Diffusion Weighted MR and Dynamic Contrast Enhanced MRI for Characterization of Ovarian Tumors

Background: For comprehensive internal architecture identification of ovarian tumors, DCE-MRI is advised. An imaging technique known as diffusion weighted (DW) assists in differentiating between benign and malignant lesions. The purpose of this study was to assess the effectiveness of DCE-MRI and diffusion-weighted MRI in characterizing ovarian cancers and distinguishing malignant from benign tumors.

Methods: This retrospective study was carried out on 40 patients aged from 21 to 63 years old presented by ovarian masses based on clinical examinations and on US study. All patients were subjected to full history taking, laboratory investigations including pregnancy tests, complete blood counts and some tumour markers, pelvi-abdominal ultrasound and MRI.

Results: MRI have a sensitivity of 53.85%, a specificity of 92.59%, positive predictive value (PPV) of 77.78%, negative predictive value (NPV) of 80.65% and accuracy of 80% compared to pathology of the studied patient. DCE has a sensitivity of 67.15%, a specificity of 100%, PPV of 100%, NPV of 79.4% and accuracy of 82.5%. compared to pathology of the studied patient. DWI score at a cut-off point (≤1.1) predicted patients with malignant ovarian tumours, with 97% accuracy, sensitivity of 88.89% and specificity of 100% (p < 0.001). There was a high statistical significance between findings on DWI-MRI, DCE-MRI, and pathological types (P <0.001 for benign versus malignant lesions). Higher magnetic resonance elastography (MRE) was seen with malignant ovarian lesions (MRE < 85% suspected malignancy).

Conclusions: Conventional MR images are the mainstays for assessment of patients with adnexal lesions. The addition of DWI and DCE-MR imaging enhances the specificity of MRI, boosting the radiologist's confidence in picture interpretation and ultimately affecting the patients’ prognosis.