Value of 3T diffusion weighted MRI in comparison with CECT in detection of ovarian cancer and ovarian cancer recurrence
Purpose: To investigate the value of 3T diffusion weighted magnetic resonance imaging (DW-MRI) compared to contrast enhanced computed tomography (CECT), in the preoperative staging of patients with suspected ovarian cancer (OC) or with suspected recurrence of ovarian cancer (ROC).
Materials and methods: Thirty-two women (mean age 65 ± 14) with suspected (n = 23) or recurrent (n = 9) ovarian cancer were included prospectively in a single center study. CECT and abdominal 3T DW-MRI were performed. Both methods were used to independently score the presence of 1) ovarian tumor, 2) peritoneal or omental carcinomatosis, 3) pathological lymph nodes (LN), along with 4) liver parenchymal, 5) liver capsular, 6) diaphragmatic, and 7) extra-abdominal metastases. Findings were scored as: 0=benign, 1=suspicious for malignancy, or 2=definitely malignant. In addition, the lowest ADC values were measured in existing primary tumors. The extent of disease burden and correlation to histopathological findings were analyzed.
Results: The mean disease score was higher in DW-MRI than in CT (4.9 ± 2.6 vs. 3.5 ± 2.2, P < 0.001). Compared to CT, DW-MRI depicted more LN (P = 0.001) and diaphragmatic (P = 0.024) lesions. The lowest ADC values were significantly lower in malignant tumors (n = 18) than in benign tumors (n = 5) (0.640 x10-3mm2/s ± 159 vs. 0.992 x10-3mm2/s ± 218, P = 0.002).
Conclusion: The results of our prospective single center study show incremental value of abdominal 3T DW-MRI in comparison with CECT, especially in detecting diaphragmatic and peritoneal ovarian cancer metastases, excluding lymph nodal metastases and in differentiating malignant adnexal tumors from benign.