Diffusion MRI of uterine and ovarian masses: identifying the benign lesions

Amir H Davarpanah; Avinash Kambadakone; Nagaraj S Holalkere; Alexander R Guimaraes; Peter F Hahn; Susanna I Lee

doi:10.1007/s00261-016-0909-2

Diffusion MRI of uterine and ovarian masses: identifying the benign lesions

Abdom Radiol (NY). 2016 Dec;41(12):2466-2475. doi: 10.1007/s00261-016-0909-2.

Authors

Amir H Davarpanah¹, Avinash Kambadakone², Nagaraj S Holalkere³, Alexander R Guimaraes⁴, Peter F Hahn², Susanna I Lee²

Affiliations

¹ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA. adavarpanah@mgh.harvard.edu.
² Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA.
³ Department of Radiology, Boston University Medical Center, Boston, MA, USA.
⁴ Department of Radiology, Oregon Health and Sciences University, Portland, OR, USA.

PMID: 27660280
DOI: 10.1007/s00261-016-0909-2

Abstract

Purpose: The purpose of the study was to assess the diagnostic performance of qualitative and quantitative diffusion-weighted imaging (DWI) in differentiating benign from malignant ovarian and uterine masses.

Materials and methods: Institutional review board approval was obtained for this HIPAA-compliant retrospective study, with waiver of informed consent. DWI MRIs of 222 women acquired over 1.5 years were evaluated. Reference standard was pathology or follow-up imaging. For qualitative assessment, two radiologists independently reviewed DWI and apparent diffusion coefficient (ADC) images for diffusion restriction. Differences were resolved by consensus. For quantitative assessment, a single reader measured ADC values. Readers were blinded to the reference standard.

Results: 222 lesions, 121 ovarian (99 benign and 22 malignant) and 101 uterine (54 benign and 47 malignant), were included. Final diagnosis was established with pathology in 129 (58%) or with imaging follow-up in 93 (42%). Mean (range) follow-up interval was 27 (13-48) months. Qualitative assessment yielded sensitivity (ratio, 95% CI), specificity, PPV and NPV of 100% (22/22, 85-100), 68% (68/99, 58-76), 41% (22/54, 27-54), and 100% (68/68, 94-100) for ovarian and 94% (44/47, 83-98), 91% (49/54, 80-96), 90% (44/49, 78-95) and 94% (49/52, 84-98) for uterine malignancies. ADC (mean ± SD) between benign ovarian [(1.11 ± 0.76) × 10^-3 mm²/s] vs. malignant [(0.71 ± 0.26) × 10^-3 mm²/s] lesions was significantly different (p < 0.001). ADC cutoff value of 1.55 × 10^-3 mm²/s for ovarian lesions resulted in 99.9% confidence for the absence of malignancy. ADC (mean ± SD) of benign uterine [(0.64 ± 0.38) × 10^-3 mm²/s] vs. malignant [(0.68 ± 0.19) × 10^-3 mm²/s] lesions was not significantly different (P < 0.54).

Conclusion: Quantitative and qualitative DWI assessment can be used to confidently characterize a subset of ovarian lesions as benign. With uterine lesions, although DWI is useful in differentiating benign from malignant lesions, the technique does not allow for definitive quantitative characterization.

Keywords: Apparent diffusion coefficient; Diffusion-weighted imaging; Magnetic resonance imaging; Pelvic neoplasms.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Contrast Media
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging / methods
Female
Humans
Image Interpretation, Computer-Assisted
Middle Aged
Ovarian Neoplasms / diagnostic imaging*
Ovarian Neoplasms / pathology
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Uterine Neoplasms / diagnostic imaging*
Uterine Neoplasms / pathology

Substances

Contrast Media