European Radiology

, Volume 24, Issue 9, pp 2292–2299 | Cite as

Diffusion-weighted MR imaging for differentiating borderline from malignant epithelial tumours of the ovary: pathological correlation

  • Shu Hui Zhao
  • Jin Wei QiangEmail author
  • Guo Fu ZhangEmail author
  • Feng Hua Ma
  • Song Qi Cai
  • Hai Ming Li
  • Li Wang



To investigate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiating borderline from malignant epithelial tumours of the ovary.


This retrospective study included 60 borderline epithelial ovarian tumours (BEOTs) in 48 patients and 65 malignant epithelial ovarian tumours (MEOTs) in 54 patients. DW imaging as well as conventional MR imaging was performed. Signal intensity on DW imaging was assessed and apparent diffusion coefficient (ADC) value was measured. The results were correlated with histopathology and cell density.


The majority of MEOTs showed high signal intensity on DW imaging, whereas most BEOTs showed low or moderate signal intensity (P = 0.000). The mean ADC value of the solid components in BEOTs (1.562 ± 0.346 × 10−3 mm2/s) was significantly higher than in MEOTs (0.841 ± 0.209 × 10−3 mm2/s). A threshold value of 1.039 × 10−3 mm2/s permitted the distinction with a sensitivity of 97.0 %, a specificity of 92.2 % and an accuracy of 96.4 %. There was an inverse correlation between ADC value and cell density (r = −0.609; P = 0.0000) which was significantly lower in BEOTs than in MEOTs.


DW imaging is useful for differentiating borderline from malignant epithelial tumours of the ovary.

Key Points

DW MR imaging is useful for differentiating BEOTs from MEOTs.

Patients with BEOTs are treated differently from patients with MEOTs.

Conservative fertility-sparing laparoscopic surgery can be performed in patients with BEOTs.

BEOTs often affect young women of childbearing age.


Ovary Epithelial tumours Borderline Malignant Diffusion-weighted MR imaging 



apparent diffusion coefficient


borderline epithelial ovarian tumour




malignant epithelial ovarian tumour


magnetic resonance



The scientific guarantor of this publication is Jin Wei Qiang. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by Science and Technology Commission of Shanghai Municipality (no. 124119a3301). Ruo Kun Li kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, diagnostic study, performed at one institution.

Grants from Shanghai Municipal Commission of Science & Technology (No.124119a3300) and Shanghai Municipal Commission of Health and Family Planning (No. 2013SY075, No. ZK2012A16).


  1. 1.
    Hart WR (2005) Borderline epithelial tumors of the ovary. Mod Pathol 18:S33–S50PubMedCrossRefGoogle Scholar
  2. 2.
    Eltabbakh GH, Natarajan N, Piver MS (1999) Epidemiologic differences between women with borderline ovarian tumors and women with epithelial ovarian cancer. Gynecol Oncol 74:103–107PubMedCrossRefGoogle Scholar
  3. 3.
    Barakat RR (1994) Borderline tumors of the ovary. Obstet Gynecol Clin N Am 21:93–105Google Scholar
  4. 4.
    Morotti M, Valenzano M, Gillott DJ, Venturini PL, Ferrero S (2012) The preoperative diagnosis of borderline ovarian tumors: a review of current literature. Arch Gynecol Obstet 285:1103–1112PubMedCrossRefGoogle Scholar
  5. 5.
    Anfinan N, Sait K, Ghatage P, Nation J, Chu P (2011) Ten years experience in the management of borderline ovarian tumors at Tom Baker Cancer Centre. Arch Gynecol Obstet 284:731–735PubMedCrossRefGoogle Scholar
  6. 6.
    Nam JH (2010) Borderline ovarian tumors and fertility. Curr Opin Obstet Gynecol 22:227–234PubMedCrossRefGoogle Scholar
  7. 7.
    Dodge JE, Covens AL, Lacchetti C et al (2012) Management of a suspicious adnexal mass: a clinical practice guideline. Curr Oncol 19:e244–e257PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Bent CL, Sahdev A, Rockall AG, Singh N, Sohaib SA, Reznek RH (2009) MRI appearances of borderline ovarian tumors. Clin Radiol 64:430–438PubMedCrossRefGoogle Scholar
  9. 9.
    Tanaka YO, Okada S, Satoh T et al (2011) Ovarian serous surface papillary borderline tumors form sea anemone-like masses. J Magn Reson Imaging 33:633–640PubMedGoogle Scholar
  10. 10.
    deSouza NM, O'Neill R, Mclndoe GA, Dina R, Soutter WP (2005) Borderline tumors of the ovary: CT and MRI features and tumor markers in differentiation from stage I disease. AJR Am J Roentgenol 184:999–1003PubMedCrossRefGoogle Scholar
  11. 11.
    Bazot M, Daraï E, Nassar-Slaba J, Lafont C, Thomassin-Naggara I (2008) Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist Tomogr 32:712–723PubMedCrossRefGoogle Scholar
  12. 12.
    Lalwani N, Shanbhogue AK, Vikram R, Nagar A, Jagirdar J, Prasad SR (2010) Current update on borderline ovarian neoplasms. AJR Am J Roentgenol 194:330–336PubMedCrossRefGoogle Scholar
  13. 13.
    Bammer R (2003) Basic principles of diffusion-weighted imaging. Eur J Radiol 45:169–184PubMedCrossRefGoogle Scholar
  14. 14.
    Takeuchi M, Matsuzaki K, Nishitani H (2010) Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J Comput Assist Tomogr 34:173–176PubMedCrossRefGoogle Scholar
  15. 15.
    Li W, Chu C, Cui Y, Zhang P, Zhu M (2012) Diffusion-weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components. Abdom Imaging 37:897–903PubMedCrossRefGoogle Scholar
  16. 16.
    Sarty GE, Kendall EJ, Loewy J, Dhir A, Olatunbosun OA, Pierson RA (2004) Magnetic resonance diffusion imaging of ovarian masses: a first experience with 12 cases. MAGMA 16:182–193PubMedCrossRefGoogle Scholar
  17. 17.
    Fujii S, Kakite S, Nishihara K et al (2008) Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions. J Magn Reson Imaging 28:1149–1156PubMedGoogle Scholar
  18. 18.
    Nakayama T, Yoshimitsu K, Irie H et al (2005) Diffusion-weighted echo-planar MR imaging and ADC mapping in the differential diagnosis of ovarian cystic masses: usefulness of detecting keratinoid substances in mature cystic teratomas. J Magn Reson Imaging 22:271–278PubMedGoogle Scholar
  19. 19.
    Moteki T, Ishizaka H (2000) Diffusion-weighted EPI of cystic ovarian lesions: evaluation of cystic contents using apparent diffusion coefficients. J Magn Reson Imaging 12:1014–1019PubMedGoogle Scholar
  20. 20.
    Thomassin-Naggara I, Daraï E, Cuenod CA et al (2009) Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol 19:1544–1552PubMedCrossRefGoogle Scholar
  21. 21.
    Outwater EK, Huang AB, Dunton CJ, Talerman A, Capuzzi DM (1997) Papillary projections in ovarian neoplasms: appearance on MRI. J Magn Reson Imaging 7:689–695PubMedGoogle Scholar
  22. 22.
    Gooneratne S, Sassone M, Blaustein A, Talerman A (1982) Serous surface papillary carcinoma of the ovary: a clinicopathologic study of 16 cases. Int J Gynecol Pathol 1:258–269PubMedCrossRefGoogle Scholar
  23. 23.
    Kim HJ, Kim JK, Cho KS (2004) CT features of serous surface papillary carcinoma of the ovary. AJR Am J Roentgenol 183:1721–1724PubMedCrossRefGoogle Scholar
  24. 24.
    Moteki T, Horikoshi H, Endo K (2002) Relationship between apparent diffusion coefficient and signal intensity in endometrial and other pelvic cysts. Magn Reson Imaging 20:463–470PubMedCrossRefGoogle Scholar
  25. 25.
    Trope C, Kaern J (1998) Management of borderline tumors of the ovary: state of the art. Semin Oncol 25:372–380PubMedGoogle Scholar
  26. 26.
    Camatte S, Morice P, Thoury A et al (2004) Impact of surgical staging in patients with macroscopic “stage I” ovarian borderline tumours: analysis of a continuous series of 101 cases. Eur J Cancer 40:1842–1849PubMedCrossRefGoogle Scholar
  27. 27.
    Trimble CL, Kosary C, Trimble EL (2002) Long-term survival and patterns of care in women with ovarian tumors of low malignant potential. Gynecol Oncol 86:34–37PubMedCrossRefGoogle Scholar
  28. 28.
    Houck K, Nikrui N, Duska L et al (2000) Borderline tumours of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol 95:839–843PubMedCrossRefGoogle Scholar
  29. 29.
    Song T, Choi CH, Kim HJ et al (2011) Accuracy of frozen section diagnosis of borderline ovarian tumours. Gynecol Oncol 122:127–131PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Shu Hui Zhao
    • 1
  • Jin Wei Qiang
    • 1
    Email author
  • Guo Fu Zhang
    • 2
    Email author
  • Feng Hua Ma
    • 1
  • Song Qi Cai
    • 1
  • Hai Ming Li
    • 1
  • Li Wang
    • 3
  1. 1.Department of Radiology, Jinshan HospitalFudan UniversityShanghaiChina
  2. 2.Department of Radiology, Obstetrics & Gynecology HospitalFudan UniversityShanghaiChina
  3. 3.Department of Pathology, Jinshan HospitalFudan UniversityShanghaiChina

Personalised recommendations