.CrossRefPubMed Moteki T, Ishizaka H: Evaluation of cystic ovarian lesions using apparent diffusion coefficient from turboFLASH MR images. Br J Radiol. 1998, 71: 612-620.CrossRefPubMed
14.
go back to reference Fujii S, Kakite S, Nishihara K, Kanasaki Y, Harada T, Kigawa J, Kaminou T, Ogawa T: Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions. J Magn Reson Imaging. 2008, 28: 1149-1156. 10.1002/jmri.21575.CrossRefPubMed Fujii S, Kakite S, Nishihara K, Kanasaki Y, Harada T, Kigawa J, Kaminou T, Ogawa T: Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions. J Magn Reson Imaging. 2008, 28: 1149-1156. 10.1002/jmri.21575.CrossRefPubMed
15.
go back to reference Thomassin-Naggara I, Toussaint I, Perrot N, Rouzier P, Cuenod CA, Bazot M, Darai ED: Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging. Radiology. 2011, 258: 793-803. 10.1148/radiol.10100751.CrossRefPubMed Thomassin-Naggara I, Toussaint I, Perrot N, Rouzier P, Cuenod CA, Bazot M, Darai ED: Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging. Radiology. 2011, 258: 793-803. 10.1148/radiol.10100751.CrossRefPubMed
16.
go back to reference Takeuchi M, Matsuzaki K, Nishitani : Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J Comput Assist Tomogr. 2010, 34: 173-176. 10.1097/RCT.0b013e3181c2f0a2.CrossRefPubMed Takeuchi M, Matsuzaki K, Nishitani : Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J Comput Assist Tomogr. 2010, 34: 173-176. 10.1097/RCT.0b013e3181c2f0a2.CrossRefPubMed
17.
go back to reference Li XC, Zhang WD, Zhu GB, Liu QG, Shen YC: Imaging features and pathologic characteristics of ovarian thecoma. J Comput Assist Tomogr. 2012, 36: 46-53. 10.1097/RCT.0b013e31823f6186.CrossRefPubMed Li XC, Zhang WD, Zhu GB, Liu QG, Shen YC: Imaging features and pathologic characteristics of ovarian thecoma. J Comput Assist Tomogr. 2012, 36: 46-53. 10.1097/RCT.0b013e31823f6186.CrossRefPubMed
18.
go back to reference Umemoto M, Shiota M, Shimono T, Hoshiai H: Preoperative diagnosis of ovarian tumors, focusing on the solid area based on diagnostic imaging. J Obstet Gynaecol Res. 2006, 32: 195-201. 10.1111/j.1447-0756.2006.00381.x.CrossRefPubMed Umemoto M, Shiota M, Shimono T, Hoshiai H: Preoperative diagnosis of ovarian tumors, focusing on the solid area based on diagnostic imaging. J Obstet Gynaecol Res. 2006, 32: 195-201. 10.1111/j.1447-0756.2006.00381.x.CrossRefPubMed
19.
go back to reference Erturk SM, Ichikawa T, Sano K, Motosugi U, Sou H, Araki T: Diffusion-weighted magnetic resonance imaging for characterization of focal liver masses: impact of parallel imaging (SENSE) and b value. J Comput Assist Tomogr. 2008, 32: 865-871. 10.1097/RCT.0b013e3181591cf2.CrossRefPubMed Erturk SM, Ichikawa T, Sano K, Motosugi U, Sou H, Araki T: Diffusion-weighted magnetic resonance imaging for characterization of focal liver masses: impact of parallel imaging (SENSE) and b value. J Comput Assist Tomogr. 2008, 32: 865-871. 10.1097/RCT.0b013e3181591cf2.CrossRefPubMed
20.
go back to reference Nakai G, Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, Yamada T: Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging. J Comput Assist Tomogr. 2008, 32: 764-768. 10.1097/RCT.0b013e318153fd43.CrossRefPubMed Nakai G, Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, Yamada T: Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging. J Comput Assist Tomogr. 2008, 32: 764-768. 10.1097/RCT.0b013e318153fd43.CrossRefPubMed
Metadata
Title
Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T
Authors
Ping Zhang
Yanfen Cui
Wenhua Li
Gang Ren
Caiting Chu
Xiangru Wu
Publication date
01-12-2012
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2012
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-10-237

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