Analysis of MRI Values and Hemoglobin and Total Protein Concentrations of Cystic Ovarian Tumors

How to improve O-RADS MRI score for rating adnexal masses with cystic component?

OBJECTIVES

To test the performance of the Ovarian-Adnexal Reporting Data System (O-RADS) MRI in characterizing adnexal masses with cystic components and to test new specific MRI features related to cystic components to improve the ability of the O-RADS MRI score to stratify lesions according to their risk of malignancy.

METHODS

The EURopean ADnexal study (EURAD) database was retrospectively queried to identify adnexal masses with a cystic component. One junior and 13 radiologists independently reviewed cases blinded to the pathological diagnosis. For each lesion, the size of the whole lesion, morphological appearance, number of loculi, presence of a thickened wall, thickened septae, signal intensity of the cystic components on T1-weighted/T2-weighted/diffusion weighted, mean value of the apparent diffusion coefficient, and O-RADS MRI score were reported. Univariate and multivariate logistic regression analysis was performed to determine significant features to predict malignancy.

RESULTS

The final cohort consisted of 585 patients with 779 pelvic masses who underwent pelvic MRI to characterize an adnexal mass(es). Histology served as the standard of reference. The diagnostic performance of the O-RADS MRI score was 0.944, 95%CI [0.922-0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADCmean of cystic component > 1.69, number of loculi > 3, lesion size > 75 mm, the presence of a thick wall, and a low T1-weighted, a high T2-weighted, and a low diffusion-weighted signal intensity of the cystic component. Multivariate analysis demonstrated that an O-RADS MRI score ≥ combined with an ADC mean of the cystic component > 1.69, size > 75 mm, and low diffusion-weighted signal of the cystic component significantly improved the diagnostic performance up to 0.958, 95%CI [0.938-0.973].

CONCLUSION

Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses.

KEY POINTS

• O-RADS MRI score combined with specific cystic features (area under the receiving operating curve, AUROC = 0.958) improves the diagnostic performance of the O-RADS MRI score (AUROC = 0.944) for predicting malignancy in this cohort. • Cystic features that improve the prediction of malignancy are ADC mean > 1.69 (OR = 7); number of loculi ≥ 3 (OR = 5.16); lesion size > 75 mm (OR = 4.40); the presence of a thick wall (OR = 3.59); a high T2-weighted signal intensity score 4 or 5 (OR = 3.30); a low T1-weighted signal intensity score 1, 2, or 3 (OR = 3.45); and a low diffusion-weighted signal intensity (OR = 2.12). • An adnexal lesion with a cystic component rated O-RADS MRI score 4 and an ADC value of the cystic component < 1.69 associated with a low diffusion-weighted signal, has virtually a 0% risk of malignancy.

Useful preoperative examination findings to classify the grade of ovarian primary mucinous tumor

PURPOSE

To evaluate various imaging features on magnetic resonance imaging (MRI) and tumor markers and their utility to assess various grades of ovarian primary mucinous tumors (OPMTs): benign, borderline, or malignant.

METHODS

Ninety-five pathologically diagnosed OPMTs [53 benign, 24 borderline malignant (BM), and 18 malignant] were selected in this retrospective study. MRI features of the ovarian mass, namely the maximum diameter, honeycomb loculi, solid components (SC), stained-glass pattern, and signal intensity of the cyst on T1- (T1WI) and T2-weighted imaging (T2WI) with/without fat suppression, and preoperative STMs, namely carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and CA125, were compared between the three tumor grades using univariate analysis. We also analyzed the findings to estimate the pathological diagnosis using classification tree (CT) analysis.

RESULTS

Maximum diameter, honeycomb loculi, SC, stained-glass pattern, signal intensity of the cyst [hyperintensity on both T1WI and T2WI (T1-hyper/T2-hyper), and hyperintense on T1WI and hypointense on T2WI (T1-hyper/T2-hypo)], and CEA and CA 19-9 concentrations were significantly different between the three tumor grades (p < 0.05). The concordance rate with the pathological diagnosis was the highest with diagnosis by the CT comprising T1-hyper/T2-hypo, CEA, and CA 19-9 and by the CT comprising T1-hyper/T2-hypo, CEA, and SC.

CONCLUSION

Four types of findings were important for OPMT grading. Lesions negative for both T1-hyper/T2-hypo and CEA suggest benign; lesions positive for T1-hyper/T2-hypo and negative for CA 19-9 or SC suggest BM; and lesions negative for T1-hyper/T2-hypo and positive for CEA, or positive for both T1-hyper/T2-hypo and CA 19-9 or SC suggest malignancy.