Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Gynecological Masses

Background: Diffusion-weighted MRI has potential for tissue differentiation, including cancer. It can also determine cancer histologic type. The ADC value reflects tumor cellular density, allowing tumor grading evaluation. This study aims to assess the role of DW-MRI in gynecological masses.

Methods: This prospective cross-sectional research was conducted on 30 female patients between the ages of 20 and 75 who were sent from the gynaecological department to the Radio diagnostic and Medical Imaging department at Tanta University hospitals. All patients gave their informed permission in writing. We included patients with clinically or sonographically suspected uterine and cervical lesions. Patients having indeterminate ultrasonography criteria for adnexal lesions.

Results: Resistance Index (RI) showed significant predictive value of the malignant masses (p=0.13), with an area under curve (AUC) of 0.84. An RI cutoff value of ≥0.365 could predict malignant masses with a sensitivity of 81.8% and specificity of 87.5%. T ROC curve analysis to assess the validity of ADC to discriminate malignant masses is illustrated. ADC values showed significant predictive value of the malignant masses (p<0.001*), with an area under curve (AUC) of 0.89. An ADC cutoff value of ≤1 could predict malignant masses with a sensitivity of 85.7% and specificity of 89.5%.

Conclusions: Combined ultrasound and MRI examination produced radiologic findings with 98 percent sensitivity, 92.9 percent specificity, 95 percent positive predictive value, and 97 percent negative predictive value when compared to the final pathologic diagnosis. The research indicated that DWI and ADC mapping are excellent imaging methods for discriminating benign from malignant tumours with a high degree of sensitivity and specificity. However, their effectiveness and benefits depend on a precise diagnosis of the lesions' essential features, such as their origin, size, and composition, as assessed by ultrasound and standard MRI tests.