Logo
homeHome
toggle_offCompany ProfilegroupsBoards & Staffsworkspace_premiumMemberships & PartnersschoolAcademy of Journalismperson_addCareerslinkBlog(EN)emailContact Us
list_altOur JournalslightbulbInstruction for AuthorsbookmarkBrieflands PolicieshandshakePublish My Researchplay_circleJournal Management Systemcredit_cardArticle Processing Chargeszoom_inOpen Peer ReviewimagePublishing Services
menu_bookPublish My Book

IJ Radiology

An Innovative Journal in the Field of Radiology

homeHome
play_arrowCurrent IssuelistAll Issuesformat_indent_increaseIn Presscheck_circleAccepted ManuscriptssearchSearch
helpInstructions
bookmarkJournal InformationgroupsEditors and BoardsshareIndexing and Listing Sourcesshow_chartJournal Metricszoom_inOpen Peer Review (OPR)balancePublication Ethics and Malpractice Statementassignment_indReviewer and AE Registration FormemailSupportphoneContact Us
format_list_bulletedAPC
Authors GuideSubmit Manuscript

Outlines

https://doi.org/10.5812/iranjradiol.21333

Effectiveness of Semi-Quantitative Multiphase Dynamic Contrast-Enhanced MRI at 3 Tesla as a Predictor of Malignancy in Adnexal Masses

Author(s):
Leila TorbatiLeila Torbati1,*, Mahrooz MalekMahrooz Malek2
1Private Clinique
2Department of Radiology, Imam khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
IJ Radiology:Vol. 11, issue 30th Iranian Congress of Radiology; e21333
Published online:Feb 28, 2014
Article type:Research Article
How to Cite:Torbati L, Malek M. Effectiveness of Semi-Quantitative Multiphase Dynamic Contrast-Enhanced MRI at 3 Tesla as a Predictor of Malignancy in Adnexal Masses. I J Radiol. 2014;11(30th Iranian Congress of Radiology):e21333. doi: https://doi.org/10.5812/iranjradiol.21333

Abstract

Background:

Ovarian cancer is the second commonest gynecological malignancy, the fifth commonest cancer affecting women in the developed world, and the leading indication for gynecologicaloncological surgery. There is a wide range of management options for ovarian cancers from conservative to radical surgery; conservative laparoscopic surgery in young women wishing to preserve their childbearing potential (borderline epithelial tumors) is the preferred method. The current investigation tool for management of ovarian masses consist of a TVS as the screening tool and determining the RMI using US score, menopausal state and CA 125 levels. MRI with Gd is the next preferred method, while it keeps indeterminate masses which are managed intra-operatively using macroscopic and histological frozen section analysis of vegetations or solid tumor components. Several studies have emphasized the diagnostic performance of new imaging modalities such as dynamic contrast enhanced MRI (DCE-MRI) as well as their DWI and MRS findings in the determination of adnexal masses.

Objectives:

The aim of this study was to determine diagnostic accuracy of semi-quantitative factors resulted from dynamic curves of enhancement of adnexal masses at 3 tesla MRI and to determine threshold criteria of malignancy or benignity using them.

Patients and Methods:

Forty-nine adnexal masses in 40 patients hospitalized in onco-gynecologic ward of Valiasr hospital with surgical plan from 2011 to 2012, were investigated with multiphasic dynamic contrast enhanced MRI using 3 tesla MRI. After choosing ROI, semi-quantitative factors of enhancement were drawn from the enhancement curve through home-made MATLAB software. Using histological result of resected adnexal mass as the gold standard, masses were categorized into benign versus malignant group. Myometrium and psoas muscle enhancement patterns were also analyzed as the internal reference.

Results:

The maximum actual enhancement (SI max), maximum relative enhancement (SI rel) and Wash out rate (WOR) did not show any significant difference in the two groups while the amount of Wash in rate (WIR), Area under curve in 60 s (AUC60), SI peak tumor, SI tumor in 30 s also SI max (tumor)/SI max (psoas), WIR (tumor)/WIR (psoas), SI max (tumor)/SI max (myometrium) and WIR (tumor)/WIR (myometrium) ratios were significantly higher in malignant group in comparison with benign ones (P value less than 0.05). Using area under the ROC curve (AUROC) malignancy and benignity threshold were determined for each of semi-quantitative factors; WIR value of more than 2.45 could be indicative of a malignant adnexal mass (specificity and PPV of 100%) while WIR value of less than 0.38 could be predictive of a benign one (sensitivity and NPV of 100%). Similar to WIR, the SI max (tumor)/SI max (psoas) more than 3.25, SI max (tumor)/SI max (myometrium) more than 2.8 and WIR (tumor)/ WIR (psoas) more than 22.5 were more accompanied by malignant adnexal masses while SI max (tumor)/ SI max (psoas) less than 0.99, SI max (tumor)/ SI max (myometrium) less than 0.61 and WIR (tumor)/ WIR (psoas) less than 0.91 were more suggestive of a benign adnexal mass.

Conclusions:

This study showed that DCE sequences are more effective than simple CE sequences for qualitative assessment of enhancement, and based on this evidence, we assume DCE-MRI should be incorporated into our institutions standard practice to be used routinely during qualitative evaluation of images.

Full Text

Full text is available in PDF
Import into EndNoteImport into BibTex
Crossmark
Crossmark
Checking
Share on
Comments
Number of Comments:0
Cited by
Metrics
Get Permission (article level)

Purchasing Reprints

  • Copyright Clearance Center (CCC) handles bulk orders for article reprints for Brieflands. To place an order for reprints, please click here (   https://www.copyright.com/landing/reprintsinquiryform/ ). Clicking this link will bring you to a CCC request form where you can provide the details of your order. Once complete, please click the ‘Submit Request’ button and CCC’s Reprints Services team will generate a quote for your review.
Search Relations

Author(s):

Related Articles

Related Article in PubMed

Related Article in Google Scholar

Create Citation Alert via Google Reader