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Comparison of conventional diffusion-weighted imaging, diffusion kurtosis imaging and intravoxel incoherent motion in characterization of sonographically indeterminate adnexal masses

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Abstract

Purpose

To evaluate the role of conventional diffusion weighted imaging, diffusion kurtosis imaging (DKI), and intravoxel incoherent motion (IVIM) in distinguishing benign from malignant adnexal masses.

Methods

38 patients with 45 adnexal masses were enrolled in this prospective study and assessed with multiparametric MRI, including the IVIM-DKI sequence, on a 3 T MRI system. The mean apparent diffusion coefficient (ADC) from conventional DWI, the apparent diffusion coefficient derived from DKI (Dapp), the apparent kurtosis coefficient (Kapp), true diffusion coefficient (Dt), perfusion fraction (f) and pseudo-diffusion coefficient (Dp) were measured.

Results

The mean ADC, Dapp, and Dt were significantly higher in benign adnexal masses than in malignant adnexal masses (p < 0.001). f and Dp were also significantly higher in benign adnexal masses, with p values of 0.026 and 0.002, respectively. Kapp was higher in malignant masses (p < 0.001). Among mean ADC, Dapp, and Dt, mean ADC had the highest area under the curve (AUC) of 0.885. However, no statistically significant differences were observed between the ROCs of various diffusion parameters.

Conclusion

The mean ADC, Dapp, and Kapp are useful parameters in discriminating between benign and malignant adnexal masses. Dt derived from IVIM also helps in distinguishing benign and malignant adnexal masses; however, no incremental role of IVIM and DKI over ADC could be identified in our study.

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References

  1. Forstner R, Thomassin-Naggara I, Cunha TM, Kinkel K, Masselli G, Kubik-Huch R, et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol. 2017;27(6):2248–57.

    Article  PubMed  Google Scholar 

  2. Iima M, Le Bihan D. Clinical Intravoxel Incoherent Motion and Diffusion MR Imaging: Past, Present, and Future. Radiology. 2016;278(1):13–32.

    Article  PubMed  Google Scholar 

  3. Li HM, Zhao SH, Qiang JW, Zhang GF, Feng F, Ma FH, et al. Diffusion kurtosis imaging for differentiating borderline from malignant epithelial ovarian tumours: A correlation with Ki-67 expression: DKI for Differentiating BEOT From MEOT. J Magn Reson Imaging. 2017;46(5):1499–506.

    Article  PubMed  Google Scholar 

  4. Mokry T, Mlynarska-Bujny A, Kuder TA, Hasse FC, Hog R, Wallwiener M, et al. Ultra-High- b -Value Kurtosis Imaging for Noninvasive Tissue Characterization of Ovarian Lesions. Radiology. 2020;296(2):358–69.

    Article  PubMed  Google Scholar 

  5. Steven AJ, Zhuo J, Melhem ER. Diffusion Kurtosis Imaging: An Emerging Technique for Evaluating the Microstructural Environment of the Brain. American Journal of Roentgenology. 2014;202(1):W26–33.

    Article  PubMed  Google Scholar 

  6. Wang F, Wang Y, Zhou Y, Liu C, Xie L, Zhou Z, et al. Comparison between types I and II epithelial ovarian cancer using histogram analysis of monoexponential, biexponential, and stretched-exponential diffusion models: Comparison of Types I and II Ovarian Cancer. J Magn Reson Imaging. 2017;46(6):1797–809.

    Article  PubMed  Google Scholar 

  7. Song X, Wang L, Ren H, Wei R, Ren J, Niu J. Intravoxel Incoherent Motion Imaging in Differentiation Borderline From Malignant Ovarian Epithelial Tumors: Correlation With Histological Cell Proliferation and Vessel Characteristics. J Magn Reson Imaging. 2020;51(3):928–35.

    Article  PubMed  Google Scholar 

  8. He M, Song Y, Li H, Lu J, Li Y, Duan S, et al. Histogram Analysis Comparison of Monoexponential, Advanced Diffusion‐Weighted Imaging, and Dynamic Contrast‐Enhanced MRI for Differentiating Borderline From Malignant Epithelial Ovarian Tumors. J Magn Reson Imaging. 2020;52(1):257–68.

    Article  PubMed  Google Scholar 

  9. El Ameen NF, Eissawy MG, Mohsen LAMS, Nada OM, Beshreda GM. MR diffusion versus MR perfusion in patients with ovarian tumors; how far could we get? Egypt J Radiol Nucl Med. 2020;51(1):35.

    Article  Google Scholar 

  10. Li W, Chu C, Cui Y, Zhang P, Zhu M. Diffusion-weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components. Abdom Radiol. 2012;37(5):897–903.

    Article  Google Scholar 

  11. Nasr E, Hamed I, Abbas I, Khalifa NM. Dynamic contrast enhanced MRI in correlation with diffusion weighted (DWI) MR for characterization of ovarian masses. The Egyptian Journal of Radiology and Nuclear Medicine. 2014;45(3):975–85.

    Article  Google Scholar 

  12. Manganaro L, Anastasi E, Porpora MG, Vinci V, Saldari M, Bernardo S, et al. Biparametric Magnetic Resonance Imaging as an Adjunct to CA125 and HE4 to Improve Characterization of Large Ovarian Masses. Anticancer Res. 2015;35(11):6341–51.

    CAS  PubMed  Google Scholar 

  13. Malek M, Pourashraf M, Mousavi AS, Rahmani M, Ahmadinejad N, Alipour A, et al. Differentiation of Benign from Malignant Adnexal Masses by Functional 3 Tesla MRI Techniques: Diffusion-Weighted Imaging and Time-Intensity Curves of Dynamic Contrast-Enhanced MRI. Asian Pacific Journal of Cancer Prevention. 2015 ;16(8):3407–12.

    Article  PubMed  Google Scholar 

  14. Emad-Eldin S, Grace MN, Wahba MH, Abdella RM. The diagnostic potential of diffusion weighted and dynamic contrast enhanced MR imaging in the characterization of complex ovarian lesions. The Egyptian Journal of Radiology and Nuclear Medicine. 2018 ;49(3):884–91.

    Article  Google Scholar 

  15. Kim SH. Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging. Yeungnam Univ J Med. 2019 ;36(3):231–40.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Türkoğlu S, Kayan M. Differentiation between benign and malignant ovarian masses using multiparametric MRI. Diagnostic and Interventional Imaging. 2020;101(3):147–55.

    Article  PubMed  Google Scholar 

  17. Huang C, Zhan C, Hu Y, Yin T, Grimm R, Ai T. Histogram analysis of breast diffusion kurtosis imaging: a comparison between readout-segmented and single-shot echo-planar imaging sequence. Quant Imaging Med Surg. 2023;13(2):735–46.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Le Bihan, D. et al. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 168, 497–505 (1988).

    Article  PubMed  Google Scholar 

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India

    Gurkawal Kaur, Smita Manchanda, Raju Sharma, Surabhi Vyas, Devasenathipathy Kandasamy & Smriti Hari

  2. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

    Neerja Bhatla

  3. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Sandeep R. Mathur

Authors
  1. Gurkawal Kaur
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  2. Smita Manchanda
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  3. Raju Sharma
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  4. Surabhi Vyas
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  5. Devasenathipathy Kandasamy
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  6. Smriti Hari
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  7. Neerja Bhatla
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  8. Sandeep R. Mathur
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Contributions

GK and SM contributed to conceptualization, data collection, methodology, analysis, and writing. RS was involved in the methodology, review, and editing of the paper. SV, DK, SH, NB, and SRM contributed to the data interpretation and review of the paper. All authors have approved the final version for publication.

Corresponding author

Correspondence to Smita Manchanda.

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Competing interests

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

The study was approved by institute ethics committee (IECPG-676/23.12.2020, RT-05/27.01.2021).

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Informed consent and consent to publish was obtained from all individual participants included in the study.

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Kaur, G., Manchanda, S., Sharma, R. et al. Comparison of conventional diffusion-weighted imaging, diffusion kurtosis imaging and intravoxel incoherent motion in characterization of sonographically indeterminate adnexal masses. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04292-x

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  • DOI: https://doi.org/10.1007/s00261-024-04292-x

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