Hricak H, Chen M, Coakley F V, Kinkel K, Yu K K, Sica G, Bacchetti P, Powell C B
Department of Radiology, University of California-San Francisco 94143-0628, USA.
Radiology. 2000 Jan;214(1):39-46. doi: 10.1148/radiology.214.1.r00ja3939.
To evaluate the accuracy of magnetic resonance (MR) imaging in the detection and characterization of complex adnexal masses, with particular reference to the findings predictive of malignancy, role of gadolinium-enhanced contrast material, and observer variability.
Preoperative MR imaging of the pelvis was performed in 128 consecutive patients with clinically or ultrasonographically detected complex adnexal masses. Histopathologic examination demonstrated 187 masses, 96 of which were malignant. MR imaging studies were prospectively and independently reviewed by two radiologists, one of whom reevaluated the studies after a 6-month interval. The predictive value of MR imaging findings was determined with multivariate logistic regression analysis. The value of gadolinium enhancement was assessed by using receiver operating characteristic analysis. Inter- and intraobserver variabilities were assessed by using weighted K statistics.
Gadolinium-enhanced MR imaging depicted 176 (94%) of 187 adnexal masses, with an overall accuracy for the diagnosis of malignancy of 93%. The MR imaging findings that were most predictive of malignancy were necrosis in a solid lesion (odds ratio, 107) and vegetations in a cystic lesion (odds ratio, 40). Use of gadolinium-based contrast material contributed significantly to lesion characterization. Interobserver (K, 0.79-0.85) and intraobserver (K, 0.84-0.86) agreement were excellent.
Gadolinium-enhanced MR imaging is highly accurate in the detection and characterization of complex adnexal masses, with excellent inter- and intraobserver agreement.
评估磁共振（MR）成像在检测和鉴别复杂附件包块方面的准确性，特别关注预测恶性肿瘤的表现、钆增强对比剂的作用以及观察者间的差异。
对128例经临床或超声检查发现有复杂附件包块的连续患者进行术前盆腔MR成像检查。组织病理学检查显示共有187个包块，其中96个为恶性。两名放射科医生对MR成像研究进行了前瞻性独立评估，其中一人在间隔6个月后重新评估这些研究。通过多变量逻辑回归分析确定MR成像表现的预测价值。使用受试者操作特征分析评估钆增强的价值。通过加权K统计评估观察者间和观察者内的差异。
钆增强MR成像显示了187个附件包块中的176个（94%），对恶性肿瘤诊断的总体准确率为93%。最能预测恶性肿瘤的MR成像表现为实性病变中的坏死（优势比，107）和囊性病变中的赘生物（优势比，40）。使用基于钆的对比剂对病变特征的显示有显著帮助。观察者间一致性（K，0.79 - 0.85）和观察者内一致性（K，0.84 - 0.86）均极佳。
钆增强MR成像在检测和鉴别复杂附件包块方面高度准确，观察者间和观察者内一致性极佳。
