The Role of Diffusion Weighted Imaging in suspected cases of ovarian cancer

Abstract

Background: Ovarian cancer is a common gynecological malignancy and often diagnosed late with extensive peritoneal and nodal metastasis. Diffusion-weighted imaging (DWI) provides valuable information about the structural properties of the tissue and has shown great value in cancer imaging. Recently developed postprocessing three-dimensional apparent diffusion coefficient (3D ADC) map has a significant value in variable tumors yet its role in ovarian cancer is not well established. We aim to evaluate the added value of DWI and 3D ADC maps in the diagnosis of ovarian masses, detection of nodal and peritoneal deposits, and so appropriate management planning. Results: Conventional MRI and DWI were performed to fifty-one patients with complex cystic or solid adnexal lesions depicted by gynecological ultrasonography. Results were compared with surgical and histopathologic findings revealing 23/51 (45%) had malignant ovarian tumors and 28/51 (55%) had benign ovarian pathologies. The mean 3D ADC values were 0.977 ± 0.32, 0.934 ± 0.27, and 0.956 ± 0.25 × 10 −3 mm 2 /s for ovarian, nodal, and peritoneal malignancy respectively which were significantly lower than the mean 3D ADC values of benign ovarian lesions, non-metastatic lymph nodes and benign peritoneal lesions/fat which were measured 1.516 ± 0.6, 1.208 ± 0.25, and 1.46 ± 0.43 × 10 −3 mm 2 /s respectively. Conclusion: Adding DWI and 3D ADC maps to routine MRI improves the sensitivity, specificity, and accuracy for detecting ovarian malignancy, nodal, and peritoneal metastasis. They also provide qualitative data helping in the differentiation of malignant and non-malignant entities.

Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Gynecological Masses

“…In variance with this study findings, the recent Egyptian study of Ali et al [38] Combining DWI with standard MRI sequences revealed a poor sensitivity (71,4 percent) for discriminating malignant adnexal masses. The authors explained that this low specificity was due to the presence of eight false-positive cases (eight benign adnexal masses that mimicked malignancy), including necrotizing caseating granuloma, mature cystic teratomas, infarcted ovary, and cyst-adenofibroma, which were excluded from the current study.…”

“…In order to increase lesion characterization and disease mapping, diffusion weighted imaging has been introduced to pelvic magnetic resonance imaging techniques [10]. Proton mobility and diffusion-weighted imaging (DWI) are affected by pathological alterations in tissue cellularity, membrane integrity, extracellular space perfusion, and fluid viscosity.…”

Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article

“…The addition of DWI to conventional MRI sequences aids in the diagnosis and detection of female pelvic malignancies, and locally recurrent and metastatic disease, and provides useful information for tumor response assessment and differentiation from post-radiation fibrosis [ 23 , 24 ]. Standardization of DWI techniques with ADC values may be helpful in the evaluation of response but need validation in future prospective trials [ 25 , 26 ].…”

“…Multiparametric MRI with DWI and DCE MRI have higher accuracy for differentiating between benign and malignant ovarian lesions [ 51 ]. DWI, ADC maps, and conventional MRI sequences improve sensitivity, specificity, and accuracy for detecting ovarian cancer and its nodal and metastatic peritoneal disease [ 24 ]. In serous ovarian cancer, significant correlation was found between DWI parameters and tumor biomarkers Ki67 and VEGF predicting the treatment-free survival.…”

Diagnostic Value of MRI Compared to Histopathological Results in Differentiating Benign from Malignant Ovarian Masses

“…However, proficient image interpretation skills are essential for the clinical utilization of this technique (6). In Farghaly Ali et al, adding DW images to routine MRI improved the diagnostic accuracy for detecting ovarian malignancies, e xhibiting a sensitivity of 100%, a specificity of 71.4%, a negative predictive value of 100%, a positive predictive value of 74.2% and an efficiency of 84.3% (7). Furthermore, another study indicated the usefulness of dynamic contrast-enhanced MRI in characterizing complex ovarian tumors.…”