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Adnexal masses characterized on 3 tesla magnetic resonance imaging – added value of diffusion techniques

Julia Dimova
Julia Dimova
, 
Dora Zlatareva
Dora Zlatareva
, 
Rumiana Bakalova
Rumiana Bakalova
, 
Ichio Aoki
Ichio Aoki
 und 
George Hadjidekov
George Hadjidekov
   | 21. Okt. 2020
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Article Category: Research Article
Online veröffentlicht: 21. Okt. 2020
Seitenbereich: 419 - 428
Eingereicht: 19. Juni 2020
Akzeptiert: 14. Sept. 2020
DOI: https://doi.org/10.2478/raon-2020-0061
© 2020 Julia Dimova, Dora Zlatareva, Rumiana Bakalova, Ichio Aoki, George Hadjidekov, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

(A) Box plot presenting ADC values in four different types of adnexal tumors – highest ADC value found in a simple cyst; lowest found in a malignant tumor. (B) Mean apparent diffusion coefficient (ADC) values of twelve patients with histologically proven benign adnexal lesion and twelve patients with histologically proven malignant adnexal lesion. All values are expressed as mean value ± standard deviation (SD) x 10 -3 mm 2 /s.
(A) Box plot presenting ADC values in four different types of adnexal tumors – highest ADC value found in a simple cyst; lowest found in a malignant tumor. (B) Mean apparent diffusion coefficient (ADC) values of twelve patients with histologically proven benign adnexal lesion and twelve patients with histologically proven malignant adnexal lesion. All values are expressed as mean value ± standard deviation (SD) x 10 -3 mm 2 /s.

Figure 2

Type III time intensity curve (TIC) of a malignant adnexal mass.
Type III time intensity curve (TIC) of a malignant adnexal mass.

Figure 3

45-year old patient with bilateral adnexal masses; serous papillary cystadenoma (arrow) and mucinous cystadenoma (arrowhead); both masses have predominantly high signal intensity on T2WI and T2WI fat sat (A), (B) and low signal intensity on T1WI fat sat (C).
45-year old patient with bilateral adnexal masses; serous papillary cystadenoma (arrow) and mucinous cystadenoma (arrowhead); both masses have predominantly high signal intensity on T2WI and T2WI fat sat (A), (B) and low signal intensity on T1WI fat sat (C).

Figure 4

68-year old patient with previous hysterectomy; right serous cystadenofibroma (arrow); complex mass - heterogeneous on T2WI (A) which shows peripheral enhancement on T1WI fat sat with contrast (B). (C) Macroscopic histological preparation of the tumor.
68-year old patient with previous hysterectomy; right serous cystadenofibroma (arrow); complex mass - heterogeneous on T2WI (A) which shows peripheral enhancement on T1WI fat sat with contrast (B). (C) Macroscopic histological preparation of the tumor.

Figure 5

57- year old patient with left serous papillary adenocarcinoma (arrow); predominantly cystic mass with high signal intensity on T2WI (A) and solid component which is enhanced on T1WI fat sat with contrast (B). Part of the mass characterizes with diffusion restriction (C). (D) Microscopy preparation of the tumor.
57- year old patient with left serous papillary adenocarcinoma (arrow); predominantly cystic mass with high signal intensity on T2WI (A) and solid component which is enhanced on T1WI fat sat with contrast (B). Part of the mass characterizes with diffusion restriction (C). (D) Microscopy preparation of the tumor.

Figure 6

63- year old patient with right ovarian metastasis from adenocarcinoma with intestinal phenotype; complex septated mass with heterogeneous signal intensity on T2WI (A); enhancement mostly in wall and septi on T1WI fat sat with contrast (B); part of the mass (arrowhead) has restricted diffusion; (D) Microscopy preparation of the metastasis.
63- year old patient with right ovarian metastasis from adenocarcinoma with intestinal phenotype; complex septated mass with heterogeneous signal intensity on T2WI (A); enhancement mostly in wall and septi on T1WI fat sat with contrast (B); part of the mass (arrowhead) has restricted diffusion; (D) Microscopy preparation of the metastasis.

Figure 7

54- year old patient with mucinous cystadenoma (arrow) coexisting with benign Brenner tumor (arrowhead); mucinous cystadenoma has high signal intensity on T2WI (A) and low on T1WI fat sat (B); compared to it Brenner tumor has low signal intensity on T2WI (A) and high on T1WI fat sat (B); on T1 fat sat with contrast (C) only Brenner tumor shows enhancement and on DWI (D) only Brenner tumor shows restricted diffusion.
54- year old patient with mucinous cystadenoma (arrow) coexisting with benign Brenner tumor (arrowhead); mucinous cystadenoma has high signal intensity on T2WI (A) and low on T1WI fat sat (B); compared to it Brenner tumor has low signal intensity on T2WI (A) and high on T1WI fat sat (B); on T1 fat sat with contrast (C) only Brenner tumor shows enhancement and on DWI (D) only Brenner tumor shows restricted diffusion.

Diffusion MRI appearance of histologically different groups

Histopathological findingsDWI restrictedDWI Facilitated
Simple cyst-5
Inclusion cyst-1
Abscess1-
Endometrioma125
Teratoma5-
Serous cystadenoma-2
Mucinous cystadenoma11
Serous adenofibroma1-
Serous cystadenofibroma1-
Brenner tumor-1
Seromucinous carcinoma2-
Serous papillary adenocarcinoma2-
Adenosarcoma1-
Metastases6-

Results of 124 ovarian masses according to their MRI features

MalignantBenignBorderline
Cystic masses5/41 (12.2%)61/71 (85.9%)6/12 (50%)
Solid masses10/41 (24.4%)4/71 (5.6%)2/12 (16.6%)
Mixed masses26/41 (63.4%)6/71 (8.5%)4/12 (33.4%)
Cases with one ovary involvement18/30 (60%)46/58 (79.3%)9/10 (90%)
Cases with both ovaries’ involvement12/30 (40%)12/58 (20.7%)1/10 (10%)
Size of the mass (more than 4 cm)37/41 (90.2%)22/71 (31%)8/12 (66.7%)
Masses with adipose tissue presence-5/71 (7%)1/12 (8.3%)
Masses with high signal intensity in T2WI5/41 (12.2%)42/71 (59.1%)5/12 (41.6%)
Masses with low signal intensity in T2WI7/41 (17.1%)18/71 (25.4%)1/12 (8.4%)
Heterogeneous masses29/41 (70.7%)11/71 (15.5%)6/12 (50%)
Diffusion restriction39/41 (95.1%)19/71 (26.8%)7/12 (58.4%)
Wall thickness (more than 3 mm)20/41 (48.8%)12/71 (16.9%)5/12 (41.7%)
Presence of septa25/41 (61%)11/71 (15.5%)5/12 (41.7%)
Papillary projections presented14/41 (34.1%)-2/12 (16.6%)
Cases with presence of ascites16/30 (53.3%)15/58 (25.9%)2/10 (20%)
Lymph nodes involvement and metastases20/30 (66.6%)3/58* (5.2%)1/10 (10%)

3 Tesla Siemens and 3 Tesla Philips MRI protocols

SIEMENS VERIO 3.0T
FOV (mm)Matrix (mm)Slice thickness (mm)TR (ms)TE (ms)Voxel size (mm)TA(min)
T1 COR300390/32055008.70.9×0.9×5.001:36
T2 SAG200320/320433001330.6×0.6×4.003:44
T2 paracor200320/320437001400.6×0.6×4.003:24
T2 paracor +FS200256/256437001310.8×0.8×4.001:58
T2 paratra200320/320437401480.6×0.6×4.003:29
T2 paratra + FS200256/256437001380.8×0.8×4.002:13
T1 SAG160217/1924569120.4×0.4×4.003:44
T1 vibe dixon AX380188/3203.53.921.270.6×0.6×3.500:19
DWI AX (b50-400-800)360100/12854700571.4×1.4×5.002:49
POST C
T1 vibe dixon AX380188/3203.53.921.270.6×0.6×3.500:19
T1 SAG160217/1924569120.4×0.4×4.003:44
T1 COR300390/32055008.70.9×0.9×5.001:36
PHILIPS INGENIA 3.0T
COR STIR340228/18655622501.5×1.5×5.003:45
T2 SAG229208/208337761001.1×1.1×3.003:01
COR T2315392/29754846900.8×1.6×5.001:56
COR T1315392/315548380.8×1.2×5.002:11
AX T2261328/251548051000.8×1.0×5.002:05
AX T2 FS261236/20854346801.11×1.25×5.002:37
DWI 3b 0,100,800375124/10645299773.0×3.0×4.001:51
POST C
MDixon AX240220/2223,55.41.961.09×1.08×3.502:58
COR T1 FS315392/309551980.8×1.02×5.002:17
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