Abstract
We aim to assess the additional value of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) for the risk stratification of sonographically indeterminate ovarian neoplasms. A total of 21 patients with diagnosed adnexal masses between 2014 and 2017 were divided into malignant (four serous cystadenocarcinomas, four endometrioid carcinomas, three clear cell carcinomas, and one carcinosarcoma) and benign (four cystadenomas, two teratomas, one fibroma, one endometrioma, and one corpus luteal cyst) groups. An apparent diffusion coefficient (ADC) value of 1.27 × 10−3 mm2/s was considered as the optimal threshold in distinguishing malignant from benign ovarian tumors (sensitivity and specificity: 100% and 77.8%, respectively). Choline peaks were detected in six of seven O-RADS (Ovarian-Adnexal Imaging-Reporting Data System) 4 lesions and corrected all of the DWI false-negative clear cell carcinoma. Based on the presence of the choline peaks, the diagnostic performance of MRS showed a sensitivity of 77.8%, a specificity of 100%, and an accuracy of 85.7%, respectively. In conclusion, MRS could potentially play a complementary role for DWI in tumor characterization, particularly for O-RADS 4 tumors or clear cell carcinomas.
Highlights
Ovarian cancer is the leading cause of death among gynecological malignancies [1]
We aim to assess the additional value of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) for the risk stratification of sonographically indeterminate ovarian neoplasms
The Magnetic resonance imaging (MRI) Ovarian-Adnexal Imaging-Reporting Data System (O-RADS) scoring system is derived from the ADNEX MR scoring system [7], and according to published literature, a score ≥ 4 suggests the need for prompt surgery [17,18]
Summary
Ovarian cancer is the leading cause of death among gynecological malignancies [1]. Diagnosis is challenging because ovarian cancer is asymptomatic until it reaches an advanced stage. The initial workup includes a physical examination, imaging, and an evaluation of tumor markers to differentiate between benign and malignant lesions. The best outcomes have been observed in patients whose primary treatment included the complete resection of all visible diseased tissue with optional combination chemotherapy [2]. Ultrasonography remains the primary tool for the noninvasive detection and initial evaluation of suspicious malignancies. The use of risk stratification systems—the Ovarian-Adnexal Imaging-Reporting Data System (O-RADS), have been proposed for providing standardized descriptors and consistent interpretations, 22% of ovarian lesions were reported to remain indeterminate in ultrasonographic imaging because the field of view and scanning windows are relatively limited [3]
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