Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist Tomogr. 2008;32:712-723. [PMID: 18830100 DOI: 10.1097/rct.0b013e31815881ef]

Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses

OBJECTIVE

We evaluated the feasibility of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement in differentiating benign and malignant ovarian tumors.

METHODS

Surgically proven 49 ovarian tumors (39 malignant/borderline malignant and 10 benign) were examined.

RESULTS

The solid portion of all 39 malignant tumors showed homogeneous or heterogeneous high intensity on DWI, whereas only 3 of the 10 benign tumors (3 thecomas) showed high intensity. The mean (SD) ADC value in the 39 malignant tumors (1.03 [0.19]) was significantly lower than that in 10 benign tumors (1.38 [0.30]). A relatively low ADC (1.08-1.20) in the 3 thecomas may reflect their abundant cellular nature, and the presence of low intensity on T2-weighted images was suggestive for benign fibrous tumor.

CONCLUSIONS

Low intensity on DWI with high ADC may suggest benign lesions; however, it may be occasionally difficult to differentiate benign and malignant lesions only on the basis of DWI.

Advances in sonographic detection of ovarian cancer: depiction of tumor neovascularity with microbubbles

OBJECTIVE

The purpose of this article is to discuss and illustrate the use of contrast-enhanced transvaginal sonography for the early detection of ovarian cancer and suggest how this technique may best be used to distinguish benign from malignant ovarian masses.

CONCLUSION

Microbubble-enhanced transvaginal sonography can enhance the evaluation of ovarian masses by early detection of tumor microvascularity.

MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization

OBJECTIVE

The purpose of this article is to describe the role of MR, CT, and PET/CT in the detection of ovarian cancer and the evaluation of adnexal lesions.

CONCLUSION

The goal of imaging in ovarian cancer detection is to expeditiously distinguish benign adnexal lesions from those requiring further pathologic evaluation for malignancy. For lesions indeterminate on ultrasound, MRI increases the specificity of imaging evaluation, thus decreasing benign resections. CT is useful in diagnosis and treatment planning of advanced cancer. Although (18)F-FDG-avid ovarian lesions in postmenopausal women are considered suspicious for malignancy, PET/CT is not recommended for primary cancer detection because of high false-positive rates.

Diagnostic parameters to differentiate benign from malignant ovarian masses with contrast-enhanced transvaginal sonography

OBJECTIVE

The aim of this study was to evaluate diagnostic parameters to differentiate between benign versus malignant ovarian masses using contrast-enhanced transvaginal sonography (TVS).

METHODS

Thirty-three consecutive patients with 36 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic TVS. The following parameters were assessed: presence of contrast enhancement, time to peak enhancement, peak contrast enhancement, half wash-out time, and area under the enhancement curve (AUC). Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors.

RESULTS

Twenty-six benign masses and 10 malignancies were studied. Of all examined criteria, an AUC of greater than 787 seconds(-1) was the most accurate diagnostic criterion for ovarian cancer, with 100.0% sensitivity and 96.2% specificity. Additionally, peak contrast enhancement of greater than 17.2 dB (90.0% sensitivity and 98.3% specificity) and half wash-out time of greater than 41.0 seconds (100.0% sensitivity and 92.3% specificity) proved to be useful.

CONCLUSIONS

Our data suggest that the AUC, peak enhancement, and half wash-out time had the greatest diagnostic accuracy for contrast-enhanced TVS in differentiation between benign and malignant ovarian masses.