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Updated: Dec 18, 2025
A Coregistered Ultrasound and Photoacoustic Imaging Protocol for the Transvaginal Imaging of Ovarian Lesions
Published on: March 3, 2023
Ultra-High-b-Value Kurtosis Imaging for Noninvasive Tissue Characterization of Ovarian Lesions
Theresa Mokry1, Anna Mlynarska-Bujny1, Tristan Anselm Kuder1
1From the Department of Diagnostic and Interventional Radiology, Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany (T.M., F.C.H., H.U.K.); Department of Radiology (T.M., A.M.B., R.H., R.G., H.P.S., S.B.) and Department of Medical Physics in Radiology (A.M.B., T.A.K.), German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany (A.M.B.); Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (M.W., C.D., J.B.); Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany (P.S.); Hospital for General Obstetrics and Gynecology, Frankfurt Hoechst, Germany (J.R.); Junior Group Medical Imaging and Radiology-Cancer Prevention, German Cancer Research Center, Heidelberg, Germany (R.H., S.B.); and Institute of Radiology, University Hospital Erlangen, Erlangen, Germany (S.B.).
Abstract:
Background MRI with contrast material enhancement is the imaging modality of choice to evaluate sonographically indeterminate adnexal masses. The role of diffusion-weighted MRI, however, remains controversial. Purpose To evaluate the diagnostic performance of ultra-high-b-value diffusion kurtosis MRI in discriminating benign and malignant ovarian lesions. Materials and Methods This prospective cohort study evaluated consecutive women with sonographically indeterminate adnexal masses between November 2016 and December 2018. MRI at 3.0 T was performed, including diffusion-weighted MRI (b values of 0-2000 sec/mm2). Lesions were segmented on b of 1500 sec/mm2 by two readers in consensus and an additional independent reader by using full-lesion segmentations on a single transversal slice. Apparent diffusion coefficient (ADC) calculation and kurtosis fitting were performed. Differences in ADC, kurtosis-derived ADC (Dapp), and apparent kurtosis coefficient (Kapp) between malignant and benign lesions were assessed by using a logistic mixed model. Area under the receiver operating characteristic curve (AUC) for ADC, Dapp, and Kapp to discriminate malignant from benign lesions was calculated, as was specificity at a sensitivity level of 100%. Results from two independent reads were compared. Histopathologic analysis served as the reference standard. Results A total of 79 ovarian lesions in 58 women (mean age ± standard deviation, 48 years ± 14) were evaluated. Sixty-two (78%) lesions showed benign and 17 (22%) lesions showed malignant histologic findings. ADC and Dapp were lower and Kapp was higher in malignant lesions: median ADC, Dapp, and Kapp were 0.74 µm2/msec (range, 0.52-1.44 µm2/msec), 0.98 µm2/msec (range, 0.63-2.12 µm2/msec), and 1.01 (range, 0.69-1.30) for malignant lesions, and 1.13 µm2/msec (range, 0.35-2.63 µm2/msec), 1.45 µm2/msec (range, 0.44-3.34 µm2/msec), and 0.65 (range, 0.44-1.43) for benign lesions (P values of .01, .02, < .001, respectively). AUC for Kapp of 0.85 (95% confidence interval: 0.77, 0.94) was higher than was AUC from ADC of 0.78 (95% confidence interval: 0.67, 0.89; P = .047). Conclusion Diffusion-weighted MRI by using quantitative kurtosis variables is superior to apparent diffusion coefficient values in discriminating benign and malignant ovarian lesions and might be of future help in clinical practice, especially in patients with contraindication to contrast media application. © RSNA, 2020 Online supplemental material is available for this article.
Insights
Ultra-high-b-value diffusion kurtosis MRI, using apparent kurtosis coefficient (Kapp), effectively distinguishes benign from malignant ovarian lesions. This advanced MRI technique shows superior diagnostic performance compared to apparent diffusion coefficient (ADC) values.
Area of Science:
- Radiology and Imaging Science
- Oncology and Women's Health
Background:
- Contrast-enhanced MRI is standard for evaluating indeterminate adnexal masses.
- The diagnostic utility of diffusion-weighted MRI (DW-MRI) for ovarian lesions remains debated.
Purpose of the Study:
- To assess the diagnostic accuracy of ultra-high-b-value diffusion kurtosis MRI in differentiating benign and malignant ovarian lesions.
- To compare the performance of diffusion kurtosis metrics against traditional apparent diffusion coefficient (ADC) values.
Main Methods:
- Prospective cohort study of 79 women with sonographically indeterminate adnexal masses.
- 3.0 T MRI including DW-MRI (b values 0-2000 sec/mm²).
- Analysis of apparent diffusion coefficient (ADC), kurtosis-derived ADC (D_app), and apparent kurtosis coefficient (K_app) using logistic mixed models and ROC analysis.
Main Results:
- Malignant lesions showed significantly lower ADC and D_app, and higher K_app compared to benign lesions (P < .05 for all).
- The area under the receiver operating characteristic curve (AUC) for K_app (0.85) was significantly higher than for ADC (0.78) (P = .047).
- K_app demonstrated superior performance in discriminating malignant from benign ovarian lesions.
Conclusions:
- Quantitative diffusion kurtosis MRI metrics, particularly K_app, offer superior diagnostic performance over ADC for classifying ovarian lesions.
- Diffusion kurtosis MRI may enhance clinical decision-making, especially for patients with contraindications to contrast agents.
