TY - JOUR
T1 - Diffusion MRI of uterine and ovarian masses
T2 - identifying the benign lesions
AU - Davarpanah, Amir H.
AU - Kambadakone, Avinash
AU - Holalkere, Nagaraj S.
AU - Guimaraes, Alexander R.
AU - Hahn, Peter F.
AU - Lee, Susanna I.
N1 - Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
AB - 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.
KW - Apparent diffusion coefficient
KW - Diffusion-weighted imaging
KW - Magnetic resonance imaging
KW - Pelvic neoplasms
UR - http://www.scopus.com/inward/record.url?scp=84988700548&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84988700548&partnerID=8YFLogxK
U2 - 10.1007/s00261-016-0909-2
DO - 10.1007/s00261-016-0909-2
M3 - Article
C2 - 27660280
AN - SCOPUS:84988700548
SN - 2366-004X
VL - 41
SP - 2466
EP - 2475
JO - Abdominal Radiology
JF - Abdominal Radiology
IS - 12
ER -