Comparison of Qualitative (Time Intensity Curve Analysis), Semi-Quantitative, and Quantitative Multi-Phase 3T DCEMRI Parameters as Predictors of Malignancy in Adnexal

Abstract

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