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DOI: 10.1016/j.rxeng.2020.05.006
Available online 9 March 2021
Usefulness of dynamic contrast-enhanced magnetic resonance imaging in characterizing ovarian tumors classified as indeterminate at ultrasonography
Utilidad de la resonancia magnética dinámica con contraste para caracterizar tumores ováricos ecográficamente indeterminados
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S. Amado Cabana
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sara.amado.cabana@sergas.es

Corresponding author.
, J.C. Gallego Ojea, M. Félez Carballada
Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, Spain
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Tables (5)
Table 1. Study protocol performed on Philips Intera 1.0T MRI scanner.
Table 2. Study protocol performed on Philips Ingenia 1.5T MRI scanner.
Table 3. Breakdown of the types of tumour in the overall study sample.
Table 4. Cross-tabulation showing the relationship between the different types of tumour and curve, and the statistical significance in the χ2 test.
Table 5. Means and standard deviations of the values for the semiquantitative parameters in each group of tumours. Statistical significance (Kruskal-Wallis test) of the differences between the group of malignant tumours and the other two groups.
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Abstract
Objectives

To determine whether there is a significant relationship between the shape of the time-intensity curve on dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of ovarian tumours classified as indeterminate at ultrasonography and the type of lesion (benign, borderline, or malignant) to enable an accurate presurgical diagnosis.

Material and methods

We used dynamic contrast-enhanced MRI to study 68 ovarian tumours that were classified as indeterminate at ultrasonography. We included only cases for which a definitive diagnosis (histologic diagnosis or ≥1 year stability on imaging tests) was available. Each case was classified as benign, borderline, or malignant.

To analyse the MRI studies, we marked regions of interest in the lesion and in the myometrium (as a reference). We obtained a curve defined by the relation between the intensity of enhancement and time and classified each tumour according to four predefined curve types. We also analysed semiquantitative parameters. Finally, we compared the results for each of the three groups of tumours.

Results

We found significant associations (P<.001) between the curves without early enhancement and benign and borderline lesions as well as between the curves with early enhancement and malignant lesions. Malignant lesions were significantly associated with the semiquantitative enhancement parameters: maximum (P=.002), maximum relative (P=.006), and relative (P=.018).

Conclusions

In ovarian tumours classified as indeterminate at ultrasonography, dynamic contrast-enhanced MRI can be useful for classification as benign, borderline, or malignant because the malignant lesions are significantly associated with early enhancement curves.

Keywords:
Magnetic resonance imaging
Contrast media
Image enhancement
Ovarian tumors
Differential diagnosis
Resumen
Objetivos

Determinar si existe una relación significativa entre la morfología de la curva intensidad-tiempo del estudio de resonancia magnética (RM) dinámica con gadolinio de los tumores ováricos ecográficamente indeterminados y el tipo de lesión (benigna, borderline o maligna), para poder realizar un diagnóstico prequirúrgico correcto.

Material y métodos

Se analizaron 68 tumoraciones ováricas ecográficamente indeterminadas, valoradas mediante RM con secuencia dinámica. Únicamente se incluyeron los casos con diagnóstico histológico o con estabilidad en pruebas de imagen tras al menos un año de seguimiento. Cada caso se clasificó en benigno, borderline o maligno.

Para su análisis, se marcaron regiones de interés en la lesión y en el miometrio (como referencia). Se obtuvo una curva definida por la relación entre la intensidad del realce y el tiempo, cuya morfología permitió clasificar cada tumour dentro de uno de los cuatro tipos de curva predefinidos. También se analizaron parámetros semicuantitativos. Finalmente, se compararon los resultados de cada uno de los tres grupos de tumores.

Resultados

Se demostró una relación significativa (P<,001) entre las curvas sin realce precoz con las lesiones benignas y borderline, y entre las malignas con curvas con realce precoz. Las lesiones malignas se asociaron de forma significativa con los parámetros semicuantitativos de realce: máximo (P=,002), relativo máximo (P=,006) y relativo (P=,018).

Conclusiones

En tumores ováricos ecográficamente indeterminados, la RM dinámica con contraste puede ser útil a la hora de clasificarlos como benignos, borderline o malignos, al mostrar las neoplasias malignas una asociación estadísticamente significativa con curvas con realce precoz.

Palabras clave:
Resonancia magnética
Medios de contraste
Realce de imagen
Neoplasias de ovario
Diagnóstico diferencial

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