title: Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging.
abstract: OBJECTIVE
  To retrospectively determine the value of adding perfusion-weighted (PW) and diffusion-weighted (DW) sequences to a conventional magnetic resonance (MR) imaging protocol to differentiate benign from malignant tumors.
  
  
  METHODS
  The institutional ethics committee approved this retrospective study and waived the requirement to obtain informed consent. MR images in 87 women (age range, 25-87 years) who underwent imaging before surgery for complex adnexal masses-excluding endometriomas and cystic teratomas-were analyzed. Conventional morphologic, perfusion, and diffusion MR criteria of malignancy were recorded. Three independent observers reviewed images in four steps: conventional MR images alone, conventional MR images and PW images combined, conventional MR images and DW images combined, and conventional, PW, and DW MR images combined. Receiver operating characteristic curve analysis was performed to compare the results of the readings. A recursive partitioning model was built to establish a multivariate decision tree.
  
  
  RESULTS
  There was almost perfect agreement for lesion characterization regardless of the reader experiment or step considered (κ = 0.811-0.929). Area under the receiver operating characteristic curve values were higher for conventional and DW images combined, conventional and PW images combined, and conventional, DW, and PW images combined compared with conventional MR images alone (P < .05). For all readers, the accuracy of conventional, PW, and DW imaging combined was higher than that of conventional MR imaging alone for benign masses (P < .01) but not for malignant masses (P = .24). The addition of both PW and DW images led to a correct change in the diagnosis in 19% (11 of 57 patients), 23% (13 of 57 patients), and 24% (14 of 57 patients) of cases for readers 1, 2, and 3, respectively, with no incorrect changes. Conventional, PW, and DW MR imaging criteria were combined to generate a decision tree giving an accuracy of 95%.
  
  
  CONCLUSIONS
  The addition of PW and DW sequences to a conventional MR imaging protocol improved the diagnostic accuracy in the characterization of complex adnexal masses.
authors.affiliation: Department of Radiology, Hôpital Tenon, Université Pierre et Marie Curie, 4 rue de la Chine, 75020 Paris, France. isabelle.thomassin@tnn.aphp.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Thomassin-Naggara
authors.forename: Irwin
authors.initials: I
authors.lastname: Toussaint
authors.forename: Nicolas
authors.initials: N
authors.lastname: Perrot
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Charles A
authors.initials: CA
authors.lastname: Cuenod
authors.forename: Marc
authors.initials: M
authors.lastname: Bazot
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
mesh_terms: D000291:Adnexal Diseases / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine