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

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

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Sep 22 2016

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Diffusion Magnetic Resonance Imaging
Pathology
Health Insurance Portability and Accountability Act
Research Ethics Committees
Informed Consent
Neoplasms
Retrospective Studies

Keywords

  • Apparent diffusion coefficient
  • Diffusion-weighted imaging
  • Magnetic resonance imaging
  • Pelvic neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology

Cite this

Davarpanah, A. H., Kambadakone, A., Holalkere, N. S., Guimaraes, A., Hahn, P. F., & Lee, S. I. (Accepted/In press). Diffusion MRI of uterine and ovarian masses: identifying the benign lesions. Abdominal Radiology, 1-10. https://doi.org/10.1007/s00261-016-0909-2

Diffusion MRI of uterine and ovarian masses : identifying the benign lesions. / Davarpanah, Amir H.; Kambadakone, Avinash; Holalkere, Nagaraj S.; Guimaraes, Alexander; Hahn, Peter F.; Lee, Susanna I.

In: Abdominal Radiology, 22.09.2016, p. 1-10.

Research output: Contribution to journalArticle

Davarpanah, Amir H. ; Kambadakone, Avinash ; Holalkere, Nagaraj S. ; Guimaraes, Alexander ; Hahn, Peter F. ; Lee, Susanna I. / Diffusion MRI of uterine and ovarian masses : identifying the benign lesions. In: Abdominal Radiology. 2016 ; pp. 1-10.
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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.",
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AU - Kambadakone, Avinash

AU - Holalkere, Nagaraj S.

AU - Guimaraes, Alexander

AU - Hahn, Peter F.

AU - Lee, Susanna I.

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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.

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