Background Distinguishing borderline ovarian tumors (BOTs) from stage I malignant epithelial ovarian tumors (MOTs) preoperatively remains a clinical challenge with major implications for surgical planning and fertility preservation. Diffusion-weighted MRI (DWI-MRI) has emerged as a promising tool for characterizing adnexal masses. Aim This study aimed to assess the diagnostic value of DWI-MRI, particularly apparent diffusion coefficient (ADC) measurements, in differentiating BOTs from stage I MOTs. Patients and methods A study analysis of 40 patients with histopathologically confirmed epithelial ovarian tumors was conducted. All patients underwent conventional MRI and DWI. ADC values of solid tumor components were measured and correlated with morphological MRI features, O-RADS ultrasound classification, Doppler vascularity scores, and CA-125 levels. Results Malignant tumors showed significantly lower ADC values than BOTs (average ADC cut-off: 1.1 × 10–3mm2/s; minimum ADC cut-off: 0.8 × 10–3mm2/s). BOTs were more often associated with smaller smooth solid components, low Doppler scores, Ovarian-Adnexal reporting and data system 4 classification, and lower CA-125 levels. In contrast, MOTs presented larger irregular solid components, higher Doppler vascularity, Ovarian-Adnexal reporting and data system5 classification, elevated CA-125, bilateral involvement, and a higher frequency of ascites. Conclusion DWI-MRI, particularly through quantitative ADC values, represents a reliable non-invasive adjunct to conventional imaging in distinguishing BOTs from stage I MOTs. Incorporating diffusion metrics with morphological and clinical features can improve preoperative diagnostic accuracy, guide fertility-sparing decisions, and optimize individualized patient management.
Hassan et al. (Tue,) studied this question.