Abstract
Purpose
We prospectively investigated the diagnostic accuracy of magnetic resonance imaging (MRI) at 3.0 Tesla (3T) for the detection of suspected primary adnexal masses in a large cohort of patients.
Methods
This prospective clinical study included 223 patients with suspected gynaecological disease who were referred for 3T MRI assessments before laparoscopy or laparotomy. Fifty-nine patients were excluded. All detected adnexal pathologies on MRI were categorized into the four groups (endometric cysts, teratomas, benign tumours and malignant tumours). Histological findings were used as the comparative reference standard. As measures to detect or rule out primary adnexal masses, accuracy, sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were determined by lesion-based evaluations.
Results
The reference standard method detected 141 primary adnexal lesions in 125 patients. The areas under the receiver operating characteristic curve of the lesion-based evaluations for endometric cysts, teratomas, benign lesions and malignant lesions were 92.8, 93.6, 95.1 and 94.4 %. Lesion-based evaluation yielded an accuracy of 90.3 %, sensitivity of 92.7 %, specificity of 89.3 %, PPV of 77.6 % and NPV of 96.8 % in differentiating malignancies from non-malignant lesions. The diagnostic value of 3T MRI for detecting malignancies was superior to that for benign tumours.
Conclusions
3T MRI well categorize the characteristics of primary adnexal lesions and may be a reliable modality for distinguishing malignancies from benign tumours.
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References
Myers ERBL, Havrilesky LJ, Kulasingam SL, Terplan M, Cline KE, Gray RN et al (2006) Management of adnexal mass. Evid Rep Technol Assess (Full Rep) 2006(130):1–145
Rajkotia K, Veeramani M, Macura KJ (2006) Magnetic resonance imaging of adnexal masses. Top Magn Reson Imaging 17:379–397
Griffin N, Grant LA, Sala E (2010) Adnexal masses: characterization and imaging strategies. Seminars Ultrasound CT MRI 31:330–346
Hricak H, Chen M, Coakley FV, Kinkel K, Yu KK, Sica G et al (2000) Complex adnexal masses: detection and characterization with MR imaging—multivariate analysis1. Radiology 214:39–46
Sohaib SA, Mills TD, Sahdev A, Webb JAW, VanTrappen PO, Jacobs IJ et al (2005) The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol 60:340–348
Funt SA, Hann LE (2002) Detection and characterization of adnexal masses. Radiol Clin North Am 40:591–608
Adusumilli S, Hussain HK, Caoili EM, Weadock WJ, Murray JP, Johnson TD et al (2006) MRI of sonographically indeterminate adnexal masses. Am J Roentgenol 187:732–740
Yamashita Y, Torashima M, Hatanaka Y, Harada M, Higashida Y, Takahashi M et al (1995) Adnexal masses: accuracy of characterization with transvaginal us and precontrast and postcontrast MR imaging. Radiology 194:557–565
Komatsu T, Konishi I, Mandai M, Togashi K, Kawakami S, Konishi J et al (1996) Adnexal masses: transvaginal us and gadolinium-enhanced MR imaging assessment of intratumoral structure. Radiology 198:109–115
Grab D, Flock F, Stöhr I, Nüssle K, Rieber A, Fenchel S et al (2000) Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol 77:454–459
Sohaib SAA, Sahdev A, Trappen PV, Jacobs IJ, Reznek RH (2003) Characterization of adnexal mass lesions on MR imaging. Am J Roentgenol 180:1297–1304
Bazot M, Nassar-Slaba J, Thomassin-Naggara I, Cortez A, Uzan S, Darai E (2006) MR imaging compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors; correlation with final histology. Eur Radiol 16:2687–2699
Engelen MJA, Bongaerts AHH, Sluiter WJ, de Haan HH, Bogchelman DH, TenVergert EM et al (2008) Distinguishing benign and malignant pelvic masses: the value of different diagnostic methods in everyday clinical practice. Eur J Obstet Gynecol Reprod Biol 136:94–101
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 tumors. J Magn Reson Imaging 28:111–120
Chilla B, Hauser N, Singer G, Trippel M, Froehlich J, Kubik-Huch R (2011) Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions. Eur Radiol 21:1301–1310
Medeiros LR, Freitas LB, Rosa DD, Silva FR, Silva LS, Birtencourt LT et al (2011) Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review. Am J Obstet Gynecol 204:67.e61
Thomassin-Naggara I, Toussaint I, Perrot N, Rouzier R, Cuenod CA, Bazot M et al (2011) Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging. Radiology 258:793–803
Manganaro L, Fierro F, Tomei A, Irimia D, Lodise P, Sergi ME et al (2012) Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis. Eur J Radiol 81:1381–1387
Sala E, Kataoka MY, Priest AN, Gill AB, McLean MA, Joubert I et al (2012) Advanced ovarian cancer: multiparametric MR imaging demonstrates response- and metastasis-specific effects. Radiology 263:149–159
Rieber A, Nüssle K, Stöhr I, Grab D, Fenchel S, Kreienberg R et al (2001) Preoperative diagnosis of ovarian tumors with MR imaging. Am J Roentgenol 177:123–129
Shen J, Xia X, Lin Y, Zhu W, Yuan J (2011) Diagnosis of struma ovarii with medical imaging. Abdom Imaging 36:627–631
Kim KA, Park CM, Lee JH, Kim HK, Cho SM, Kim B et al (2004) Benign ovarian tumors with solid and cystic components that mimic malignancy. Am J Roentgenol 182:1259–1265
Togashi K (2003) Ovarian cancer: the clinical role of us, CT, and MRI. Eur Radiol 13:L87–L104
Sala E, Rockall A, Rangarajan D, Kubik-Huch RA (2010) The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis. Eur J Radiol 76:367–385
Moyle P, Addley HC, Sala E (2010) Radiological staging of ovarian carcinoma. Semin Ultrasound CT MR 31:388–398
Togashi K, Nishimura K, Kimura I, Tsuda Y, Yamashita K, Shibata T et al (1991) Endometrial cysts: diagnosis with MR imaging. Radiology 180:73–78
Acknowledgments
We would like to thank Dr. Yong-Dong Li from the Department of Radiology, Sixth Hospital, Shanghai Jiao Tong University, for his invaluable suggestions during preparation of this manuscript.
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We declare that we have no conflicts of interest.
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Zhang, H., Zhang, GF., He, ZY. et al. Prospective evaluation of 3T MRI findings for primary adnexal lesions and comparison with the final histological diagnosis. Arch Gynecol Obstet 289, 357–364 (2014). https://doi.org/10.1007/s00404-013-2990-x
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DOI: https://doi.org/10.1007/s00404-013-2990-x