Advertisement

European Radiology

, Volume 20, Issue 9, pp 2176–2183 | Cite as

Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass?

  • Philip DilksEmail author
  • Priya Narayanan
  • Rodney Reznek
  • Anju Sahdev
  • Andrea Rockall
Magnetic Resonance

Abstract

Objectives

Our aim was to establish threshold criteria based on quantitative DCE-MRI data as independent predictors of malignancy in a complex (solid, solid/cystic) ovarian mass.

Methods

The MRI of 26 lesions in 25 patients with a complex ovarian mass (age range, 17–80 years; mean 43 years) was retrospectively reviewed and correlated with histology following resection. Cases with solid tumour components, definitive histology and relevant dynamic imaging were included. These were categorised into two groups, benign (N = 14) and malignant (N = 12). Following dynamic contrast-enhanced imaging, regions of interest were drawn around the solid tumour component. Maximum actual enhancement (SImax), maximum relative enhancement (SIrel), wash-in rate (WIR) and SImax (tumour)/SImax (psoas) ratio were analysed. Threshold criteria for malignancy were established.

Results

There was a significant difference in SImax (p < 0.001), SIrel (p < 0.05), WIR (p < 0.001) and SImax (tumour)/SImax (psoas) between the two groups. Optimal threshold criteria for malignancy were established; SImax ≥ 250 or SImax (tumour)/SImax (psoas) ≥ 2.35 divided the two groups with 100% sensitivity, specificity and accuracy.

Conclusion

Threshold criteria established in this preliminary study using quantitative DCE-MRI provide an accurate method for the prediction of malignancy, particularly in preoperative indeterminate cases.

Keywords

Adnexal mass Indeterminate Ovarian cancer Quantitative dynamic contrast-enhanced magnetic resonance imaging Borderline ovarian cancer 

References

  1. 1.
    Office for National Statistics (2009) Mortality statistics. Deaths registered in 2007. Available via http://www.statistics.gov.uk/downloads/theme_health/DR2007/DR_07_2007.pdf. Accessed 29 Jan 2010
  2. 2.
    Curtin JP (1994) Management of the adnexal mass. Gynecol Oncol 55:S42–S46CrossRefPubMedGoogle Scholar
  3. 3.
    Report of the Ultrasonography Task Force (1991) Gynecological Sonography. JAMA 265:2851–2855CrossRefGoogle Scholar
  4. 4.
    Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H (2005) Indeterminate ovarian mass at US: incremental value of second imaging test for characterization–meta-analysis and Bayesian analysis. Radiology 236:85–94CrossRefPubMedGoogle Scholar
  5. 5.
    Strigini FA, Gadducci A, Del Bravo B, Ferdeghini M, Genazzani AR (1996) Differential diagnosis of adnexal masses with transvaginal sonography, color flow imaging, and serum ca125 assay in pre and post menopausal women. Gynecol Oncol 61:68–72CrossRefPubMedGoogle Scholar
  6. 6.
    Chapron C, Dubuisson JB, Kadoch O et al (1998) Laparoscopic management of organic ovarian cysts: is there a place for frozen section diagnosis? Hum Reprod 13:324–329CrossRefPubMedGoogle Scholar
  7. 7.
    Guerriero S, Ajossa S, Garau N, Piras B, Paoletti AM, Melis GB (2005) Ultrasonography and color Doppler-based triage for adnexal masses to provide the most appropriate surgical approach. Am J Obstet Gynecol 192:401–406CrossRefPubMedGoogle Scholar
  8. 8.
    Obeidat BR, Amarin ZO, Latimer JA et al (2004) Risk of malignancy index in the preoperative evaluation of pelvic masses. Int J Gynecol Obstet 85:255–258CrossRefGoogle Scholar
  9. 9.
    Sohaib SA, Mills TD, Sahdev A, Webb JA, Vantrappen PO, Jacobs IJ, Reznek RH (2005) The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 60:340–348CrossRefPubMedGoogle Scholar
  10. 10.
    Hricak H, Chen M, Coakley FV et al (2000) Complex adnexal masses: detection and characterization with MR imaging–multivariate analysis. Radiology 214:39–46PubMedGoogle Scholar
  11. 11.
    Imaoka I, Wada A, Kaji Y, Hayashi T, Hayashi M, Matsuo M, Sugimura K (2006) Developing an MR imaging strategy for diagnosis of ovarian masses. Radiographics 26:1431–1448CrossRefPubMedGoogle Scholar
  12. 12.
    Funt SA, Hann LE (2002) Detection and characterization of adnexal masses. Radiol Clin North Am 40:591–608CrossRefPubMedGoogle Scholar
  13. 13.
    Sohaib SA, Sahdev A, Van Trappen P, Jacobs IJ, Reznek RH (2003) Characterization of adnexal mass lesions on MR imaging. Am J Roentgenol 180:1297–1304Google Scholar
  14. 14.
    Thomassin-Naggara I, Daraï E, Nassar-Slaba J, Cortez A, Marsault C, Bazot M (2007) Value of dynamic enhanced magnetic resonance imaging for distinguishing between ovarian fibroma and subserous uterine leiomyoma. J Comput Assist Tomogr 31:236–242CrossRefPubMedGoogle Scholar
  15. 15.
    Adusumilli S, Hussain HK, Caoili EM, Weadock WJ, Murray JP, Johnson TD, Chen Q, Desjardins B (2006) MRI of sonographically indeterminate adnexal masses. Am J Roentgenol 187:732–740CrossRefGoogle Scholar
  16. 16.
    Van Vierzen PB, Massuger LF, Ruys SH, Barentsz JO (1998) Borderline ovarian malignancy: ultrasound and fast dynamic MR findings. Eur J Radiol 28:136–142CrossRefPubMedGoogle Scholar
  17. 17.
    Spencer JA, Forstner R, Cunha TM, Kinkel K (2009) on behalf of the ESUR Female Imaging Sub-Committee. ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithmic approach. Eur Radiol 20:25–35CrossRefGoogle Scholar
  18. 18.
    Newatia A, Khatri G, Friedman B, Hines J (2007) Subtraction imaging. Applications for non-vascular. MRI Am J Roentgenol 188:1018–1025CrossRefGoogle Scholar
  19. 19.
    Kuhl CK, Mielcareck P, Klaschik S, Leutner WE, Gieseke J, Schild HH (1999) Dynamic breast MR imaging: are signal time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110PubMedGoogle Scholar
  20. 20.
    Ren J, Huan Y, Wang H, Chang YJ, Zhao HT, Ge YL, Liu Y, Yang Y (2008) Dynamic contrast-enhanced MRI of benign prostatic hyperplasia and prostatic carcinoma: correlation with angiogenesis. Clin Radiol 63:153–159CrossRefPubMedGoogle Scholar
  21. 21.
    Ho VB, Allen SF, Hood MN, Choyke PL (2002) Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology 224:695–700CrossRefPubMedGoogle Scholar
  22. 22.
    Kuhl CK, Schmutzler RK, Leutner C, Kempe A, Wardelmann E, Hocke A, Maringa M, Pfeifer U, Krebs D, Schild HH (2000) Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results. Radiology 215:267–279PubMedGoogle Scholar
  23. 23.
    Ocak I, Bernardo M, Metzger G, Barrett T, Pinto P, Albert PS, Choyke PL (2007) Dynamic contrast-enhanced MRI of prostate cancer at 3 T: a study of pharmacokinetic parameters. Am J Roentgenol 189:849CrossRefGoogle Scholar
  24. 24.
    Thomassin-Naggara I, Bazot M, Daraï E, Callard P, Thomassin J, Cuenod CA (2008) Epithelial ovarian tumors: value of dynamic contrast-enhanced MR imaging and correlation with tumor angiogenesis. Radiology 248:148–159CrossRefPubMedGoogle Scholar
  25. 25.
    Thomassin-Naggara I, Darai E, Cuenod CA, Rouzier R, Callard P, Bazot M (2008) Dynamic contrast enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumours. J Magn Reson Imaging 28:111–120CrossRefPubMedGoogle Scholar
  26. 26.
    Tempfer CB, Polterauer S, Bentz EK et al (2007) Accuracy of intraoperative frozen section analysis in borderline tumours of the ovary: a retrospective analysis of 96 cases and review of the literature. Gynaecol Oncol 107:248–252CrossRefGoogle Scholar
  27. 27.
    Taskiran C, Erdem O, Onan A, Bozkurt N, Yaman-Tunc S, Ataoglu O, Guner H (2008) The role of frozen section evaluation in the diagnosis of an adnexal mass. Int J Gynecol Cancer 18:235–240CrossRefPubMedGoogle Scholar
  28. 28.
    Bazot M, Nassar-Slaba J, Thomassin-Naggara I, Cortez A, Uzan S, Daraï E (2006) MR imaging compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors; correlation with final histology. Eur Radiol 16:2687–2699CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Philip Dilks
    • 1
    • 4
    Email author
  • Priya Narayanan
    • 2
  • Rodney Reznek
    • 3
  • Anju Sahdev
    • 1
  • Andrea Rockall
    • 1
  1. 1.Barts and The London NHS TrustLondonUK
  2. 2.Chelsea and Westminster NHS Foundation TrustLondonUK
  3. 3.Queen Mary, University of LondonLondonUK
  4. 4.LondonUK

Personalised recommendations