OVARIAN CANCER STAGING: COMPARISON BETWEEN DIFFUSION-WEIGHTED MRI AND MULTISPIRAL COMPUTED TOMOGRAPHY
Abstract
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.
About the Authors
A. E. Solopova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
PhD in Medical sciences, Associate Professor of Chair of Radiology and Radiotherapy, Faculty of Medicine, I.M. Sechenov First MSMU. Address: 8/2 Trubetskay st., 119991 Moscow, Russia
S. K. Ternovoi
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
Grand PhD in Medical Science, Professor, Fellow of the Russian Academy of Sciences, head of Chair of Radiology and Radiotherapy, Faculty of Medicine, I.M. Sechenov First MSMU. Address: 8/2 Trubetskay st., 119991 Moscow, Russia. Phone number: +7(499)2487791
V. I. Alipov
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
student of Faculty of Medicine, I.M. Sechenov First MSMU. Postal address: 2-4 Bolshaya Pirogovskaya st., 119048 Moscow, Russia
A. D. Makatsariya
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
Grand PhD in Medical Science, Professor, corresponding member of the Russian Academy of Sciences, head of Chair of Obstetrics and Gynecology, Faculty of Medicine, I.M. Sechenov First MSMU. Postal address: 8/2 Trubetskay st., 119048 Moscow, Russia. Phone number: +7(495)7885840
References
1. Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015; 65 (1): 5-29.
2. Jayson G.C., Kohn E.C., Kitchener H.C., Ledermann J.A. Ovarian cancer. Lancet. 2014; 384: 1376-88.
3. Kurman R.J., Shih I.M. Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer-shifting the paradigm. Hum Pathol. 2011; 42 (7): 918-31.
4. Eddie S.L., Quartuccio S.M, У hainmhir E., et al. Tumorigenesis and peritoneal colonization from fallopian tube epithelium. Oncotarget. 2015; 6 (24): 20500-12.
5. Solopova A.E., Chashchin A.A., Solopova A.G., Makatsariya A.D. Akusherstvo, ginekologiya i reproduktsiya / Obstetrics, gynecology and reproduction. 2016; 10 (1): 75-83.
6. Kandukuri S.R., Rao J. FIGO 2013 staging system for ovarian cancer: what is new in comparison to the 1988 staging system. Curr Opin Obstet Gynecol. 2015; 27: 48-52.
7. Mann J.W., Chalas E., Valea F.A. Cancer of the ovary, fallopian tube, and peritoneum: staging and initial management. URL: www.UpToDate.com (2015). Accessed: 19.01.2016.
8. Ledermann J.A., Raja F.A., Fotopoulou C., et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24: 24-32.
9. Chang S.J., Hodeib M., Chang J., Bristow R.E. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis. Gynecol Oncol. 2013; 130 (3): 493-8.
10. Suidan R.S., Ramirez P.T., Sarasohn D.M., et al. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to
11. predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol. 2014; 134 (3): 455-61.
12. Kyriazi S., Kaye S.B., Desouza N.M. Imaging ovarian cancer and peritoneal metastases-current and emerging techniques. Nat Rev Clin Oncol. 2010; 7 (7): 381-93.
13. Coakley F.V., Choi P.H., Gougoutas C.A., et al. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology. 2002; 223 (2): 495-9.
14. Tempany C.M., Zou K.H., Silverman S.G., Brown D.L., Kurtz A.B., Mcneil B.J. Staging of advanced ovarian cancer: comparison of imaging modalities-report from the Radiological Diagnostic Oncology Group. Radiology. 2000; 215 (3): 761-7.
15. Espada M., Garcia-Flores J.R., Jimenez M., et al. Diffusion-weighted magnetic resonance imaging evaluation of intra-abdominal sites of implants to predict likelihood of suboptimal cytoreductive surgery in patients with ovarian carcinoma. Eur Radiol. 2013; 23: 2636-2642.
16. Mukuda N., Fujii S., Inoue C., et al. Apparent diffusion coefficient (ADC) measurement in ovarian tumor: Effect of region-of-interest methods on ADC values and diagnostic ability. J Magn Reson Imaging. 2016; 43 (3): 720-5.
17. Solopova A.E., Ternovoi S.K., Makatsariya A.D., Gurov S.N. REJR. 2016; 6 (4): 68-80.
18. Gelezhe P.B., Trofimenko I.A., Morozov S.P. The basics of whole-body diffusion- weighted imaging interpretation. REJR. 2015; 5 (3): 65-73.
19. Sugarbaker P.H. Comprehensive management of peritoneal surface malignancy using cytoreductive surgery and perioperative intraperitoneal chemotherapy: the Washington Cancer Institute approach. Expert Opin Pharmacother. 2009; 10 (12): 1965-77.
20. Coffey J.C., O'Leary D.P., The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol. 2016; 1: 238-47
21. Mizumoto A., Canbay E., Hirano M., et al. Morbidity and mortality outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a single institution in Japan. Gastroenterol Res Pract. 2012; 2012: 836425.
22. Casado-adam A., Alderman R., Stuart O.A., Chang D., Sugarbaker P.H. Gastrointestinal complications in 147 consecutive patients with peritoneal surface malignancy treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. Int J Surg Oncol. 2011; 2011: 468698.
23. Low R.N., Barone R.M., Lucero J. Comparison of MRI and CT for predicting the Peritoneal Cancer Index (PCI) preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol. 2015; 22 (5): 1708-15.
24. Michielsen K., Vergote I., Op de beeck K., et al. Whole-body MRI with diffusion- weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol. 2014; 24 (4): 889-901.
25. Oh J.W., Rha S.E., Oh S.N., Park M.Y., Byun J.Y., Lee A. Diffusion-weighted MRI of epithelial ovarian cancers: correlation of apparent diffusion coefficient values with histologic grade and surgical stage. Eur J Radiol. 2015; 84 (4): 590-5.
For citation:
Solopova A.E., Ternovoi S.K., Alipov V.I., Makatsariya A.D. OVARIAN CANCER STAGING: COMPARISON BETWEEN DIFFUSION-WEIGHTED MRI AND MULTISPIRAL COMPUTED TOMOGRAPHY. Obstetrics, Gynecology and Reproduction. 2017;11(1):19-25. (In Russ.) https://doi.org/10.17749/2313-7347.2017.11.1.019-025
Views: 185
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 