Abstract
Pathological analysis of ovarian cysts shows specific fluid characteristics that cannot be standardly evaluated on computer tomography (CT) examinations. This study aimed to assess the ovarian cysts’ fluid attenuation values on the native (Np), arterial (Ap), and venous (Vp) contrast phases of seventy patients with ovarian cysts who underwent CT examinations and were retrospectively included in this study. Patients were divided according to their final diagnosis into the benign group (n = 32) and malignant group (n = 38; of which 27 were primary and 11 were secondary lesions). Two radiologists measured the fluid attenuation values on each contrast phase, and the average values were used to discriminate between benign and malignant groups and primary tumors and metastases via univariate, multivariate, multiple regression, and receiver operating characteristics analyses. The Ap densities (p = 0.0002) were independently associated with malignant cysts. Based on the densities measured on all three phases, neoplastic lesions could be diagnosed with 89.47% sensitivity and 62.5% specificity. The Np densities (p = 0.0005) were able to identify metastases with 90.91% sensitivity and 70.37% specificity, while the combined densities of all three phases diagnosed secondary lesions with 72.73% sensitivity and 92.59% specificity. The ovarian cysts’ fluid densities could function as an adjuvant criterion to the classic CT evaluation of ovarian cysts.
Highlights
Imaging has an important role in the assessment of ovarian cysts since a precise characterization of these lesions dictates their further management [1]
The multiple regression analysis showedphases that the conducted on the Ap were independent predictors of malignant cysts, and the attenuation values measured from Np were of benign from malignant cysts was obtained by the densities measured on Ap
Our results show that benign and malignant cysts could be differentiated based on the average values recorded on all three contrast phases (Nm, p = 0.0083; Am, p = 0.0002; Vm, p = 0.0029), but the only measurements that functioned as independent predictors of malignant tumors were the ones conducted on the arterial phase
Summary
Imaging has an important role in the assessment of ovarian cysts since a precise characterization of these lesions dictates their further management [1]. Ultrasonography (US) is the first imaging modality involved in investigating adnexal cysts, but in some cases, it cannot certify their benign or malignant nature [2,3], mostly due to its low specificity rates [4]. While magnetic resonance imaging (MRI) can bring additional information about the characteristics of an ovarian tumor [5], computer tomography (CT) is usually reserved for evaluation in pre-treatment planning of a suspected adnexal malignancy [6]. The CT features of ovarian cysts have been investigated in several studies in the literature. These features include these lesions’ behavior under contrast administration [7], and the imaging appearance of several histological entities [4,8]; even diagnostic workups have been developed [9]
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