Perfusion-based functional magnetic resonance imaging for differentiating serous borderline ovarian tumors from early serous ovarian cancers in a rat model.

BACKGROUND: Differentiation of borderline tumors from early ovarian cancer has recently received increasing attention, since borderline tumors often affect young women of childbearing age who desire to preserve fertility. However, previous studies have demonstrated that non-enhanced magnetic resonance imaging (MRI) sequences cannot sufficiently differentiate these tumors. PURPOSE: To investigate the value of dynamic contrast-enhanced MRI (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in differentiating serous borderline ovarian tumors (SBOT) from early serous ovarian cancers (eSOCA). MATERIAL AND METHODS: Twenty SBOT and 20 eSOCA rat models were performed with DCE-MRI and IVIM-DWI at 3.0-T MR scanner. Qualitative and quantitative parameters of DCE-MRI were acquired and compared between two groups and correlated with the microvessel density (MVD). The receiver operating characteristic (ROC) curve analyses were conducted to determine their differentiating performances. RESULTS: SBOTs presented significantly lower values of the initial area under the enhancement curve (iAUC), volume transfer constant (Ktrans), and extracellular extravascular volume fraction (ve) (P < 0.05) and a significantly higher value of true diffusion (D) (P = 0.001) compared with eSOCAs. The diagnostic effectiveness of ve combined with D was significantly better than that of ve or Ktrans alone (P ≤ 0.039). CONCLUSION: DCE-MRI may represent a promising tool for differentiating SBOTs from eSOCAs and may not be replaced by IVIM-DWI. Combining DCE-MRI with DWI may improve the diagnostic performance of ovarian tumors.

Prediction of Platinum-based Chemotherapy Response in Advanced High-grade Serous Ovarian Cancer: ADC Histogram Analysis of Primary Tumors.

RATIONALE AND OBJECTIVES: To investigate the feasibility of apparent diffusion coefficient (ADC) histogram analysis of primary advanced high-grade serous ovarian cancer (HGSOC) to predict patient response to platinum-based chemotherapy. MATERIALS AND METHODS: A total of 70 patients with 102 advanced stage HGSOCs (International Federation of Gynecology and Obstetrics (FIGO) stages III-IV) who received standard treatment of primary debulking surgery followed by the first line of platinum-based chemotherapy were retrospectively enrolled. Patients were grouped as platinum-resistant and platinum-sensitive according to whether relapse occurred within 6 months. Clinical characteristics, including age, pretherapy CA125 level, International Federation of Gynecology and Obstetrics stage, residual tumor, and histogram parameters derived from whole tumor and solid component such as ADCmean; 10th, 20th, 25th, 30th, 40th, 50th, 60th, 70th, 75th, 80th, 90th percentiles; skewness and kurtosis, were compared between platinum-resistant and platinum-sensitive groups. RESULTS: No significantly different clinical characteristics were observed between platinum-sensitive and platinum-resistant patients. There were no significant differences in any whole-tumor histogram-derived parameters between the two groups. Significantly higher ADCmean and percentiles and significantly lower skewness and kurtosis from the solid-component histogram parameters were observed in the platinum-sensitive group when compared with the platinum-resistant group. ADCmean, skewness and kurtosis showed moderate prediction performances, with areas under the curve of 0.667, 0.733 and 0.616, respectively. Skewness was an independent risk factor for platinum resistance. CONCLUSION: Pretreatment ADC histogram analysis of primary tumors has the potential to allow prediction of response to platinum-based chemotherapy in patients with advanced HGSOC.

Whole solid tumor volume histogram parameters for predicting the recurrence in patients with epithelial ovarian carcinoma: a feasibility study on quantitative DCE-MRI.

BACKGROUND: Preoperative prediction of the recurrence of epithelial ovarian carcinoma (EOC) can guide the clinical treatment and improve the prognosis. However, there are still no reliable predictive biomarkers. PURPOSE: To evaluate whether whole solid tumor volume histogram parameters measured from quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can predict the recurrence in patients with EOC. MATERIAL AND METHODS: We followed up 56 patients with surgical and histopathologically diagnosed EOC who underwent quantitative DCE-MRI scans. The differences of the histogram parameters between patients with and without recurrence were compared. Mann-Whitney U test, Pearson's Chi-squared test, or Fisher's exact test, and receiver operating characteristic (ROC) curves were used for statistical analysis. RESULTS: All histogram parameters of Ktrans, kep, and ve were not significantly different between EOC patients with and without recurrence (P>0.05). For 30 patients with high-grade serous ovarian carcinoma (HGSOC), the histogram parameters of Ktrans (mean and 5th, 10th, 25th, 50th, 75th percentiles) and kep (mean and 50th percentile) in 12 patients with recurrence were significantly lower than those in 18 patients without recurrence (all P<0.05). ROC curves showed that the 5th percentile of Ktrans had the largest area under the curve (AUC) of 0.792 for predicting the recurrence in patients with HGSOC. When the threshold value was ≤0.0263/min, the sensitivity, specificity, and accuracy were 100%, 66.7%, and 80%, respectively. CONCLUSION: Instead of predicting the recurrence of EOC, whole solid tumor volume quantitative DCE-MRI histogram parameters could predict the recurrence of HGSOC and may be potential biomarkers for the prediction of HGSOC recurrence.

Computed Tomography and Magnetic Resonance Imaging Appearances of Malignant Vaginal Tumors in Children: Endodermal Sinus Tumor and Rhabdomyosarcoma.

PURPOSE: The aim of this study is to analyze retrospectively the computed tomography and magnetic resonance imaging (MRI) features of pediatric vaginal endodermal sinus tumor (EST) and rhabdomyosarcoma (RMS) in a case series. METHODS: Seven children with vaginal EST and 2 children with vaginal RMS underwent MRI and/or computed tomography examination before the biopsy and treatment. Images were evaluated by 2 observers for the following features: (a) tumor extent; (b) margin; (c) tumor shape; (d) tumor size; (e) architecture (solid, cystic, or mixed cystic-solid); (f) hemorrhage, necrosis, and calcification; (g) magnetic resonance T2 signal intensity; (h) pattern of the enhancement; and (i) signal intensity on diffusion-weighted imaging and apparent diffusion coefficient (ADC) value. RESULTS: All of the 7 ESTs showed as a round-shaped solid mass with a location limited to the vagina without vulva and bladder invasion, whereas RMSs have an irregular grape-like appearance filling the whole vagina with vulva and bladder invasion. The invasion to the cervix was not observed in EST or RMS. Both EST and RMS were heterogeneously hyperintense on T2-weighted magnetic resonance images and enhanced remarkably and heterogeneously. Heterogeneous high signal on diffusion-weighted imaging were observed in vaginal EST and RMS. The ESTs showed a lower ADC value (mean, 1.04×10 mm/s), while RMSs showed a relatively high ADC value (mean, 1.51 × 10 mm/s). CONCLUSIONS: Computed tomography and MRI may be useful tools in diagnosing the vaginal RMS and EST.

Value of normalized apparent diffusion coefficients in differentiating between borderline and malignant epithelial ovarian tumors.

PURPOSE: To compare the diagnostic performance of normalized apparent diffusion coefficients (nADCs) of different references with that of ADCs at differentb factors in differentiating borderline epithelial ovarian tumors (BEOTs) from malignant epithelial ovarian tumors (MEOTs). METHOD: This retrospective study included 53 BEOTs and 148 MEOTs. Conventional magnetic resonance and diffusion-weighted imaging withb factors of 800 and 1000s/mm2 were performed. ADC was measured three times at solid components of tumors, gluteus maximus muscle (GMM), iliopsoas muscle (IM) and urine and then averaged. ADCtumor, nADCs were then obtained. Differences and the diagnostic performance of ADCtumor and nADCs between BEOTs and MEOTs with different b factors were compared. RESULTS: ADCtumor, nADCs regardless of b factors were significantly higher in BEOTs than MEOTs. The diagnostic performance of nADCurine regardless of b factors was significantly larger than that of nADCGMM and nADCIM. There was no significant difference in the diagnostic performance between ADCtumor and nADCurine regardless of b factors. A significantly lower ADCtumor and a larger diagnostic performance for ADCtumor was found with a b factor of 1000s/mm2 than 800 s/mm2. There were no significant differences in nADCurine of BEOTs or MEOTs or in the diagnostic performance of nADCurine with b factors between 800 and 1000s/mm2. CONCLUSIONS: ADCtumor and nADCs were both capable of differentiating BEOTs from MEOTs. nADCurine was the best of all nADCs and was superior to ADCtumor because of its stable performance in differentiating BEOTs from MEOTs, regardless of b factors.

A rat model of serous borderline ovarian tumors induced by 7,12-dimethylbenz[a]anthracene.

Serous borderline ovarian tumors (SBOTs) behave between benign cystadenomas and carcinomas, and the effective detection and clinical management of SBOTs remain clinical challenges. Because it is difficult to isolate and enrich borderline tumor cells, a borderline animal model is in need. 7,12-dimethylbenz[a]anthracene (DMBA) is capable of inducing the initiation, promotion, and progression of serous ovarian tumors. This study aims to investigate the proper dosage and induction time of DMBA for rat models of SBOTs, and explore their morphological features demonstrated by magnetic resonance (MR) imaging and molecular genetic characteristics. Rats were randomly divided into six groups (1 mg/70 D, 2 mg/70 D, 3 mg/70 D, 2 mg/50 D, 2 mg/90 D, and 2 mg/110 D). The 3 mg/70 D group induced the most SBOTs (50.0%, 12/24). The micropapillary projections were shown on MR imaging, which was the characteristic of SBOTs. The Cyclin D1 characterizing an early pathogenetic event strongly expressed in induced serous benign tumors (SBTs). The immunoreactivity staining scores of P53 expression significantly increased from SBTs, SBOTs to serous ovarian carcinomas (SCAs), which elucidate that P53 might be a promising biomarker to grade serous ovarian tumors. Based on morphological and molecular genetic similarities, this rodent SBOT model was suitable for investigating the pathogenesis of serous ovarian tumors and developing an early detection strategy.

The value of MR-detectable ipsilateral ovaries in characterizing the origin and malignancy of an adnexal tumors.

OBJECTIVE: To investigate the magnetic resonance (MR) imaging morphological relationship between adnexal tumors and the ipsilateral ovaries to characterize the origin and malignancy of tumors. MATERIAL AND METHODS: Clinical and MR imaging data of 496 adnexal tumors confirmed by histology (ovary tumors, n = 400, non-ovarian tumors, n = 96; benign tumors, n = 183, borderline tumors, n = 120, and malignant tumors, n = 193) were retrospectively analyzed. The presence and shape of the ipsilateral ovaries within the context of adnexal tumors of different origins, malignancies and configurations were evaluated. The relationships between the presence of the ipsilateral ovary and patient age, menstrual status and tumor size were also analyzed. RESULT: The ipsilateral ovary was detected on MRI in 23% (90/400) of ovarian tumors and in 45% (43/96) of non-ovarian tumors (p < 0.001). A normal ovoid morphology of the ipsilateral ovary was found in only 7% (26/400) of ovarian tumors and in 26% (25/96) of non-ovarian tumors (p < 0.001). The ipsilateral ovary was detectable in 38% (69/183) of benign tumors, 35% (42/120) of borderline tumors, and 11% (22/193) of malignant tumors (p < 0.001); in 24% (24/101) of cystic tumors, 27% (49/179) of mixed cystic-solid tumors and 28% (60/216) of solid tumors (p = 0.737); and in 40% (120/303) of adnexal tumors in premenopausal patients and 7% (13/193) of adnexal tumors in postmenopausal patients (p < 0.001). CONCLUSION: Detection of the ipsilateral ovary contributes to the localization and characterization of adnexal tumors. The ipsilateral ovary can be detected more frequently in non-ovarian tumors and in benign or borderline ovarian tumors.

The value of MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary: emphasis on diffusion-weighted MR imaging.

BACKGROUND: To investigate MRI for differentiating benign from malignant sex cord-stromal tumors of the ovary (SCSTs) emphasizing on the value of diffusion-weighted (DW) magnetic resonance (MR) imaging. METHODS: This retrospective study included 29 benign SCSTs in 28 patients and 13 malignant SCSTs in 13 patients. DW imaging as well as conventional MR imaging was performed. Signal intensity on DW imaging was assessed and apparent diffusion coefficient (ADC) value was measured. In addition, T2 signal intensity and contrast enhancement pattern were also assessed and compared between benign and malignant SCSTs. RESULTS: Both of the T2 hypointensity and mild enhancement were specific to benign SCSTs. The majority of malignant SCSTs showed high signal intensity on DW imaging, whereas most benign SCSTs showed low or moderate signal intensity (p = 0.000). Fibromas were the tumors with the lowest observed ADC value (0.470 × 10- 3 mm2/s). Sclerosing stromal tumors were the tumors with the highest observed ADC value (2.291 × 10- 3 mm2/s). ADC value of solid component was significantly lower in malignant SCSTs (0.825 ± 0.129 × 10- 3 mm2/s) than in benign SCSTs (1.343 ± 0.528 × 10- 3 mm2/s) when fibromas were excluded (p = 0.024). T2, DCE and DW imaging has a limited value on the differential diagnosis of the benign and malignant SCSTs with an accuracy of 69.0%,71.4% and 78.1% respectively. Combination of T2, DCE and DW imaging permitted the distinction with an accuracy of 88.0%. CONCLUSIONS: It is more helpful for distinction of the benign and malignant SCSTs by combining of T2, DCE and DW imaging than using each of the three sequences independently.

Quantitative dynamic contrast-enhanced MR imaging for differentiating benign, borderline, and malignant ovarian tumors.

PURPOSE: This study aimed to investigate the diagnostic performance of quantitative DCE-MRI for characterizing ovarian tumors. METHODS: We prospectively assessed the differences of quantitative DCE-MRI parameters (Ktrans, kep, and ve) among 15 benign, 28 borderline, and 66 malignant ovarian tumors; and between type I (n = 28) and type II (n = 29) of epithelial ovarian carcinomas (EOCs). DCE-MRI data were analyzed using whole solid tumor volume region of interest (ROI) method, and quantitative parameters were calculated based on a modified Tofts model. The non-parametric Kruskal-Wallis test, Mann-Whitney U test, Pearson's chi-square test, intraclass correlation coefficient (ICC), variance test, and receiver operating characteristic curves (ROC) were used for statistical analysis. RESULTS: The largest Ktrans and kep values were observed in ovarian malignant tumors, followed by borderline and benign tumors (all P < 0.001). Kep was the better parameter for differentiating benign tumors from borderline and malignant tumors, with a sensitivity of 89.3% and 95.5%, a specificity of 86.7% and 100%, an accuracy of 88.4% and 96.3%, and an area under the curve (AUC) of 0.94 and 0.992, respectively, whereas Ktrans was better for differentiating borderline from malignant tumors with a sensitivity of 60.7%, a specificity of 78.8%, an accuracy of 73.4%, and an AUC of 0.743. In addition, a combination with kep could further improve the sensitivity to 78.9%. The median Ktrans and kep values were significantly higher in type II than in type I EOCs. CONCLUSION: DCE-MRI with volume quantification is a technically feasible method, and can be used for the differentiation of ovarian tumors and for discriminating between type I and type II EOCs.

MRI features and score for differentiating borderline from malignant epithelial ovarian tumors.

PURPOSE: To identify the MRI features of borderline epithelial ovarian tumors (BEOTs) and to differentiate BEOTs from malignant epithelial ovarian tumors (MEOTs). MATERIALS AND METHODS: The clinical and MRI data of 89 patients with a BEOT and 109 patients with a MEOT proven by surgery and histopathology were retrospectively reviewed. MRI features, including bilaterality, size, shape, margin, cystic-solid interface, configuration, papillae or nodules, signal intensity, enhancement, presence of an ipsilateral ovary, peritoneal implants and ascites were analyzed and compared. Based on the odds ratio (OR) values, the significant risk features for BEOTs were scored as 3 (OR≈∞), 2 (5≤OR<∞) or 1 (OR<5). RESULTS: There were 89 BEOT patients with 113 tumors [mean size of (13±6.7)cm], with bilateral ovary involvement in 24 cases. There were 109 MEOT patients with 142 tumors [(9.3±4.2)cm] with bilateral ovary involvement in 33 cases. There were eight significant risk factors for BEOTs, including round or oval shape (OR=2.714), well-defined margins (OR=3.318), clear cystic-solid interfaces (OR=5.593), purely cystic (OR=15.206), predominantly cystic with papillae or nodules (OR=2.579), exophytic papillae or nodules (OR=5.351), branching papilla (OR≈∞) and the presence of an ipsilateral ovary (OR≈∞). Based on the scoring of the eight risk factors, a cut-off score of 3.5 yielded a differential sensitivity, specificity, and accuracy of 82%, 85% and 84%, respectively. CONCLUSION: In contrast to MEOTs, BEOTs frequently had the following features on MRI: round or oval, with well-defined margins and clear cystic-solid interfaces, purely cystic or predominantly cystic with papillae or nodules, branching or exophytic papillae, with the presence of an ipsilateral ovary. MRI can reveal the distinct morphological features of BEOTs and MEOTs and facilitate their discrimination.

Diffusion kurtosis imaging for differentiating borderline from malignant epithelial ovarian tumors: A correlation with Ki-67 expression.

PURPOSE: To investigate the use of diffusion kurtosis imaging (DKI) in differentiating borderline from malignant epithelial ovarian tumors (MEOTs) and to correlate DKI parameters with Ki-67 expression. MATERIALS AND METHODS: Fifty-two consecutive patients with epithelial ovarian tumors (17 borderline epithelial ovarian tumors, BEOTs; 35 MEOTs) were prospectively evaluated using DKI with b values of 0, 500, 1000, 1500, 2000, and 2500 s/mm2 and standard diffusion-weighted imaging (DWI) with b values of 0 and 1000 s/mm2 using a 1.5T magnetic resonance imaging (MRI) unit. The kurtosis (K) and diffusion coefficient (D) from DKI and apparent diffusion coefficient (ADC) from standard DWI were measured, compared, and correlated with Ki-67 expression between the two groups. Statistical analyses were performed using the Mann-Whitney U-test, receiver operating characteristic (ROC) curves, and Spearman's correlation. RESULTS: The K value was significantly lower in BEOTs than in MEOTs (0.55 ± 0.09 vs. 0.9 ± 0.2), while the D and ADC values were significantly higher in BEOTs than in MEOTs (2.27 ± 0.35 vs. 1.39 ± 0.37 and 1.72 ± 0.36 vs. 1.1 ± 0.25, respectively) (P < 0.001). For differentiating between BEOTs and MEOTs, the sensitivity, specificity, and accuracy were 88.2%, 94.3%, and 92.3% for K value; 88.2%, 91.4%, and 90.4% for D value; and 88.2%, 88.6%, and 88.5% for ADC value, respectively. However, there were no differences in the diagnostic performances among the three parameters above (K vs. ADC, P = 0.203; D vs. ADC, P = 0.148; K vs. D, P = 0.904). The K value was positively correlated with Ki-67 expression (r = 0.699), while the D and ADC values were negatively correlated with Ki-67 expression (r = -0.680, -0.665, respectively). CONCLUSION: Preliminary findings demonstrate that DKI is an alternative tool for differentiating BEOTs from MEOTs, and is correlated with Ki-67 expression. However, no added value is found for DKI compared with standard DWI. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1499-1506.

The value of dynamic contrast-enhanced MRI in characterizing complex ovarian tumors.

BACKGROUND: The study aimed to investigate the utility of dynamic contrast enhanced MRI (DCE-MRI) in the differentiation of malignant, borderline, and benign complex ovarian tumors. METHODS: DCE-MRI data of 102 consecutive complex ovarian tumors (benign 15, borderline 16, and malignant 71), confirmed by surgery and histopathology, were analyzed retrospectively. The patterns (I, II, and III) of time-signal intensity curve (TIC) and three semi-quantitative parameters, including enhancement amplitude (EA), maximal slope (MS), and time of half rising (THR), were evaluated and compared among benign, borderline, and malignant ovarian tumors. The types of TIC were compared by Pearson Chi-square χ 2 between malignant and benign, borderline tumors. The mean values of EA, MS, and THR were compared using one-way ANOVA or nonparametric Kruskal-Wallis test. RESULTS: Fifty-nine of 71 (83%) malignant tumors showed a type-III TIC; 9 of 16 (56%) borderline tumors showed a type-II TIC, and 10 of 15 (67%) benign tumors showed a type-II TIC, with a statistically significant difference between malignant and benign tumors (P < 0.001) and between malignant and borderline tumors (P < 0.001). MS was significantly higher in malignant tumors than in benign tumors and in borderline than in benign tumors (P < 0.001, P = 0.013, respectively). THR was significantly lower in malignant tumors than in benign tumors and in borderline than in benign tumors (P < 0.001, P = 0.007, respectively). There was no statistically significant difference between malignant and borderline tumors in MS and THR (P = 0.19, 0.153) or among malignant, borderline, and benign tumors in EA (all P > 0.05). CONCLUSIONS: DCE-MRI is helpful for characterizing complex ovarian tumors; however, semi-quantitative parameters perform poorly when distinguishing malignant from borderline tumors.

[Marine Aerosol Using On-board Aerosol Mass Spectrometry].

Marine aerosols were measured in real-time by an on-board signal particle aerosol mass spectrometer(SPAMS) over the Southeast China Sea. The chemical compositions and size distribution characteristics of aerosol particles were obtained, and the sources and ion spectra were analyzed. The results showed that particle number concentration decreased with the distance apart from the coastal area. In the coastal area, the aerosol compositions were mainly determined by the emissions of industry, such as vessel, traffic and coal combustion etc. When it was far from the continent, aerosols were mainly affected by the sea sources. Aerosol particles during the observation period disturbed singly with a peak diameter value of 0.5 µm. Most of the particles were in the size range of 0.2 µm to 0.8 µm. High signal intensity of EC with high K+ intensity in the positive spectrum and HSO4- intensity in negative spectrum was present in the marine aerosol over the coastal area. However, the signals of NO3- and NO2- were absent in the negative spectrum. The signal intensity of EC was weak in the marine aerosol over the sea area far from the coastal area. High signal intensity of Na+ and weak Mg+,Ca+ and NaCl+ signals were present in the positive spectrum, while high signal intensity of MSA-,CN-,O- and HSO4- were present in negative spectrum which was considered to be the special ions spectrum of marine biological sources. It indicated that ambient aerosols over the observation area were influenced not only by the anthropogenic emission sources but also affected by the marine aerosol formation.

[Sources Analysis of Heavy Metal Aerosol Particles in North Suburb of Nanjing].

Heavy metal aerosol particles were first measured with Single Particle Aerosol Mass Spectrometry (SPAMS) in north suburb of Nanjing from January to December, 2013. Using the ART-2a neural network algorithm, we studied the chemical characteristics of aerosol particles and found that the main sources of heavy metal aerosols in Nanjing were industrial emissions, biomass burning, traffic emissions, fuel combustion and dust, accounting for 35.7%, 34.45%, 13.6%, 11.03% and 4.07% respectively. Pb, Cd and Cr-containing aerosols mainly came from industrial emissions. Cu, Co and Hg-containing aerosols mainly came from biomass burning. V, Zn and Ba-containing aerosols mainly came from traffic emissions. As and Ni-containing aerosols mainly came from fuel combustion.

MRI for differentiating ovarian endometrioid adenocarcinoma from high-grade serous adenocarcinoma.

PURPOSE: To investigate magnetic resonance imaging (MRI) features for differentiating ovarian endometrioid adenocarcinoma (OEC) from high-grade serous adenocarcinoma (HGSC). MATERIALS AND METHODS: Twenty-three patients with 25 OECs and 93 patients with 139 HGSCs confirmed by surgery and pathology underwent conventional MRI and diffusion-weighted imaging (DWI). The MRI features of the tumors, including laterality, size, shape, configuration, signal intensity, ADC value of solid component, enhancement, ascites, synchronous primary cancer (SPC) of the ovary and endometrium, and clinical stage, were evaluated and compared between two groups. RESULTS: The following characteristics were significantly more common for OECs than HGSCs: unilateral (91.3% vs 50.5%, P < 0.001), larger mass (80.0% vs 48.2%, P = 0.005), round or oval shape (64.0% vs 17.3%, P < 0.001), mainly cystic with mural nodules or papillary projections (72.0% vs 18.7%, P < 0.001), cystic component with homogeneous iso- or hyperintensity on T1WI (82.6% vs 4.3%, P < 0.001), moderate enhancement (52.0% vs 26.6%, P = 0.011), no or mild ascites (91.3% vs 57.0%, P = 0.002), and SPC (43.5% vs 4.3%, P < 0.001). The ADC value of the solid component was higher in OECs (0.979 ± 0.197 × 10(-3) mm(2)/s) than in HGSCs (0.820 ± 0.112 × 10(-3) mm(2)/s) (P = 0.002). When a mainly cystic mass with mural nodules or papillary projections was associated with any one of homogeneously iso- or hyperintense cystic component on TIWI, a relatively higher ADC value and SPC, the sensitivity, specificity, accuracy, and positive and negative predictive values for characterizing OEC were 87.0%, 93.5%, 92.2%, 76.9%, and 96.7%, respectively. CONCLUSIONS: Conventional MRI combining DWI is helpful for differentiating OECs from HGSCs.

Primary ovarian endometrioid adenocarcinoma: magnetic resonance imaging findings including a preliminary observation on diffusion-weighted imaging.

OBJECTIVE: This study aimed to investigate the magnetic resonance imaging (MRI) features of ovarian endometrioid adenocarcinoma (OEC) and to evaluate conventional MRI and diffusion-weighted imaging (DWI) for diagnosing OEC. MATERIALS AND METHODS: Twenty patients with OEC proven by surgery and pathology underwent MRI. The MRI features of the tumors evaluated included laterality, shape, size, configuration, mural nodules, signal intensity, apparent diffusion coefficient (ADC) values, enhancement, peritoneal implants, ascites, and synchronous primary cancer (SPC) of the ovary and endometrium. RESULTS: Unilateral ovarian masses were observed in 18 (90%) of the 20 patients with 22 OEC lesions, whereas the remaining 2 (10%) patients had bilateral masses. Oval, lobulated, and irregular shapes were observed in 13 (59%), 6 (27%), and 3 (14%) tumors, respectively. The maximum diameter of the tumors ranged from 3.7 to 22.5 cm, with a mean of 11.2 ± 5.1 cm. Fifteen (68%) masses were mainly cystic with mural nodules, 5 (23%) were mixed cystic-solid, and 2 (9%) were solid. The solid components of tumors showed isointensity (100%) on T1-weighted imaging (T1WI), heterogeneous hyperintensity on T2-weighted imaging (T2WI) (86%), and hyperintensity on DWI (82%), with a mean ADC value of (0.96 ± 0.20) × 10 mm/s. The cystic components showed isointensity or hyperintensity (85%) on T1WI, hyperintensity on T2WI (100%), and hypointensity on DWI (63%), with a mean ADC value of (2.27 ± 0.27) × 10 mm/s. Ten (50%) of the patients were SPC. The mean ADC values of the solid components were (0.85 ± 0.19) × 10 mm/s and (1.08 ± 0.15) × 10 mm/s in only-OEC and SPC, respectively, with a statistically significant difference (P = 0.012). CONCLUSIONS: Ovarian endometrioid adenocarcinoma usually appears as a large, oval, or lobulated cystic mass with mural nodules. Cystic components show isointensity or hyperintensity on T1WI, solid components and hyperintensity on T2WI and DWI. Synchronous primary cancer of the ovary endometrium is another characteristic feature of OEC.

MR Spectroscopy for Differentiating Benign From Malignant Solid Adnexal Tumors.

OBJECTIVE: The purpose of this article is to investigate the proton MR spectroscopy ((1)H-MRS) features of solid adnexal tumors and to evaluate the efficacy of (1)H-MRS for differentiating benign from malignant solid adnexal tumors. MATERIALS AND METHODS: Sixty-nine patients with surgically and histologically proven solid adnexal tumors (27 benign and 42 malignant) underwent conventional MRI and (1)H-MRS. Single-voxel spectroscopy was performed using the point-resolved spectroscopy localization technique with a voxel size of 2 × 2 × 2 cm(3). Resonance peak integrals of choline, N-acetyl aspartate (NAA), creatine, lactate, and lipid were analyzed, and the choline-tocreatine, NAA-to-creatine, lactate-to-creatine, and lipid-to-creatine ratios were recorded and compared between benign and malignant tumors. RESULTS: A choline peak was detected in all 69 cases (100%), NAA peak in 67 cases (97%, 25 benign and 42 malignant), lipid peak in 47 cases (17 benign and 30 malignant), and lactate peak in eight cases (four benign and four malignant). The mean (± SD) choline-tocreatine ratio was 5.13 ± 0.6 in benign tumors versus 8.90 ± 0.5 in malignant solid adnexal tumors, a statistically significant difference (p = 0.000). There were no statistically significant differences between benign and malignant tumors in the NAA-to-creatine and lipid-to-creatine ratios (p = 0.263 and 0.120, respectively). When the choline-to-creatine threshold was 7.46 for differentiating between benign and malignant tumors, the sensitivity, specificity, and accuracy were 94.1%, 97.1%, and 91.2%, respectively. CONCLUSION: Our preliminary study shows that the (1)H-MRS patterns of benign and malignant solid adnexal tumors differ. The choline-to-creatine ratio can help clinicians differentiate benign from malignant tumors.

MRI for differentiating primary fallopian tube carcinoma from epithelial ovarian cancer.

PURPOSE: To compare potential discriminatory magnetic resonance imaging (MRI) features of primary fallopian tube carcinoma (PFTC) and primary epithelial ovarian cancer (EOC). MATERIALS AND METHODS: MRI features (the laterality, shape, size, signal intensity, enhancement of solid portion, amount of ascites, peritoneal planting, lymph nodes, or distant metastasis) of 27 tumors in 23 patients with PFTC confirmed by surgery and pathology were compared with 42 tumors in 37 patients with EOC. RESULTS: The mean maximum diameter was 6.1 ± 0.7 cm in PFTC versus 10.2 ± 0.6 cm in EOC. MRI features of PFTC were sausage-like shape (19/27, 70%), or irregular (8/27, 30%) shape; solid (20/27, 74%) or cystic-solid (7/27, 26%) mass; homogeneous (21/27, 78%) or heterogeneous (6/27, 22%) signal on T2 -weighted images; mild (8/27, 30%), moderate (13/27, 48%), or prominent (6/27, 22%) enhancement; associated hydrosalpinx (13/27, 48%) or intrauterine fluid accumulation (7/23, 30%). Significant differences between PFTC and EOC were found in the size, shape, configuration, signal homogeneity, and enhancement pattern, associated hydrosalpinx, and intrauterine fluid accumulation (P < 0.001, < 0.001, 0.015, 0.001, < 0.001, < 0.001, and 0.001, respectively). CONCLUSION: PFTC often appears as a small-sized solid mass, with a sausage-like shape, homogeneous signal, mild or moderate enhancement, hydrosalpinx, or intrauterine fluid accumulation. Our preliminary study shows that MRI can identify the characteristic features of PFTC and differentiate PFTC from EOC.

Primary fallopian tube carcinoma: correlation between magnetic resonance and diffuse weighted imaging characteristics and histopathologic findings.

OBJECTIVE: The aim of this study was to investigate the magnetic resonance (MR) and diffusion-weighted (DW) imaging characteristics of primary fallopian tube carcinoma (PFTC). METHODS: The clinical, MR, and DW imaging characteristics and pathologic findings of 23 patients with 27 tumors were studied retrospectively. The MR and DW imaging appearance of tumors including laterality, size and shape, architecture, signal intensity, apparent diffusion coefficient (ADC) value, enhancement pattern, hydrosalpinx, and intrauterine fluid collection were evaluated and correlated with pathologic findings. RESULTS: Histopathologically, all 27 tumors were serous carcinoma with a unilateral tumor in 19 patients and bilateral tumors in 4 patients. Thirteen patients (57%) with PFTC were misdiagnosed preoperatively, 10 of which as epithelial ovarian carcinoma. The mean (SD) largest diameter was 61 (7) mm. The tumor shape was fusiform, sausagelike, or serpentine in 19 patients (70%) and nodular or irregular in 8 patients (30%). Twenty (74%) of the 27 tumors were solid, and 7 (26%) were cystic-solid. The solid components showed hypointensity to isointensity on T1-weighted imaging, and isointensity to slight hyperintensity on T2-weighted imaging. There were obvious hyperintensity on DW imaging; obvious hypointensity on ADC maps with a mean (SD) ADC value of 0.79 (0.22) × 10 mm; and mild (8/27, 30%), moderate (13/27, 48%), and marked (6/27, 22%) enhancement on contrast-enhanced imaging. Ipsilateral hydrosalpinx, intrauterine fluid collection, and ascites were found in 14 tumors (52%) and 7 (30%) and 5 (22%) patients, respectively. CONCLUSIONS: The PFTC has some characteristic MR imaging features. The DW imaging, ADC maps, and ADC values are helpful for the detection and differentiation of PFTC from other pelvic masses.

MRI appearances of ovarian serous borderline tumor: pathological correlation.

PURPOSE: To investigate the spectrum of MRI appearances of ovarian serous borderline tumor (SBT). MATERIALS AND METHODS: Following ethics approval, 31 patients with 51 histologically proven ovarian SBTs underwent preoperative MRI. Images were evaluated, by two observers for the location, shape, size, internal architecture, signal intensity, and extent or stage of the tumors. The MRI findings were correlated with pathological findings. RESULTS: Twenty of 31 patients (65%) demonstrated bilateral ovarian SBTs on MRI. Three MRI morphological patterns of ovarian SBT were identified: (i) Mainly cystic mass with multiple intracystic papillary projections from the wall and septations was observed in 24 (47%) tumors. (ii) Solid mass with hierarchical branching papillary and fibrous stalk architecture was observed in 8 (16%) tumors. The branching papillary projections were hyperintensity on T2WI, intermediate intense on DWI, and enhanced intensely after the administration of Gd-DTPA. The internal branching fibrous stalks were hypointensity on T2WI and enhanced slightly. (iii) Mixed cystic-solid mass was observed in 19 (37%) tumors. The cystic and solid components had the architecture and signal intensity similar to those of cystic and solid SBTs. Papillary projections were the common architecture of all three types of tumors. CONCLUSION: On MRI, the ovarian SBT has some morphological distinguishing features. The solid papillary architecture with internal branching fibrous stalk is a somewhat more characteristic MRI appearance.