Diffusion weighted MRI in ovarian cancer

The role of diffusion weighted MRI (DW-MRI) in ovarian cancer management has been the focus of recent research. In this article, the main research interests and the current and future clinical applications of DW-MRI in ovarian cancer will be discussed.

For characterization of complex adnexal masses, the absence of residual signal intensity on high b-value diffusion weighted images in the solid component of a mass is a strong indicator of benignity, with a high negative predictive value for cancer. Detection of malignant peritoneal implants can be achieved with a high sensitivity and specificity. This is mainly due to the high contrast resolution obtained on DW-MRI images. Changes in the quantifiable parameter of diffusion, the apparent diffusion coefficient (ADC), can be measured to identify response following chemotherapy. Changes in ADC may reflect biological events in the tissue and ultimately may allow the early identification of nonresponders. Differences in ADC or ADC change post-therapy at different tumour sites within the same patient may reflect tumour heterogeneity.

The use of DW-MRI in the characterization of indeterminate adnexal masses is becoming well established and may have an important role in the preoperative confirmation of benignity. DW-MRI in the detection of sites of peritoneal disease and in the early detection of response to chemotherapy remain areas of research interest with great potential.