title: Qualitative and quantitative analysis of diffusion-weighted imaging of gestational trophoblastic disease: Can it predict progression of molar pregnancy to persistent form of disease?
abstract: OBJECTIVE
  To describe the diffusion-weighted imaging (DWI) appearance of gestational trophoblastic disease (GTD) and to determine its apparent diffusion coefficient (ADC) values. To evaluate the feasibility of DWI to predict progression of hydatidiform mole (HM) to persistent disease.
  
  
  METHODS
  During a period of 6 months, women with preliminary diagnosis of GTD, based on ultrasound and ßhCG levels, underwent 1.5T MRI (T2 high-resolution and DWI; b values 50, 400, 800; sagittal and perpendicular to the endometrium; and T1, T2 Turbo Spin Echo [TSE] axial images). Patients were followed for 6-12 months to monitor progression to persistent form of the disease. ADC values and image characteristics were compared between HM and persistent neoplasia and between GTD and non-molar pregnancy using Mann-Whitney U and Fisher's exact tests, respectively.
  
  
  RESULTS
  Among the 23 studied patients, 19 (83%) were classified as molar and 4 (17%) as non-molar, based on pathology reports. After 6-12 months of follow-up, 5 (26%) cases progressed to persistent disease and 14 (74%) cases were benign HM. There was no significant difference between ADC values for HM (1.93±0.33×10-3mm2/s) and persistent neoplasia (2.03±0.28×10-3mm2/s) (P=0.69). The ADC of non-molar pregnancies was (0.96±0.46×10-3mm2/s), which was significantly different from GTD (1.96 ±0.32×10-3mm2/s) (P=0.001). Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity were more common in GTD compared to non-molar pregnancy (P<0.05).
  
  
  CONCLUSIONS
  Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity are among the imaging characteristics of GTD. We cannot use ADC values to predict progression to persistent disease.
authors.affiliation: Medical imaging research center, Department of Radiology and Imaging, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Sefidbakht
authors.affiliation: Medical imaging research center, Department of Radiology and Imaging, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: f.hoseini88@gmail.com.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Hosseini
authors.affiliation: Abdominal Imaging/MR and Nonvascular Interventional Division, University of California, Davis, CA, USA.
authors.forename: Bijan
authors.initials: B
authors.lastname: Bijan
authors.affiliation: Obstetrics& Gynecology Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Bahareh
authors.initials: B
authors.lastname: Hamedi
authors.affiliation: Obstetrics& Gynecology Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Tayyebeh
authors.initials: T
authors.lastname: Azizi
mesh_terms: D000328:Adult; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018450:Disease Progression; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D007492:Iran; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000473:pathology; D055815:Young Adult
keywords: Apparent diffusion coefficient; Diffusion-weighted imaging; Gestational trophoblastic disease; Hydatidiform mole; MRI