Yeungnam Univ J Med.  2019 Sep;36(3):231-240. 10.12701/yujm.2019.00234.

Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging

• Kim SH

• KMID: 2460192
• DOI: http://doi.org/10.12701/yujm.2019.00234

Abstract

BACKGROUND
We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas.
METHODS
Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), K(trans) (vessel permeability), and V(e) (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences.
RESULTS
There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, K(trans), and V(e) values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively.
CONCLUSION
Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.

Keyword

Borderline ovarian tumor; Diagnosis; Magnetic resonance imaging; Stage I ovarian carcinoma

MeSH Terms

Area Under Curve
Diagnosis
Diffusion
Humans
Logistic Models
Magnetic Resonance Imaging*
ROC Curve

Figure

• 

  Fig. 1. Images of a serous cystadenoma borderline tumor in a 46-year-old woman. (A) T2-weighted fast spin-echo axial MR image shows a right ovarian tumor with cystic and solid components as solid portions (arrows) with low signal intensity. Ascites (arrowhead) is shown. (B) ADC map obtained at b=1,000 mm2/sec shows restricted diffusion in the solid portions (arrows, measured mean ADC map=1.12×10-3 mm2/sec). (C) Ktrans and Ve map color overlain on a T2-weighted MR image shows increased Ktrans and Ve values throughout the solid portions (measured Ktrans and Ve of the ROI2=0.254/min and 0.150). (D) Relative enhancement time fitting curve of the solid component of the borderline tumor is shown. MR, magnetic resonance; ADC, apparent diffusion coefficient; ROI, region of interest.

• 

  Fig. 2. Images of a stage I serous adenocarcinoma in a 42-year-old woman. (A) T2-weighted fast spin-echo axial MR image shows a right ovarian tumor with predominant solid portions (arrows) with low to intermediate signal intensity. (B) ADC map obtained at b=1,000 mm2/sec shows restricted diffusion in the solid portions (arrows, measured mean ADC map=1.07×10-3 mm2/sec). (C) Ktrans and Ve map color overlain on a T2-weighted MR image shows increased Ktrans and Ve values over the area corresponding to the carcinoma (measured Ktrans and Ve of the ROI1=0.323/min and 0.332). (D) Relative enhancement time fitting curve of the solid component of the carcinoma is shown. MR, magnetic resonance; ADC, apparent diffusion coefficient; ROI, region of interest.

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  Fig. 3. Box and whisker plot of ADC values for borderline tumors and stage I carcinomas. Data box=individual ADC value, horizontal lines=average and associated 95% confidence intervals. ADC, apparent diffusion coefficient.

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  Fig. 4. ROC curves of ADC, Ve, and Ktrans parameters in the differentiation of borderline tumors (A) and stage I carcinomas (B). 1=ADC, 2=Ve, and 3=Ktrans. ROC, receiver operating characteristic; ADC, apparent diffusion coefficient.

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  Fig. 5. ROC curves of diagnostic performance for PW sequence, DW sequence, and combining PW and DW sequences to a conventional sequence in the differentiation of borderline tumors and stage I carcinomas. 1=DW sequence only, 2=PW sequence only, and 3=combined PW+DW sequences. ROC, receiver operating characteristic; PW, perfusion-weighted; DW, diffusion-weighted.

Reference

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