Differentiation of benign from malignant adnexal masses by functional 3 tesla MRI techniques: diffusion-weighted imaging and time-intensity curves of dynamic contrast-enhanced MRI.
BACKGROUND
The aim of this study was to evaluate and compare the accuracy of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) value, and time-intensity curve (TIC) type analysis derived from dynamic contrast-enhanced MR imaging (DCE-MRI) in differentiating benign from malignant adnexal masses.


METHODS
47 patients with 56 adnexal masses (27 malignant and 29 benign) underwent DWI and DCE-MRI examinations, prior to surgery. DWI signal intensity, mean ADC value, and TIC type were determined for all the masses.


RESULTS
High signal intensity on DWI and type 3 TIC were helpful in differentiating benign from malignant adnexal masses (p<0.001). The mean ADC value was significantly lower in malignant adnexal masses (p<0.001). An ADC value<1.20?10-3 mm2/s may be the optimal cutoff for differentiating between benign and malignant tumors. The negative predictive value for low signal intensity on DWI, and type 1 TIC were 100%. The pairwise comparison among the receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) of TIC was significantly larger than the AUCs of DWI and ADC (p<0.001 for comparison of TIC and DWI, p<0.02 for comparison of TIC and ADC value).


CONCLUSIONS
DWI, ADC value and TIC type derived from DCE-MRI are all sensitive and relatively specific methods for differentiating benign from malignant adnexal masses. By comparing these functional MR techniques, TIC was found to be more accurate than DWI and ADC.
Department of Radiology, Medical Imaging Center, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran E-mail : Pourashraf_m@yahoo.com.
Mahrooz
M
Malek
Maryam
M
Pourashraf
Azam Sadat
AS
Mousavi
Maryam
M
Rahmani
Nasrin
N
Ahmadinejad
Azam
A
Alipour
Firoozeh Sadat
FS
Hashemi
Madjid
M
Shakiba
D000038:Abscess / Q000175:diagnosis*; D000291:Adnexal Diseases / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001956:Broad Ligament / Q000473:pathology; D015331:Cohort Studies; D003287:Contrast Media; D003536:Cystadenocarcinoma / Q000175:diagnosis*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004407:Dysgerminoma / Q000175:diagnosis*; D004715:Endometriosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010049:Ovarian Diseases / Q000175:diagnosis; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014384:Tuberculosis, Female Genital / Q000175:diagnosis*; D055815:Young Adult
D003287:Contrast Media