Abstract
BackgroundPreoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the usefulness of apparent diffusion coefficients (ADC) for characterizing complex solid and cystic adnexal masses.MethodsOne-hundred and 91 patients underwent diffusion-weighted (DW) magnetic resonance (MR) imaging of 202 ovarian masses. The mean ADC value of the solid components was measured and assessed for each ovarian mass. Differences in ADC between ovarian masses were tested using the Student’s t-test. The receiver operating characteristic (ROC) was used to assess the ability of ADC to differentiate between benign and malignant complex adnexal masses.ResultsEighty-five patients were premenopausal, and 106 were postmenopausal. Seventy-four of the 202 ovarian masses were benign and 128 were malignant. There was a significant difference between the mean ADC values of benign and malignant ovarian masses (p < 0.05). However, there were no significant differences in ADC values between fibrothecomas, Brenner tumors and malignant ovarian masses. The ROC analysis indicated that a cutoff ADC value of 1.20 x10-3 mm2/s may be the optimal one for differentiating between benign and malignant tumors.ConclusionsA high signal intensity within the solid component on T2WI was less frequently in benign than in malignant adnexal masses. The combination of DW imaging with ADC value measurements and T2-weighted signal characteristics of solid components is useful for differentiating between benign and malignant ovarian masses.
Highlights
Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies
Our results demonstrate that the following factors can be considered predictive of malignancy: the presence of a solid component with high or low signal intensity on T2-weighted images and high signal intensity on diffusion-weighted imaging (DWI) with low apparent diffusion coefficients (ADC) values at b = 1,000 s/mm2
The following factors can be considered predictive of a benign mass: the presence of a solid component with high or low signal intensity on T2-weighted images and high signal intensity on DW images with high ADC values, or low signal intensity on T2-weighted images and DW images with lower ADC values at b = 1,000 s/mm2
Summary
Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Ovarian tumors are the leading indication for gynecologic surgery, and the preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Magnetic resonance imaging (MRI) may be of great help in identifying malignant lesions before surgery, when US findings are suboptimal or indeterminate [4,5,6,7,8,9,10]. MRI can reveal morphologic characteristics such as papillary projections, nodularity, septa, solid portions and signal intensity on T1- and T2-weighted images, but none of these criteria reliably distinguish between benign and malignant tumors. The use of magnetic resonance (MR) diffusion-weighted imaging (DWI) may improve
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