Rationale and Objectives
To investigate the value of magnetic resonance imaging (MRI) including diffusion-weighted
imaging (DWI) findings in predicting mesenchymal transition (MT) high-grade serous
ovarian cancer (HGSOC).
Materials and Methods
Patients with HGSOC were enrolled from May 2017 to December 2020, who underwent pelvic
MRI including DWI (b = 0,1000 s/mm2) before surgery, and were assigned to the MT HGSOC or non-MT HGSOC group according
to histopathology results. Clinical characteristics and MRI features including DWI-based
histogram metrics were assessed and compared between the two groups. Univariate and
multivariate analyses were performed to identify the significant variables associated
with MT HGSOC – these variables were then incorporated into a predictive nomogram,
and ROC curve analysis was subsequently carried out to evaluate diagnostic performance.
Results
A total of 81 consecutive patients were recruited for pelvic MRI before surgery, including
37 (45.7%) MT patients and 44 (54.3%) non-MT patients. At univariate analysis, the
features significantly related to MT HGSOC were identified as absence of discrete
primary ovarian mass, pouch of Douglas implants, ovarian mass size, tumor volume,
mean, SD, median, and 95th percentile apparent diffusion coefficient (ADC) values
(all p < 0.05). At multivariate analysis, the absence of discrete primary ovarian mass {odds
ratio (OR): 46.477; p = 0.025}, mean ADC value ≤ 1.105 (OR: 1.023; p = 0.009), and median ADC value ≤ 1.038 (OR: 0.982; p = 0.034) were found to be independent risk factors associated with MT HGSOC. The
combination of all independent criteria yielded the largest AUC of 0.82 with a sensitivity
of 83.87% and specificity of 66.67%, superior to any of the single predictor alone
(p ≤ 0.012). The predictive C-index nomogram performance of the combination was 0.82.
Conclusion
The combination of absence of discrete primary ovarian mass, lower mean ADC value,
and median ADC value may be helpful for preoperatively predicting MT HGSOC.
Key Words
Abbreviations:
ADC (Apparent diffusion coefficient), AUC (Areas under the receiver operating characteristics curve), CI (Confidence interval), DWI (Diffusion weighted imaging), FIGO (International of Gynecology and Obstetrics), HGSOC (High-grade serous ovarian cancer), ICC (Interclass correlation coefficient), MT (Mesenchymal transition), NACT/IDS (neoadjuvant chemotherapy followed by interval debulking surgery), ROC (Receiver operating characteristics), SD (Standard deviation), VOI (Volumes of interest)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 28, 2022
Accepted:
June 26,
2022
Received in revised form:
June 24,
2022
Received:
March 30,
2022
Footnotes
Competing Interests: The authors have no potential conflicts of interest to disclose.
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
