title: Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI.
abstract: OBJECTIVE
  We aimed to investigate whether apparent diffusion coefficients (ADCs) measured by 3.0T diffusion-weighted magnetic resonance imaging (DWI) associate with histological aggressiveness of ovarian cancer (OC) or predict the clinical outcome. This prospective study enrolled 40 patients with primary OC, treated 2011-2014.
  
  
  METHODS
  DWI was performed prior to surgery. Two observers used whole lesion single plane region of interest (WLsp-ROI) and five small ROIs (S-ROI) to analyze ADCs. Samples from tumours and metastases were collected during surgery. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) were used to measure the expression of vascular endothelial growth factor (VEGF) and its receptors.
  
  
  RESULTS
  The interobserver reliability of ADC measurements was excellent for primary tumours ICC 0.912 (WLsp-ROI). Low ADCs significantly associated with poorly differentiated OC (WLsp-ROI P = 0.035). In primary tumours, lower ADCs significantly associated with high Ki-67 (P = 0.001) and low VEGF (P = 0.001) expression. In metastases, lower ADCs (WLsp-ROI) significantly correlated with low VEGF receptors mRNA levels. ADCs had predictive value; 3-year overall survival was poorer in patients with lower ADCs (WLsp-ROI P = 0.023, S-ROI P = 0.038).
  
  
  CONCLUSIONS
  Reduced ADCs are associated with histological severity and worse outcome in OC. ADCs measured with WLsp-ROI may serve as a prognostic biomarker of OC.
  
  
  CONCLUSIONS
  • Reduced ADCs correlate with prognostic markers: poor differentiation and high Ki-67 expression • ADCs also significantly correlated with VEGF protein expression in primary tumours • Lower ADC values are associated with poorer survival in ovarian cancer • Whole lesion single plane-ROI ADCs may be used as a prognostic biomarker in OC.
authors.affiliation: Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Auni
authors.initials: A
authors.lastname: Lindgren
authors.affiliation: Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland.|Institute of Clinical Medicine, School of Medicine, Gynaecology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Maarit
authors.initials: M
authors.lastname: Anttila
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Suvi
authors.initials: S
authors.lastname: Rautiainen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Otso
authors.initials: O
authors.lastname: Arponen
authors.affiliation: Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Annukka
authors.initials: A
authors.lastname: Kivelä
authors.affiliation: Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Mäkinen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Härmä
authors.affiliation: Department of Pathology and Forensic Medicine, Kuopio University Hospital, Kuopio, Finland.|Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Hämäläinen
authors.affiliation: Department of Pathology and Forensic Medicine, Kuopio University Hospital, Kuopio, Finland.|Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.|Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Kosma
authors.affiliation: Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Ylä-Herttuala
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.|Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.|Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Ritva
authors.initials: R
authors.lastname: Vanninen
authors.affiliation: Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland. Hanna.Sallinen@kuh.fi.|Institute of Clinical Medicine, School of Medicine, Gynaecology, University of Eastern Finland, Kuopio, Finland. Hanna.Sallinen@kuh.fi.|Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland. Hanna.Sallinen@kuh.fi.
authors.forename: Hanna
authors.initials: H
authors.lastname: Sallinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology*; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology*; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D040262:Receptors, Vascular Endothelial Growth Factor / Q000378:metabolism; D015203:Reproducibility of Results; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D042461:Vascular Endothelial Growth Factor A; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Cell proliferation; Diffusion magnetic resonance imaging; Neoplasm metastasis; Neovascularization pathologic; Ovarian neoplasms