Apparent diffusion coefficient analysis of solid tissue helps distinguish borderline from invasive malignant adnexal masses rated O-RADS MRI 4

Rimeh Bourourou ¹, Stephanie Nougaret ², Andrea Rockall ³

⁰Assistance Publique-Hôpitaux de Paris, Department of Imaging and Interventional Radiology, Hôpital Tenon, 75020, Paris, France.

Diagnostic and Interventional Imaging +

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June 15, 2024

View abstract on PubMed

Summary

Apparent diffusion coefficient (ADC) analysis of solid tissue in adnexal masses aids in distinguishing invasive tumors. This method refines risk stratification within the O-RADS MRI 4 category, particularly for mixed or mural nodule masses.

Area Of Science

Radiology
Oncology
Medical Imaging

Background

Adnexal masses require accurate characterization to differentiate benign from malignant conditions.
The O-RADS MRI scoring system aids in risk stratification, but further optimization is needed for indeterminate lesions.

Purpose Of The Study

To evaluate the utility of apparent diffusion coefficient (ADC) measurements of solid tissue in adnexal masses.
To enhance tumor characterization and refine risk stratification within the O-RADS MRI category 4.

Main Methods

Retrospective analysis of the EURAD cohort including 180 women with adnexal masses.
Independent ADC measurements of solid tissue by two radiologists, excluding artifacts and necrotic areas.
Receiver operating characteristic (ROC) curve analysis to determine the optimal ADC cutoff for invasive vs. non-invasive tumors.

Main Results

Median ADC values differed significantly between benign, borderline, and invasive masses.
In masses with mixed or mural nodule components, invasive lesions showed significantly lower ADC values (0.830 × 10<sup>-3</sup> mm<sup>2</sup>/s) compared to benign and borderline masses.
An ADC cutoff of 1.08 × 10<sup>-3</sup> mm<sup>2</sup>/s demonstrated 71.4% sensitivity and 100% specificity for identifying invasive lesions in the mixed/mural nodule subgroup (AUC 0.92).

Conclusions

ADC analysis of solid tissue is a valuable tool for distinguishing invasive adnexal masses.
This technique is particularly effective in refining the O-RADS MRI 4 category for mixed masses or those with mural nodules.

Keywords:

Adnexal masses MRI O-RADS Ovarian lesions Stratification