title: Diffusion kurtosis imaging for differentiating borderline from malignant epithelial ovarian tumors: A correlation with Ki-67 expression.
abstract: To investigate the use of diffusion kurtosis imaging (DKI) in differentiating borderline from malignant epithelial ovarian tumors (MEOTs) and to correlate DKI parameters with Ki-67 expression.
  
  
  
  Fifty-two consecutive patients with epithelial ovarian tumors (17 borderline epithelial ovarian tumors, BEOTs; 35 MEOTs) were prospectively evaluated using DKI with b values of 0, 500, 1000, 1500, 2000, and 2500 s/mm2and standard diffusion-weighted imaging (DWI) with b values of 0 and 1000 s/mm2using a 1.5T magnetic resonance imaging (MRI) unit. The kurtosis (K) and diffusion coefficient (D) from DKI and apparent diffusion coefficient (ADC) from standard DWI were measured, compared, and correlated with Ki-67 expression between the two groups. Statistical analyses were performed using the Mann-Whitney U-test, receiver operating characteristic (ROC) curves, and Spearman's correlation.
  
  
  
  The K value was significantly lower in BEOTs than in MEOTs (0.55 ± 0.09 vs. 0.9 ± 0.2), while the D and ADC values were significantly higher in BEOTs than in MEOTs (2.27 ± 0.35 vs. 1.39 ± 0.37 and 1.72 ± 0.36 vs. 1.1 ± 0.25, respectively) (P < 0.001). For differentiating between BEOTs and MEOTs, the sensitivity, specificity, and accuracy were 88.2%, 94.3%, and 92.3% for K value; 88.2%, 91.4%, and 90.4% for D value; and 88.2%, 88.6%, and 88.5% for ADC value, respectively. However, there were no differences in the diagnostic performances among the three parameters above (K vs. ADC, P = 0.203; D vs. ADC, P = 0.148; K vs. D, P = 0.904). The K value was positively correlated with Ki-67 expression (r = 0.699), while the D and ADC values were negatively correlated with Ki-67 expression (r = -0.680, -0.665, respectively).
  
  
  
  Preliminary findings demonstrate that DKI is an alternative tool for differentiating BEOTs from MEOTs, and is correlated with Ki-67 expression. However, no added value is found for DKI compared with standard DWI.
  
  
  
  1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1499-1506.
authors.affiliation: Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.|Department of Radiology, Nantong Cancer Hospital, Nantong University, Nantong, Jiangsu, P.R. China.
authors.forename: Hai Ming
authors.initials: HM
authors.lastname: Li
authors.affiliation: Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
authors.forename: Shu Hui
authors.initials: SH
authors.lastname: Zhao
authors.affiliation: Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Jin Wei
authors.initials: JW
authors.lastname: Qiang
authors.affiliation: Department of Radiology, Obstetrics & Gynecology Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Guo Fu
authors.initials: GF
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Nantong Cancer Hospital, Nantong University, Nantong, Jiangsu, P.R. China.
authors.forename: Feng
authors.initials: F
authors.lastname: Feng
authors.affiliation: Department of Radiology, Obstetrics & Gynecology Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Feng Hua
authors.initials: FH
authors.lastname: Ma
authors.affiliation: Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Yong Ai
authors.initials: YA
authors.lastname: Li
authors.affiliation: Department of Pathology, Obstetrics & Gynecology Hospital, Shanghai Medical College, Fudan University, Shanghai, 200011, P.R. China.
authors.forename: Wei Yong
authors.initials: WY
authors.lastname: Gu
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism*; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000000981:diagnostic imaging* / Q000378:metabolism*; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D019394:Ki-67 Antigen
keywords: borderline; diffusion kurtosis imaging; magnetic resonance imaging; ovarian tumors