Comparison of Qualitative (Time Intensity Curve Analysis), Semi-Quantitative, and Quantitative Multi-Phase 3T DCEMRI Parameters as Predictors of Malignancy in Adnexal

Document Type : Research Articles


1 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.

2 Neuroimaging and Analysis Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran.

3 Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.


Objective: The present study aimed to compare the qualitative (time intensity curve analysis), the semi-quantitative
and the quantitative multiphase 3T dynamic contrast-enhanced (DCE) MRI parameters as predictors of malignancy
in adnexal masses. Materials and Methods: In this prospective study, women with an adnexal mass who were
scheduled for surgical resection or were followed for more than one year period to confirm the benignity of their
lesions, underwent multiphase 3T DCE-MRI. The qualitative (time intensity curve), semi-quantitative (SImax, SIrel,
WIR) and quantitative (Ktrans, Kep, Vb) analyses were performed on DCE-MRI sequences and their predictive values
were compared. Results: A total of 17 benign and 14 malignant lesions were included. According to the qualitative
analysis, none of the lesions with Type I time intensity curves (TIC) were malignant and none of the masses with Type
III TICs were benign. The accuracy of the quantitative parameters in detection of malignancy was found to be higher
than that of semi-quantitative variables, particularly when calculated for a small ROI within the high signal area of the
mass (sROI) rather than the largest ROI including the whole mass (lROI), and when inter-MRI variations were omitted
using ratios. The Kep(tumor)/Kep(myometrium) ratio measured from sROI was the best parameter for differentiating
a malignant lesion with a sensitivity of 100% and a specificity of 92.3%. Conclusion: We concluded that a Type I TIC
confirms a benign lesion, and a type III TIC confirms the malignancy and further evaluation is not recommended for
these lesions. So complementary quantitative analysis is only recommended for adnexal masses with type II TICs.


Main Subjects