Title: Role of Diffusion Weighted MR Imaging in Adnexal lesions in Female Pelvis A Prospective study
Authors: Dr Rajasri.B, Dr Hanumath Prasad.V, Dr Shanthi Sree.V
DOI: http://dx.doi.org/10.18535/jmscr/v4i9.61
Aims &objectives: 1) MRI criteria for accurate diagnosis of adnexal lesions 2) Differentiating MR features for benign from suspicious malignant lesions. 3) Defining the potentiality of DWI in the characterization of complex adenexalmasses. Summary: The final diagnosis of the 56 patients included in the study was based on biopsy and histopathological verification in 37 patients (58.7%). The other patients were diagnosed by the characteristic MRI features, and follow up by monitoring clinical response to medical treatment (41.2%) The 6 patients diagnosed to have torsion of pedicle were later proven surgically. All the patients diagnosed with benign and malignant ovarian neoplasms were histopathologically proven. All the patients having tuberculoustubo-ovarian abcesses were pathologically proven. All the patients diagnosed as borderline ovarian neoplasms were pathologically proven. All the patients with endometriomas showed characteristic MRI features. All the patients with extraovarian pathologies were improving on medical treatment. Followup in majority of cases did not reveal any recurrence/complications. Conclusions: Sonographically indeterminate adenexal masses of solid or complex cystic content benefit from further evaluation with MRI, which is highly accurate for identifying the origin of a mass and characterising its tissue content, obviating surgery in many cases. The role of DWI in distinguishing between benign and malignant cystic tumors is limited and the ADC values calculated from the DWI will add useful information to the differential diagnosis especially ovarian cystic masses. An adenexal mass with no restricted diffusion usually is a benign lesion, however information derived from images obtained with other sequences will be helpful. Pitfalls were noted in some Ovarian cystic lesions with water diffusion restriction in cases of Abscess,mature cystic teratomas, endometriotic cysts. All malignant ovarian lesions are always restricted in the DWI with ADC values less than 0.5. DWI provides supplemental information in patients with gynecological disorders and could easily be incorporated into standard clinical protocols utilizing MRI, corroborating with histopathological findings. Keywords: Adnexal masses, Indeterminate lesions, Diffusion weighted Imaging, Magnetic Resonance Imaging. 1. Pooley RA.AAPM/RSNA physics tutorial for residents: fundamental physics of MR imaging.Radiographics.2005;25(4):1087-99 2. KohDM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol2007; 188: 1622–1635. 3. Le Behan D.molecular diffusion nuclear magnetic resonance imaging. Mag Reson Q 1991;7:1-30 4. Le BihanD, BertonE, Lallemand D, Aubin ML,ViignaudJ,Laval-jeantetM.Seperation of diffusion and perfusion in intravoxel incoherent motion MR imaging.Radiology 1988;168:497-505 5. Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T. Diffusion-weighted MR imaging with a single-shot echoplanar sequence: detection and characterization of focal hepatic lesions. AJR Am J Roentgenol 1998; 170: 397–402. 6. Yamada I, Aung W, Himeno Y, Nakagawa T, Shibuya H. Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 1999; 210: 617–623. 7. Thomassin-Naggara I, Fournier LS, Roussel A, Marsault C, Bazot M: IRM de diffusion et pelvis feminin. J Radiol, 91: 431-440, 2010. 8. Thomassin-Naggara I, Touissant I, Perrot N, Rouzier R, Cuenod CA, Bazot M, Darai E: Characterization of complex adnexal masses: value of adding perfusion- 89 and diffusion- weighted MR imaging to conventional MR imaging. Radiology, 258: 793-803, 2011. 9. Salvatore Cappabianca, Francesco Laselli, Alfonso Reginelli, AlfredoD’Andrea, Fabrizio Urraro, Roberto Grassi and Antonio Rotondo; value of Diffusion-weighted magnetic resonance imaging in the charecterization of complex adenexal masses,99:210-217,2013. 10. GriffinN, Grant LA, Sala E:Adenexal masses: charecterization and imaging strategies. Semin ultrasound CT MRI, 31:330-346,2010.Abstract
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