Role of perfusion CT in the evaluation of adnexal masses

Multiparametric MRI Evaluation of Complex Ovarian Masses

OBJECTIVE

To assess the role of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in the categorization of complex ovarian masses into benign and malignant.

MATERIALS AND METHODS

This prospective study was done on 33 complex ovarian masses. T1 and T2-weighted sequences, diffusion-weighted imaging, apparent diffusion coefficient, and dynamic contrast-enhanced magnetic resonance imaging were performed on 1.5 T MRI. Time-intensity curves, tissue signal intensity on unenhanced T1 images (SI₀), maximum absolute contrast enhancement (SI_max), time to reach SI_max (T_max), maximum relative SI (SI_rel = [SI_max - SI₀]/SI₀ ×100), maximum Slope (Slope_max = SI_rel/T_max ×100), and wash in rate (WIR = [SI_max - SI₀]/T_max) were calculated. Histopathological diagnosis was taken as gold standard.

RESULTS

A total of 20/33 masses were benign, 2/33 were borderline tumors, and 11/33 were malignant. Diffusion restriction was seen in all malignant masses and 13/20 benign masses. The mean apparent diffusion coefficient values showed a significant difference between malignant and benign, with 81.8% sensitivity and 63.6% specificity. Type III curve showed 100% specificity for malignant lesions. T_max and Slope_max were useful in differentiating benign and malignant masses; with T_max cut-off at 73.5 seconds having a high specificity (81.8%) and Slope_max cut-off at 0.83%/s having high sensitivity (91%) and negative predictive value (94.4%).

CONCLUSION

Multiparametric MRI confers high diagnostic accuracy in stratifying complex ovarian masses.