COMPARISON OF QUALITATIVE (TIME INTENSITY CURVE ANALYSIS), SEMI-QUANTITATIVE AND QUANTITATIVE MULTIPHASE 3T DCE- MRI PARAMETERS AS PREDICTORS OF MALIGNANCY IN ADNEXAL MASSES

Objective:
The present study aimed to compare the qualitative
(time intensity curve analysis), semi-quantitative and quantitative multiphase 3T dynamic contrast- enhanced (DCE) MRI parameters as predictors of malignancy in adnexal masses.
 
Materials and Methods:
In this prospective study, women with an adnexal mass who were scheduled for surgical resection or were followed for more than one year to confirm benignity of their lesions, underwent multiphase 3T DCE-MRI. Qualitative (time intensity curve), semi- quantitative (SImax, SIrel, WIR) and quantitative (Ktrans, Kep, Vb) analyses were performed on DCE- MRI sequences and their predictive values were compared.
 
Results:
A total of 17 benign and 14 malignant lesions were included. According to qualitative analysis, none of the lesions with type I time intensity curves (TIC) were malignant and none of the masses with type  III TICs were benign. The accuracy of quantitative parameters in detection of malignancy was found to be higher than that of semi-quantitative variables, particularly when calculated for a small ROI within a high signal area of the mass (sROI) rather than  the largest ROI including the whole mass (lROI), and when inter-MRI variations were omitted using ratios. The Kep(tumor)/Kep(myometrium) ratio measured from an sROI was the best parameter for differentiating a malignant lesion with a sensitivity of 100% and a specificity of 92.3%. Conclusion:
We concluded that a type I TIC confirms a benign lesion, and a type III TIC confirms malignancy and further evaluation is not recommended for these lesions. So complementary quantitative analysis is only recommended for adnexal masses with type II TICs.