Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstr. 30, Aachen, Germany.
Department of Gynecology and Obstetrics, RWTH Aachen University Hospital, Aachen, Germany; Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany.
Acad Radiol. 2022 Feb;29(2):183-197. doi: 10.1016/j.acra.2020.11.016. Epub 2020 Dec 5.
Adnexal masses detected incidentally at transvaginal ultrasound (TVUS) are a common and still challenging diagnostic problem. The primary goal of further imaging is an accurate tissue characterization so an optimal treatment plan can be devised including surgery only for lesions that are indeterminate or malignant. The aim of this prospective study was to evaluate the diagnostic utility of complementary multiparametric magnetic resonance imaging (mMRI) for treatment planning in patients with adnexal masses, and to assess how it ultimately correlates with subsequent histopathologic findings.
A total of 126 women (mean age: 54.6 years) with indeterminate adnexal masses underwent mMRI at 3T in addition to TVUS and testing to determine their CA-125 levels. The mMRI protocol consisted of a high-resolution T2-TSE in three planes, diffusion weighted images and dynamic contrast enhanced. First the character of the adnexal mass and the associated management decision (follow-up, laparoscopy or laparotomy) were assessed independently for each diagnostic method (TVUS + CA-125 and mMRI). All methods were then assessed in synopsis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each diagnostic method alone and in combination were calculated. The standard of reference was either final histology in women who underwent surgery or follow-up of at least 24 months in women who underwent follow-up.
In 67.5% (85/126) of all patients, the adnexal mass was benign; a malignant tumor was diagnosed in 28.6% (36/126) and a borderline tumor in the remaining 4% (5/126) of patients. The diagnostic indices were as follows for TVUS + CA 125 alone, mMRI alone and all three methods combined: sensitivity 86% (31/36), 97% (35/36), and 100% (36/36); specificity 32% (29/90), 83% (75/90), and 80% (68/90); PPV 34% (31/91), 70% (35/50), and 74% (40/54); and NPV 65% (29/44), 98% (75/76), and 100% (72/72). Complementary use of mMRI changed the therapeutic management decision in 34% (41/126) of all patients. In 40.7% (37/91) of patients for whom surgery had been recommended based on TVUS + CA-125, MRI revealed a typical benign finding such that those patients underwent follow-up instead of surgery. None of the examined masses exhibited (tumor) progression or malignancy during the follow-up period. A laparotomy was performed instead of a laparoscopy in 8.7% (11/126) based on the mMRI result.
MRI helps significantly improve sensitivity and specificity of diagnosis in patients with indeterminate adnexal masses detected at TVUS. Its diagnostic information revised the planned treatment in more than one-third of women.
经阴道超声（TVUS）偶然发现的附件肿块是一个常见但仍然具有挑战性的诊断问题。进一步成像的主要目标是准确的组织特征化，以便制定最佳的治疗计划，包括仅对不确定或恶性的病变进行手术。本前瞻性研究的目的是评估补充性多参数磁共振成像（mmMRI）在附件肿块患者治疗计划中的诊断效用，并评估其最终如何与后续组织病理学发现相关。
共有 126 名（平均年龄：54.6 岁）患有不确定附件肿块的女性在 3T 磁共振成像（MRI）上进行了 mMRI 检查，同时还进行了 TVUS 和 CA-125 检测。mMRI 方案包括三个平面的高分辨率 T2-TSE、弥散加权图像和动态对比增强。首先，独立评估每个诊断方法（TVUS+CA-125 和 mMRI）对附件肿块的特征和相关管理决策（随访、腹腔镜检查或剖腹手术）。然后汇总所有方法进行评估。计算每种单独和联合诊断方法的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。手术患者的标准为最终组织学，随访患者的标准为至少 24 个月的随访。
在所有患者中，67.5%（85/126）的附件肿块为良性；诊断出恶性肿瘤 28.6%（36/126），交界性肿瘤占其余 4%（5/126）。TVUS+CA 125 单独、mMRI 单独和三种方法联合的诊断指标如下：敏感性 86%（31/36）、97%（35/36）和 100%（36/36）；特异性 32%（29/90）、83%（75/90）和 80%（68/90）；PPV 34%（31/91）、70%（35/50）和 74%（40/54）；NPV 65%（29/44）、98%（75/76）和 100%（72/72）。mMRI 的补充使用改变了所有患者中 34%（41/126）的治疗管理决策。在基于 TVUS+CA-125 建议手术的 40.7%（37/91）患者中，MRI 显示出典型的良性表现，这些患者接受了随访而不是手术。在随访期间，没有任何被检查的肿块出现（肿瘤）进展或恶性肿瘤。根据 mMRI 结果，8.7%（11/126）的患者进行了剖腹手术而不是腹腔镜手术。
MRI 显著提高了 TVUS 检测到的不确定附件肿块的诊断敏感性和特异性。其诊断信息改变了三分之一以上女性的计划治疗。
