# Diagnostic value of magnetic resonance imaging for malignant ovarian tumors mis-subclassified by the ultrasound-based ADNEX model

## TL;DR

This study evaluates how MRI can help diagnose ovarian tumors that were misclassified by ultrasound-based models, showing MRI features can improve accuracy.

## Contribution

The study introduces MRI-based features as a supplementary diagnostic tool for tumors misclassified by the ADNEX ultrasound model.

## Key findings

- MRI features like ADC values and enhancement patterns significantly differ between primary and metastatic ovarian tumors.
- DWI signal, ADC value, and enhancement on MRI can help correctly classify 90.2% of misclassified malignant ovarian tumors.
- Clear cell carcinoma showed distinct ADC values compared to other tumor types.

## Abstract

Accurately predicting metastatic cancer to the adnexa, stage I and advanced ovarian cancer before surgery is crucial. The ADNEX model, based on ultrasound, is currently the only prediction model that can differentiate between these types. This study aims to analyze MRI features and diagnostic value in malignant ovarian tumors mis-subclassified by the ADNEX model, considering their diverse histopathologic types.

From January 2018 to September 2022, 164 patients with pathologically confirmed ovarian malignancies were selected from those who were examined by ultrasound. The clinical and MRI characteristics of 51 patients mis-subclassified by the ADNEX model were compared with histopathological types.

A total of 30 were confirmed with primary ovarian cancer (5 with HGSOC, 14 with CCC, 2 with EC, 4 with MC, 2 with GCT, 1 with YST, 1 with immature teratoma, and 1 with dysgerminoma). There were 21 patients who had metastatic ovarian tumors (10 with colorectal cancer, 4 with gastric cancer, 2 with uterine cervical cancer, 3 with endometrial cancer, 1 with breast cancer, and 1 with LAMN). The only significant difference between the two groups was in CEA. The mean diameters of the primary and metastatic ovarian tumors were 10.29 cm (range: 3.61 cm–26.02 cm) and 8.58 cm (range: 3.10 cm–20.30 cm), respectively. A total of 42 masses were lobulated (82.35%, 42/51), and 26 masses were solid-cystic (26/51, 50.98%). There was a significant difference between CCC and other tumors, with mean ADC values of 1.01 × 10−3 mm2/s (range: 0.68–1.28×10−3 mm2/s) and 0.74×10−3 mm2/s (range: 0.48–0.99×10−3 mm2/s), respectively (P=0.000). A total of 50 masses presented isointense-T1, hyperintense-T2, and hyperintense-DWI signal on MRI (50/51,98.04%). There were 33 masses that showed intensive enhancement (33/51,64.71%). There were 17 masses who had necrosis (17/51, 33.33%), with the majority being HGSOC and ovarian metastases from colorectal and gastric cancers (12/17, 70.59%). There were 19 masses that presented hemorrhage (19/51,37.25%), with the majority being CCC (10/19, 52.63%). A total of 46 masses were diagnosed correctly by MRI (46/51,90.20%). There were 35 and 15 masses that were rated as O-RADS score 5 and score 4, respectively. One mass was rated as score 3.

DWI signal, ADC value, degree of enhancement, and characteristic components within the mass on MRI can provide supplementary information for malignant ovarian tumors mis-subclassified by the ADNEX model.