MRI for differentiating ovarian endometrioid adenocarcinoma from high-grade serous adenocarcinoma.
OBJECTIVE
To investigate magnetic resonance imaging (MRI) features for differentiating ovarian endometrioid adenocarcinoma (OEC) from high-grade serous adenocarcinoma (HGSC).


METHODS
Twenty-three patients with 25 OECs and 93 patients with 139 HGSCs confirmed by surgery and pathology underwent conventional MRI and diffusion-weighted imaging (DWI). The MRI features of the tumors, including laterality, size, shape, configuration, signal intensity, ADC value of solid component, enhancement, ascites, synchronous primary cancer (SPC) of the ovary and endometrium, and clinical stage, were evaluated and compared between two groups.


RESULTS
The following characteristics were significantly more common for OECs than HGSCs: unilateral (91.3% vs 50.5%, P < 0.001), larger mass (80.0% vs 48.2%, P = 0.005), round or oval shape (64.0% vs 17.3%, P < 0.001), mainly cystic with mural nodules or papillary projections (72.0% vs 18.7%, P < 0.001), cystic component with homogeneous iso- or hyperintensity on T1WI (82.6% vs 4.3%, P < 0.001), moderate enhancement (52.0% vs 26.6%, P = 0.011), no or mild ascites (91.3% vs 57.0%, P = 0.002), and SPC (43.5% vs 4.3%, P < 0.001). The ADC value of the solid component was higher in OECs (0.979 ± 0.197 × 10(-3) mm(2)/s) than in HGSCs (0.820 ± 0.112 × 10(-3) mm(2)/s) (P = 0.002). When a mainly cystic mass with mural nodules or papillary projections was associated with any one of homogeneously iso- or hyperintense cystic component on TIWI, a relatively higher ADC value and SPC, the sensitivity, specificity, accuracy, and positive and negative predictive values for characterizing OEC were 87.0%, 93.5%, 92.2%, 76.9%, and 96.7%, respectively.


CONCLUSIONS
Conventional MRI combining DWI is helpful for differentiating OECs from HGSCs.
Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, 1508 Longhang Road, Shanghai, 201508, China. lihaiming0109@163.com.|Department of Radiology, Nantong Cancer Hospital, Nantong University, 30 North Tongyang Road, Tongzhou District, Nantong, Jiangsu, 226361, China. lihaiming0109@163.com.
Hai Ming
HM
Li
Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, 1508 Longhang Road, Shanghai, 201508, China. dr.jinweiqiang@163.com.
Jin Wei
JW
Qiang
Department of Radiology, Nantong Cancer Hospital, Nantong University, 30 North Tongyang Road, Tongzhou District, Nantong, Jiangsu, 226361, China. ntxg1008@aliyun.com.
Gan Lin
GL
Xia
Department of Radiology, Xinhua Hospital, Shanghai Medical College, Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China. zhaoshuhuii@sina.com.
Shu Hui
SH
Zhao
Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, 1508 Longhang Road, Shanghai, 201508, China. mafenghua9602@163.com.
Feng Hua
FH
Ma
Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, 1508 Longhang Road, Shanghai, 201508, China. csqbee@163.com.
Song Qi
SQ
Cai
Department of Radiology, Nantong Cancer Hospital, Nantong University, 30 North Tongyang Road, Tongzhou District, Nantong, Jiangsu, 226361, China. drfengfeng@163.com.
Feng
F
Feng
Department of Radiology, Nantong Cancer Hospital, Nantong University, 30 North Tongyang Road, Tongzhou District, Nantong, Jiangsu, 226361, China. klfayzt@sohu.com.
Ai Yan
AY
Fu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000175:diagnosis*; D018284:Cystadenocarcinoma, Serous / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis*