From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.).
Radiology. 2020 Aug;296(2):358-369. doi: 10.1148/radiol.2020191700. Epub 2020 Jun 16.
Background MRI with contrast material enhancement is the imaging modality of choice to evaluate sonographically indeterminate adnexal masses. The role of diffusion-weighted MRI, however, remains controversial. Purpose To evaluate the diagnostic performance of ultra-high--value diffusion kurtosis MRI in discriminating benign and malignant ovarian lesions. Materials and Methods This prospective cohort study evaluated consecutive women with sonographically indeterminate adnexal masses between November 2016 and December 2018. MRI at 3.0 T was performed, including diffusion-weighted MRI ( values of 0-2000 sec/mm). Lesions were segmented on of 1500 sec/mm by two readers in consensus and an additional independent reader by using full-lesion segmentations on a single transversal slice. Apparent diffusion coefficient (ADC) calculation and kurtosis fitting were performed. Differences in ADC, kurtosis-derived ADC ), and apparent kurtosis coefficient () between malignant and benign lesions were assessed by using a logistic mixed model. Area under the receiver operating characteristic curve (AUC) for ADC, , and to discriminate malignant from benign lesions was calculated, as was specificity at a sensitivity level of 100%. Results from two independent reads were compared. Histopathologic analysis served as the reference standard. Results A total of 79 ovarian lesions in 58 women (mean age ± standard deviation, 48 years ± 14) were evaluated. Sixty-two (78%) lesions showed benign and 17 (22%) lesions showed malignant histologic findings. ADC and were lower and was higher in malignant lesions: median ADC, , and were 0.74 µm/msec (range, 0.52-1.44 µm/msec), 0.98 µm/msec (range, 0.63-2.12 µm/msec), and 1.01 (range, 0.69-1.30) for malignant lesions, and 1.13 µm/msec (range, 0.35-2.63 µm/msec), 1.45 µm/msec (range, 0.44-3.34 µm/msec), and 0.65 (range, 0.44-1.43) for benign lesions ( values of .01, .02, < .001, respectively). AUC for of 0.85 (95% confidence interval: 0.77, 0.94) was higher than was AUC from ADC of 0.78 (95% confidence interval: 0.67, 0.89; = .047). Conclusion Diffusion-weighted MRI by using quantitative kurtosis variables is superior to apparent diffusion coefficient values in discriminating benign and malignant ovarian lesions and might be of future help in clinical practice, especially in patients with contraindication to contrast media application. © RSNA, 2020
背景 增强对比剂的 MRI 是评估超声不确定附件肿块的首选成像方式。然而，弥散加权 MRI 的作用仍存在争议。目的 评估超高 b 值扩散峰度 MRI 在鉴别卵巢良恶性病变中的诊断性能。材料与方法 本前瞻性队列研究纳入了 2016 年 11 月至 2018 年 12 月期间连续就诊的超声不确定附件肿块的女性患者。在 3.0 T 上进行 MRI 检查，包括弥散加权 MRI（ 值范围为 0-2000 sec/mm）。两名读者在共识的基础上对病变进行 1500 sec/mm 的 的分割，另一名独立读者对单一切面的全病变进行分割。计算表观扩散系数（ADC）和峰度拟合值。采用逻辑混合模型评估良恶性病变之间 ADC、峰度衍生 ADC（ ）和表观峰度系数（ ）的差异。计算 ADC、 、 和 鉴别良恶性病变的受试者工作特征曲线下面积（AUC），以及灵敏度为 100%时的特异性。比较了两名独立读者的结果。组织病理学分析作为参考标准。结果 共评估了 58 例女性患者的 79 个卵巢病变（平均年龄±标准差，48 岁±14 岁）。62 个（78%）病变为良性，17 个（22%）病变为恶性。恶性病变的 ADC 和 较低， 较高：ADC 的中位数分别为 0.74 µm/msec（范围，0.52-1.44 µm/msec）、 0.98 µm/msec（范围，0.63-2.12 µm/msec）和 1.01（范围，0.69-1.30），良性病变分别为 1.13 µm/msec（范围，0.35-2.63 µm/msec）、 1.45 µm/msec（范围，0.44-3.34 µm/msec）和 0.65（范围，0.44-1.43）（ 值分别为.01、.02、<.001）。 值为 0.85（95%置信区间：0.77，0.94）的 鉴别良恶性卵巢病变的 AUC 高于 ADC 值为 0.78（95%置信区间：0.67，0.89； =.047）。结论 基于定量峰度变量的弥散加权 MRI 在鉴别卵巢良恶性病变方面优于表观扩散系数值，可能对未来的临床实践有帮助，尤其是在有对比剂应用禁忌的患者中。 ©RSNA，2020
