Role of Adding Diffusion-Weighted MR Imaging to Conventional MR Imaging in Evaluation of Ovarian Masses

Abstract Background: Ovarian cancer is a leading cause of death among gynecological malignancies and the fifth most common cause of cancer deaths in women. Aim of Study: To determine whether the addition of DW sequences to a conventional MR imaging protocol can help in the prediction of the nature of suspicious ovarian masses which are detected previously by conventional ultrasound. Patients and Methods: Thirty-five female patients with initial undetermined ovarian lesions were included in this study during the period from December 2019 to September 2020. Women who present with an ovarian mass on previous US examination and were referred to the Radiology Department of Alexandria Main University Hospital and Radiology De-partment of Ain Shams University Hospitals for further assessment and characterization by MRI imaging with adding DW-MR imaging Sequence. Results: In the current study, the mean patient age was 41.00±13.37 years. 17 (48.57%) of 35 ovarian masses were benign, and 12 (34.29%) were malignant, and 6 (17.14%) were borderline. Diffusion-weighted MRI findings of the different histopathological types showed restricted diffusion in 83.3% of borderline lesions and 91.7% of malignant lesions while only 17.6% of benign lesions showed restriction diffusion with a statistically significant difference at p-value 0.025*. DWI had shown 91.7% sensitivity and low specificity 82.4%. Combined DWI and conventional MRI sequences had the highest accuracy 93.1%, and sensitivity at 95.3%. Conclusion: Our results concluded that the DWI can help and increase the confidence of MRI in assessment or exclude potential malignancy in ovarian masses.