Borderline and malignant ovarian epithelial tumors: differentiating using multiparameter MRI
Abstract
Objectives
To evaluate the value of multiparameter MRI (mp-MRI) including conventional MRI image features, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) in differentiating borderline from malignant ovarian epithelial tumors (OETs).
Methods
Forty-three patients with borderline OETs (BOETs) and 119 patients with malignant OETs (MOETs) who underwent mp-MRI examinations for pre-treatment assessment were respectively enrolled. Conventional MRI features (eg, tumor shape, configuration, signal intensity [SI] on T1WI and T2WI) were retrospectively analyzed. Apparent diffusion coefficient (ADC), and DCE-MRI derived parameters (rel-enhancement [RELENH], time to peak [TTP], wash-in-rate [WIR], and wash-out-rate [WOR]) were evaluated. Independent samples t-test, Mann-Whitney U test, χ2 test, multivariate logistic regression analysis, binary logistic regression, and receiver operating characteristic (ROC) curve analyses were employed as appropriate.
Results
BOETs group showed significantly lower age than MOETs group (P < .001). Multivariate logistic regression analysis indicated that tumor configuration was the independent imaging features associated with MOETs (P < .001). BOETs group showed significantly higher ADC value than MOETs group (P < .001). Among DCE-MRI derived parameters, MOETs group showed significantly shorter TTP than BOETs (P = .014). ROC analyses indicated that a combination of age ≥ 43.5 years old + non-cystic predominant type + ADC ≤ 1.05 × 10−3 mm2/s + TTP ≤ 238.87 s showed the highest efficiency (AUC, 0.930; sensitivity, 84.9%; specificity, 86.0%) in diagnosing MOETs, which was significantly higher than that of age (P = .002), configuration (P < .001), ADC (P = .027), and TTP (P < .001) alone.
Conclusions
mp-MRI might be effective in differentiating MOETs from BOETs.
Advances in knowledge
The study which combining conventional MRI, DWI, and DCE-MRI for differentiating BOETs from MOETs is still lacked until now. What is more, the study may be more accurate for the differentiation of borderline malignancy or low-grade malignant potential tumors.