OVARIAN CANCER STAGING: COMPARISON BETWEEN DIFFUSION-WEIGHTED MRI AND MULTISPIRAL COMPUTED TOMOGRAPHY

The aim is to evaluate the diagnostic potential of the diffusion-weighted MRI sequences (DW-MRI) as compared with multi-spiral computed tomography (MSCT) for staging of ovarian malignancies (OVM).

Materials and Methods. The study was conducted (from February to December 2016) on 73 patients with suspected ovarian malignancies who underwent preoperative examination, including abdominal / pelvic MSCT and DW-MRI, using a 1.5T scanner with b-factors of 0.1000 s/mm2 and the calculation of apparent diffusion coefficient (ADC). Using the obtained data, the peritoneal cancer index (PCI) was calculated and ROC curves for DW-MRI vs MSCT were created. The imaging-based diagnoses were then compared with surgical staging and histopathological examination.

Results. The following stages of OVM were determined: 5 (6.8%) IV; 35 (47.9%) IIIC; 23 (31.5%) IIIB; 10 (13.6%) IIIA. The overall sensitivity was 55% for MSCT and 77% for DW-MRI. For example, DW-MRI was markedly superior to MSCT in detecting a tumor implantation into the large intestine mesentery (83.8% and 37.8%, respectively), into the small intestine serosa (77.8% and 28.9%), and the para-aortic lymph nodes (71.4 and 35.7%). The specificity of the compared imaging modalities was similar (79.6% – DW-MRI and 81% – MSCT). The peritoneal cancer index (PCI) calculated from the DW-MRI results correlated with the surgical staging data better than the PCI based on MSCT (r=0.706 for DW-MRI, r=0.544 for MSCT). Based on the obtained data, the ROC curves were plotted to show the areas under the curves of 0.913 and 0.655 for DW-MRI and MSCT, respectively. A decrease in the ADC values was found in secondary tumor foci (1.120±0.25 for the ovaries, 0.820±0.23 for the omentum, 0.790±0.19Ч10-3 mm2/s for peritoneal implants).

Conclusion. For the assessment of ovar-ian cancer spread, DW-MRI is significantly more sensitive than MSCT.

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