Clinical evaluation of MRI in the differential diagnosis between benign and malignant ovarian tumors

Ovarian tumors present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Magnetic resonance imaging (MRI) is currently used to evaluate ovarian tumors. The aim of this study was to evaluate the diagnostic performance of MRI in patients with benign or malignant ovarian tumors and enhance its diagnostic accuracy. The MRI findings of 48 cases of ovarian tumors, which were confirmed by surgery or pathology from September 2009 to July 2011, were analyzed retrospectively. T1-, T2-, and fat-suppressed T2-weighted sequences were performed and dynamic contrast-enhanced T1-weighted gradient-echo images were performed after IV injection of Gd-DTPA by 1.5-T unit. The ovarian tumors were examined for several features including size, bilaterality, shape, content (solid–cystic), signal intensity, and enhancement. Secondary signs such as ascites, peritoneal disease, and lymphadenopathy were noted. The imaging features with the surgical and pathologic findings were compared and the MRI features of benign and malignant ovarian tumors were compared and summarized. MRI features of 33 cases of malignant ovarian tumors were cystic-solid or solid masses, with irregular wall, and intense enhancement. MRI features of 15 cases of benign ovarian tumors were cystic masses, with regular wall, and not or slightly enhanced. The differences of bilaterality, shape, content (solid–cystic), signal intensity, and enhancement between benign and malignant ovarian tumors were statistically significant (p < 0.01). The data demonstrate MRI features may help differentiate benign ovarian tumors from malignant ovarian tumors.

Ovary tumor; Magnetic resonance imaging; Diagnosis.

[1] Rieber A., Nussle K., Stohr I., Grab D., Fenchel S., Kreienberg R., et al.: “Preoperative diagnosis of ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography, and histologic findings”. AJR. Am. J. Roentgenol., 2001, 177, 123.

[2] Spencer J.A., Ghattamaneni S.: “MR imaging of the sonographically indeterminate adnexal mass”. Radiology, 2010, 256, 677.

[3] Valentini A.L., Gui B., Micco M., Mingote M.C., De Gaetano A.M., Ninivaggi V., et al.: “Benign and Suspicious Ovarian Masses-MR Imaging Criteria for Characterization: Pictorial Review”. J. Oncol., 2012, 2012, 481806.

[4] Kinkel K., Hricak H., Lu Y., Tsuda K., Filly R.A.: “US characterization of ovarian masses: a meta-analysis”. Radiology, 2000, 217, 803.

[5] Takemori M., Nishimura R., Hasegawa K.: “Clinical evaluation of MRI in the diagnosis of borderline ovarian tumors”. Acta Obstet. Gynecol. Scand., 2002, 81, 157.

[6] Hricak H., Chen M., Coakley F.V., Kinkel K., Yu K.K., Sica G., et al.: “Complex adnexal masses: detection and characterization with MR imaging--multivariate analysis”. Radiology, 2000, 214, 39.

[7] Yamashita Y., Torashima M., Hatanaka Y., Harada M., Higashida Y., Takahashi M., et al.: “Adnexal masses: accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging”. Radiology, 1995, 194, 557.

[8] Komatsu T., Konishi I., Mandai M., Togashi K., Kawakami S., Konishi J., et al.: “Adnexal masses: transvaginal US and gadoliniumenhanced MR imaging assessment of intratumoral structure”. Radiology, 1996, 198, 109.

[9] Yancik R.: “Ovarian cancer. Age contrasts in incidence, histology, disease stage at diagnosis, and mortality”. Cancer, 1993, 71, 517.

[10] Rodes ND.: “Cancer statistics”. CA Cancer. J. Clin., 1989, 39, 254.

[11] Medeiros L.R., Freitas L.B., Rosa D.D., Silva F.R., Silva L.S., Birtencourt L.T., et al.: “Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review”. Am. J. Obstet. Gynecol., 2011, 204, 67 e1.

[12] Lalwani N., Prasad S.R., Vikram R., Shanbhogue A.K., Huettner P.C., Fasih N.: “Histologic, molecular, and cytogenetic features of ovarian cancers: implications for diagnosis and treatment”. Radiographics, 2011, 31, 625.

[13] Bazot M., Nassar-Slaba J., Thomassin-Naggara I., Cortez A., Uzan S., Darai E.: “MR imaging compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors; correlation with final histology”. Eur. Radiol., 2006, 16, 2687.

[14] Medeiros L.R., Stein A.T., Fachel J., Garry R., Furness S.: “Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis”. Int. J. Gynecol. Cancer, 2008, 18, 387.

[15] Medeiros L.R., Rosa D.D., Bozzetti M.C., Rosa M.I., Edelweiss M.I., Stein A.T., et al.: “Laparoscopy versus laparotomy for FIGO Stage I ovarian cancer”. Cochrane Database. Syst. Rev., 2008, CD005344.

[16] Medeiros L.R., Rosa D.D., da Rosa M.I., Bozzetti M.C.: “Accuracy of ultrasonography with color Doppler in ovarian tumor: a systematic quantitative review”. Int. J. Gynecol. Cancer, 2009, 19, 1214.

[17] Outwater E.K., Dunton C.J.: “Imaging of the ovary and adnexa: clinical issues and applications of MR imaging”. Radiology, 1995, 194, 1-18.

[18] Ghossain M.A., Buy J.N., Ligneres C., Bazot M., Hassen K., Malbec L., et al.: “Epithelial tumors of the ovary: comparison of MR and CT findings”. Radiology, 1991, 181, 863.

[19] Stevens S.K., Hricak H., Stern J.L.: “Ovarian lesions: detection and characterization with gadolinium-enhanced MR imaging at 1.5 T”. Radiology, 1991, 181, 481.

[20] Thurnher S., Hodler J., Baer S., Marincek B., von Schulthess G.K.: “Gadolinium-DOTA enhanced MR imaging of adnexal tumors”. J. Comput. Assist. Tomogr., 1990, 14, 939.

[21] Riccio T.J., Adams H.G., Munzing D.E., Mattrey R.F.: “Magnetic resonance imaging as an adjunct to sonography in the evaluation of the female pelvis”. Magn. Reson. Imaging., 1990, 8, 699.

[22] Thomassin-Naggara I., Darai E., Cuenod C.A., Rouzier R., Callard P., Bazot M.: “Dynamic contrast-enhanced magnetic resonance imaging: a useful tool for characterizing ovarian epithelial tumors”. J. Magn. Reson. Imaging, 2008, 28, 111.

[23] Jung S.E., Lee J.M., Rha S.E., Byun J.Y., Jung J.I., Hahn S.T.: “CT and MR imaging of ovarian tumors with emphasis on differential diagnosis”. Radiographics, 2002, 22, 1305.

[24] Bazot M., Darai E., Nassar-Slaba J., Lafont C., Thomassin-Naggara I.: “Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review”. J. Comput. Assist. Tomogr., 2008, 32, 712.

[25] Thomassin-Naggara I., Darai E., Cuenod C.A., Fournier L., Toussaint I., Marsault C., et al.: “Contribution of diffusion-weighted MR imaging for predicting benignity of complex adnexal masses”. Eur. Radiol., 2009, 19, 1544.

[26] Li W., Chu C., Cui Y., Zhang P., Zhu M.: “Diffusion-weighted MRI: a useful technique to discriminate benign versus malignant ovarian surface epithelial tumors with solid and cystic components”. Abdom. Imaging, 2012, 37, 897.

[27] Thomassin-Naggara I., Toussaint I., Perrot N., Rouzier R., Cuenod C.A., Bazot M., et al.: “Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging”. Radiology, 2011, 258, 793.

[28] Takeuchi M., Matsuzaki K., Nishitani H.: “Diffusion-weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses”. J. Comput. Assist. Tomogr., 2010, 34, 173.

[29] Sohaib S.A., Sahdev A., Van Trappen P., Jacobs I.J., Reznek RH.: “Characterization of adnexal mass lesions on MR imaging”. AJR Am. J. Roentgenol., 2003, 180, 1297.