The diagnostic potential of diffusion weighted and dynamic contrast enhanced MR imaging in the characterization of complex ovarian lesions

Our aim was to evaluate the diagnostic potential of diffusion-weighted (DW) and dynamic contrast enhanced MRI (DCE-MR) in the diagnosis and characterization of complex ovarian lesions. We prospectively evaluated 59 patients with 65 complex ovarian lesions detected at US. MRI examinations were performed using a 1.5 T MRI machine. Masses were classified as benign (n = 30), borderline (n = 7) and malignant (n = 28). Regions of interest were drawn and parameters were calculated such as apparent diffusion coefficient (ADC) values for the diffusion; maximum absolute enhancement (SI-max), maximum relative enhancement (MRE), time to peak (T-max) and wash-in-rate (WIR) for the dynamic parameters. There was a significant difference in ADC values (P < 0.001), SI-max (P < 0.05), MRE% (P < 0.001), T-max (P < 0.001) and WIR (P < 0.001) between benign and borderline/invasive malignant groups. A cut-off ADC value ≤ 0.95 had a PPV of 81.8% for prediction of borderline/invasive malignant lesions; a cut-off Tmax ≤ 141 s had a specificity of 86.7% and PPV of 86.7% for predicting malignancy. The addition of DW and DCE-MRI to the conventional MRI improved its diagnostic value. They provide additional information for the lesion behavior. Thus they are recommended to be added to the routine conventional MRI to help characterization of complex masses.