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.

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.

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.

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.

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.

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.

Diffusion-weighted MR imaging for differentiating borderline from malignant epithelial tumours of the ovary: pathological correlation.

OBJECTIVES: To investigate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiating borderline from malignant epithelial tumours of the ovary. METHODS: This retrospective study included 60 borderline epithelial ovarian tumours (BEOTs) in 48 patients and 65 malignant epithelial ovarian tumours (MEOTs) in 54 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. The results were correlated with histopathology and cell density. RESULTS: The majority of MEOTs showed high signal intensity on DW imaging, whereas most BEOTs showed low or moderate signal intensity (P = 0.000). The mean ADC value of the solid components in BEOTs (1.562 ± 0.346 × 10(-3) mm(2)/s) was significantly higher than in MEOTs (0.841 ± 0.209 × 10(-3) mm(2)/s). A threshold value of 1.039 × 10(-3) mm(2)/s permitted the distinction with a sensitivity of 97.0%, a specificity of 92.2% and an accuracy of 96.4%. There was an inverse correlation between ADC value and cell density (r = -0.609; P = 0.0000) which was significantly lower in BEOTs than in MEOTs. CONCLUSIONS: DW imaging is useful for differentiating borderline from malignant epithelial tumours of the ovary. KEY POINTS: DW MR imaging is useful for differentiating BEOTs from MEOTs. Patients with BEOTs are treated differently from patients with MEOTs. Conservative fertility-sparing laparoscopic surgery can be performed in patients with BEOTs. BEOTs often affect young women of childbearing age.

Mucin-producing tumors of the ovary--preoperative differentiation between metastatic ovarian mucinous carcinoma and primary mucinous malignant tumors.

OBJECTIVE: To investigate the clinical and magnetic resonance imaging (MRI) features for preoperatively discriminating  primary ovarian mucinous malignant tumors (POMTs) and metastatic mucinous carcinomas involving the ovary (MOMCs). METHODS: This retrospective multicenter study enrolled 61 patients with 22 POMTs and 49 MOMCs, which were pathologically proved between November 2014 to Jane 2023. The clinical and MRI features were evaluated and compared between POMTs and MOMCs. Univariate and multivariate analyses were performed to identify the significant variables between the two groups, which were then incorporated into a predictive nomogram, and ROC curve analysis was subsequently carried out to evaluate diagnostic performance. RESULTS: 35.9% patients with MOMCs were discovered synchronously with the primary carcinomas; 25.6% patients with MOMCs were bilateral, and all of the patients with POMTs were unilateral. The biomarker CEA was significantly different between the two groups (p = 0.002). There were significant differences in the following MRI features: tumor size, configuration, enhanced pattern, the number of cysts, honeycomb sign, stained-glass appearance, ascites, size diversity ratio, signal diversity ratio. The locular size diversity ratio (p = 0.005, OR = 1.31), and signal intensity diversity ratio (p = 0.10, OR = 4.01) were independent predictors for MOMCs. The combination of above independent criteria yielded the largest area under curve of 0.922 with a sensitivity of 82.3% and specificity of 88.9%. CONCLUSIONS: Patients with MOMCs were more commonly bilaterally and having higher levels of CEA, but did not always had a malignant tumor history. For ovarian mucin-producing tumors, the uniform locular sizes and signal intensities were more predict MOMCs.

Magnetic Resonance Imaging and Diffusion Weighted Imaging-Based Histogram in Predicting Mesenchymal Transition High-Grade Serous Ovarian Cancer.

RATIONALE AND OBJECTIVES: To investigate the value of magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) findings in predicting mesenchymal transition (MT) high-grade serous ovarian cancer (HGSOC). MATERIALS AND METHODS: Patients with HGSOC were enrolled from May 2017 to December 2020, who underwent pelvic MRI including DWI (b = 0,1000 s/mm2) before surgery, and were assigned to the MT HGSOC or non-MT HGSOC group according to histopathology results. Clinical characteristics and MRI features including DWI-based histogram metrics were assessed and compared between the two groups. Univariate and multivariate analyses were performed to identify the significant variables associated with MT HGSOC - these variables were then incorporated into a predictive nomogram, and ROC curve analysis was subsequently carried out to evaluate diagnostic performance. RESULTS: A total of 81 consecutive patients were recruited for pelvic MRI before surgery, including 37 (45.7%) MT patients and 44 (54.3%) non-MT patients. At univariate analysis, the features significantly related to MT HGSOC were identified as absence of discrete primary ovarian mass, pouch of Douglas implants, ovarian mass size, tumor volume, mean, SD, median, and 95th percentile apparent diffusion coefficient (ADC) values (all p < 0.05). At multivariate analysis, the absence of discrete primary ovarian mass {odds ratio (OR): 46.477; p = 0.025}, mean ADC value ≤ 1.105 (OR: 1.023; p = 0.009), and median ADC value ≤ 1.038 (OR: 0.982; p = 0.034) were found to be independent risk factors associated with MT HGSOC. The combination of all independent criteria yielded the largest AUC of 0.82 with a sensitivity of 83.87% and specificity of 66.67%, superior to any of the single predictor alone (p ≤ 0.012). The predictive C-index nomogram performance of the combination was 0.82. CONCLUSION: The combination of absence of discrete primary ovarian mass, lower mean ADC value, and median ADC value may be helpful for preoperatively predicting MT HGSOC.

Optimization of 7,12-dimethylbenz(a)anthracene-induced rat epithelial ovarian tumors.

Ovarian carcinoma is the second most common malignant tumor of the female reproductive system and an notable cause of cancer death. The detection and diagnosis of early ovarian carcinomas are still clinical challenges, which calls for imaging studies using early ovarian carcinoma animal models. The present study aimed to optimize the 7,12-dimethylbenz(a)anthracene (DMBA)-induced model of rat ovarian tumors by investigating the delivery methods, induction dose and time of DMBA exposure, and explored the morphological features of tumors using MRI. Three schemes were performed. In scheme one the ovary was covered with absorbable hemostatic gauze loaded with a high concentration of liquid DMBA. For this scheme, 150 Sprague-Dawley rats were divided into three groups depending on the DMBA dose (1.0, 2.0 and 3.0 mg). In scheme two DMBA solution was injected under the ovarian capsule. For this scheme, 159 rats were divided into 0.5, 1.0 and 1.5 mg DMBA groups. In scheme three the ovary was covered with absorbable gauze loaded with a high concentration of solid DMBA. For this scheme 161 rats were divided into 1.0, 2.0 and 3.0 mg DMBA groups. Each group of the three schemes was further subdivided into 60-, 90-, 120-, 150- and 180-day groups. In scheme two, the tumor formation rate was 75.6% (99/131), which was the highest in the 1.5 mg group (86.4%, 38/44) and reached 100% (10/10) on day 120. The induced tumors were serous in 93.9% (93/99) of tumors. Borderline ovarian tumors accounted for 19.2% (19/99) of all tumors, and ovarian cancer accounted for 46.5% (46/99). The mean maximum diameter (MMD) of borderline ovarian tumors was 10.29±3.41 mm, and that of ovarian cancer was 15.19±7.10 mm. MMD of the solid components increased with increasing malignancy. Cystic, cystic-solid and solid tumors were observed. The ovarian subcapsular injection of 1.5 mg DMBA was the best scheme for the rat ovarian tumor model. The present model is ideal for investigating the occurrence, development and imaging 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.

Dynamic contrast enhanced­magnetic resonance imaging for the early evaluation of the response to docetaxel in rats with epithelial ovarian cancer.

Dynamic contrast enhanced­magnetic resonance imaging (DCE­MRI) contributes to the early detection and prediction of responses to chemotherapy in cancer. The aim of the present study was to investigate the feasibility of quantitative DCE­MRI parameters for noninvasively predicting the early response to DTX in epithelial ovarian cancer (EOC). In the present study, using 7,12­dimethylbenz (A) anthracene, orthotopic EOC was induced in Sprague Dawley rats. Rats with EOC were treated with docetaxel (DTX) on day 0. DCE­MRI was applied on days 0, 3, 7, 14 and 21. On day 21, the treated tumor types were categorized into sensitive and insensitive groups according to their change in size. Quantitative DCE­MRI parameters were used to assess the early response to therapy. The experiment was performed again, the treatment group was divided into sensitive and insensitive groups according to their initially obtained cut-off values, and histopathological analyses were performed. Comparing the sensitive group with the insensitive group, there were significant differences in the percentage change in the volume transfer constant (Ktrans), rate constant (kep) and initial area under the curve (IAUC) from day 3 and tumor size from day 14. During the early stages of treatment (on day 3), the percentage change of Ktrans combined with kep produced an AUC of 1, and a sensitivity and specificity of 100 and 100%, respectively, using a cut-off value of a 17.59% reduction in Ktrans and kep. From day 7, there were significant differences in the quantitative index percentage change in angiogenesis in the sensitive group compared with the insensitive group. The percentage change in Ktrans, kep and IAUC were positively correlated with the percentage of change in tumor size and angiogenesis, and negatively correlated with the percentage of change in necrosis. The results of the present study indicated that quantitative DCE­MRI parameters were superior to imaging tumor size for the early detection and prediction of the response to DTX chemotherapy in EOC.

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 DCE-MRI in assessing histopathological and molecular biological features in induced rat epithelial ovarian carcinomas.

BACKGROUND: To investigate dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) for assessing histopathological and molecular biological features in induced rat epithelial ovarian carcinomas (EOCs). METHODS: 7,12-dimethylbenz[A]anthracene (DMBA) was applied to induce EOCs in situ in 46 SD rats. Conventional MRI and DCE-MRI were performed to evaluate the morphology and perfusion features of the tumors, including the time-signal intensity curve (TIC), volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular space volume ratio (Ve) and initial area under the curve (IAUC). DCE-MRI parameters were correlated with histological grade, microvascular density (MVD), vascular endothelial growth factor (VEGF) and fraction of Ki67-positive cells and the serum level of cancer antigen 125 (CA125). RESULTS: Thirty-five of the 46 rats developed EOCs. DCE-MRI showed type III TIC more frequently than type II (29/35 vs. 6/35, p < 0.001) in EOCs. The two types of TIC of tumors had significant differences in the histological grade, MVD, expression of VEGF and Ki67, and the serum level of CA125 (all p < 0.01). Ktrans, Kep and IAUC values showed significant differences in different histological grades in overall and pairwise comparisons except for IAUC in grade 2 vs. grade 3 (all p < 0.01). There was no significant difference in Ve values among the three grade groups (p > 0.05). Ktrans, Kep and IAUC values were positively correlated with MVD, VEGF and Ki67 expression (all p < 0.01). Ve was not significantly correlated with MVD, VEGF expression, Ki67 expression and the CA125 level (all p > 0.05). CONCLUSIONS: TIC types and perfusion parameters of DCE-MRI can reflect tumor grade, angiogenesis and cell proliferation to some extent, thereby helping treatment planning and predicting prognosis.

Magnetic resonance imaging for distinguishing ovarian clear cell carcinoma from high-grade serous carcinoma.

BACKGROUND: To compare the magnetic resonance imaging (MRI) features of ovarian clear cell carcinoma (CCC) and high-grade serous carcinoma (HGSC), to distinguish CCC from HGSC. METHODS: MRI features (laterality, shape, size, configuration, papillary projection, signal intensity, enhancement, peritoneal implant, lymphadenopathy, ascites) of 40 tumors in 37 patients with CCC, confirmed by surgery and pathology, were compared with those of 62 tumors in 40 patients with HGSC. Statistical analysis was performed using Mann-Whitney and Fisher's exact tests. RESULTS: There was a statistically significant difference in the mean maximum diameter, laterality, and FIGO stage (P = 0.002, P < 0.001, P < 0.001, respectively) between CCC and HGSC. Compared to HGSCs, CCCs were more frequently oval (30/40, 75 % vs 12/62, 19 %; P < 0.001), more often cystic (21/40, 53 % vs 8/62, 13 %; P < 0.001) and unilocular (23/29, 79 % vs 7/31, 23 %; P < 0.001), had T1-hyperintense cystic components more often (18/29, 62 % vs 5/29, 17 %; P < 0.001), had larger papillary projections (5.13 ± 0.4 cm vs 2.91 ± 0.3 cm; P < 0.001), were peritoneally implanted less frequently (P = 0.001) and had fewer ascites (P < 0.001). CONCLUSIONS: CCC typically showed an oval, unilocular cystic mass with large papillary projection and T1-hyperintense cystic components. MRI could be helpful for distinguishing CCC from HGSC.

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.

Ovarian Sertoli-Leydig cell tumors: MRI findings and pathological correlation.

BACKGROUND: To investigate the magnetic resonance imaging (MRI) characteristics of ovarian Sertoli-Leydig cell tumors (SLCT). METHODS: The clinical, MRI and pathological findings of five cases of SLCT were reviewed retrospectively. MRI appearances of tumors including laterality, shape and size, architecture, wall, septa and vegetation, signal intensity and contrast-enhancement pattern were evaluated and correlated with pathological findings. RESULTS: Two tumors were solid which appeared as low signal intensity on T1-weighted imaging (T1WI) and moderate on T2-weighted imaging (T2WI) with multiple small cysts in one of them. The remaining three SLCT were multilocular cystic with the irregularly thickened wall and septa, and with solid area and mural nodules in one of them. The cystic components had the same signal intensity as urine. All the solid components were intensely enhanced after administration of contrast medium. All five tumors were pathologically intermediate differentiation and at FIGO stage I. CONCLUSIONS: SLCT demonstrate variable MRI morphological appearances. However, the irregularly thickened wall and septa, the moderate T2WI signal intensity and obvious enhancement in the solid components are three MRI features.