DIAGNOSTIC POTENTIAL OF DIFFUSION WEIGHTED MRI IN DIFFERENTIATING BENIGN FROM MALIGNANT OVARIAN MASSES AND CORRELATING WITH HISTOPATHOLOGY

Abstract

Background: Ovarian masses are one of the rising causes of mortality among women worldwide and remains a cause for concern because of its poor outcomes. This warrants accurate pre-operative differentiation of benign and malignant ovarian masses. This can be achieved with diffusion weighted imaging (DWI) and Apparent diffusion coefficient (ADC) values, thereby aiding in planning of appropriate treatment strategies. Aims and Objectives: Aims and objectives of this study were to evaluate morphology of the ovarian masses, to differentiate benign from malignant ovarian masses with DWI/ADC values and to correlate combined Magnetic Resonance Imaging (MRI) & DWI/ADC results with histopathological findings. Material and Methods: This prospective observational study was conducted from January 2019 to June 2020 on 32 patients with clinically suspected or sonographically diagnosed ovarian masses who underwent MRI Pelvis. Baseline data, imaging findings on MRI & DWI/ADC were recorded and compared with histopathological diagnosis. Results: A total of 32 patients were included in the study. Conventional MRI showed specificity of 84.2%, positive predictive value of 81.25% and overall diagnostic accuracy of 90.6% in characterising ovarian masses. Similarly, diffusion weighted imaging with corresponding ADC values showed specificity of 78.9%, positive predictive values of 76.47% and overall diagnostic accuracy of 87%. XV Using an ADC cut off value of 1.23 x 10-3mm2/s, the mean ADC values for benign and malignant ovarian masses showed statistical significance (p<0.001). Combined analysis of both Conventional MRI and DWI/ADC showed a significant increase in specificity, positive predictive value and diagnostic accuracy to 94.7%, 92.86% and 96.88% respectively. Conclusion: Diffusion weighted imaging plays a pivotal role in characterizing benign and malignant ovarian masses with high diagnostic accuracy and should be added to the routine MRI protocol. We recommend an optimal ADC cut off of 1.23 x 10-3 mm2/s to differentiate benign from malignant ovarian masses.