Abstract
Background and Objectives: To assess ovarian cysts with texture analysis (TA) in magnetic resonance (MRI) images for establishing a differentiation criterion for endometriomas and functional hemorrhagic cysts (HCs) that could potentially outperform their classic MRI diagnostic features. Materials and Methods: Forty-three patients with known ovarian cysts who underwent MRI were retrospectively included (endometriomas, n = 29; HCs, n = 14). TA was performed using dedicated software based on T2-weighted images, by incorporating the whole lesions in a three-dimensional region of interest. The most discriminative texture features were highlighted by three selection methods (Fisher, probability of classification error and average correlation coefficients, and mutual information). The absolute values of these parameters were compared through univariate, multivariate, and receiver operating characteristic analyses. The ability of the two classic diagnostic signs (“T2 shading” and “T2 dark spots”) to diagnose endometriomas was assessed by quantifying their sensitivity (Se) and specificity (Sp), following their conventional assessment on T1-and T2-weighted images by two radiologists. Results: The diagnostic power of the one texture parameter that was an independent predictor of endometriomas (entropy, 75% Se and 100% Sp) and of the predictive model composed of all parameters that showed statistically significant results at the univariate analysis (100% Se, 100% Sp) outperformed the ones shown by the classic MRI endometrioma features (“T2 shading”, 75.86% Se and 35.71% Sp; “T2 dark spots”, 55.17% Se and 64.29% Sp). Conclusion: Whole-lesion MRI TA has the potential to offer a superior discrimination criterion between endometriomas and HCs compared to the classic evaluation of the two lesions’ MRI signal behaviors.
Highlights
Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity [1]
This Health Insurance Portability and Accountability Act for a compliant, single-institution, and retrospective pilot study has been approved by the institutional review board, and a waiver consent was obtained owing to its retrospective nature
Reports of pelvic magnetic resonance imaging (MRI) scans were searched from January 2017 to February 2020 using the keywords: “endometriosis”, “endometrioma/s”, “hemorrhagic cyst/s”, and “ovarian cyst/s”
Summary
Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity [1]. Endometriomas are the most common form of endometriosis, being produced by repeated hemorrhage from an ectopic endometrium located in the ovaries [2]. They present in the form of cysts resulting from cyclic bleeding over months [3], being responsible for almost 17% of infertility cases in women [4]. Transvaginal ultrasonography (TVUS) is the primary diagnostic tool in the diagnosis of endometriomas In most cases, this technique can provide sufficient information for adequate preoperative planning [10]. To assess ovarian cysts with texture analysis (TA) in magnetic resonance (MRI) images for establishing a differentiation criterion for endometriomas and functional hemorrhagic cysts (HCs) that could potentially outperform their classic MRI diagnostic features
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