Apparent diffusion coefficient analysis of solid tissue helps distinguish borderline from invasive malignant adnexal masses rated O-RADS MRI 4.

The purpose of this study was to evaluate the contribution of apparent diffusion coefficient (ADC) analysis of the solid tissue of adnexal masses to optimize tumor characterization and possibly refine the risk stratification of the O-RADS MRI 4 category. The EURAD cohort was retrospectively analyzed to select all patients with an adnexal mass with solid tissue and feasible ADC measurements. Two radiologists independently measured the ADC values of solid tissue, excluding necrotic areas, surrounding structures, and magnetic susceptibility artifacts. Significant differences in diffusion quantitative parameters in the overall population and according to the morphological aspect of solid tissue were analyzed to identify its impact on ADC reliability. Receiver operating characteristics curve (ROC) was used to determine the optimum cutoff of the ADC for distinguishing invasive from non-invasive tumors in the O-RADS MRI score 4 population. The final study population included 180 women with a mean age of 57 ± 15.5 (standard deviation) years; age range: 19-95 years) with 93 benign, 23 borderline, and 137 malignant masses. The median ADC values of solid tissue was greater in borderline masses (1.310 × 10 ADC analysis of solid tissue of adnexal masses could help distinguish invasive masses within the O-RADS MRI 4 category, especially in mixed masses or those with mural nodule.

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Declaration of competing interest RB. No relevant relationships; S.N. No relevant relationships; A.R. NIHR grants to institutions;travel/accomodation/meeting expenses unrelated to activities listed from Gerbet/European Society of Radiology; M.B. No relevant relationships; L.R: No relevant relationships; I.T.N. Education learning Payment from Centre de Formation en imagerie médicale de la Société Francaise de Radiologie; payment for lectures and Advisory board from General Electric Healthcare, Hologic, Canon, Guerbet, Bracco, Bayer, Incepto and Siemens Healthcare; payment for development of educational presentations from CFIM and ESOR/ERASMUS,travel/accomodation/meeting expenses unrelated to activities listed from General Electric Healthcare.