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Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT

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Abstract

Objectives

To evaluate whole-body MRI with diffusion-weighted sequence (WB-DWI/MRI) for staging and assessing operability compared with CT and FDG-PET/CT in patients with suspected ovarian cancer.

Methods

Thirty-two patients underwent 3-T WB-DWI/MRI, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and CT before diagnostic open laparoscopy (DOL). Imaging findings for tumour characterisation, peritoneal and retroperitoneal staging were correlated with histopathology after DOL and/or open surgery. For distant metastases, FDG-PET/CT or image-guided biopsies were the reference standards. For tumour characterisation and peritoneal staging, WB-DWI/MRI was compared with CT and FDG-PET/CT. Interobserver agreement for WB-DWI/MRI was determined.

Results

WB-DWI/MRI showed 94 % accuracy for primary tumour characterisation compared with 88 % for CT and 94 % for FDG-PET/CT. WB-DWI/MRI showed higher accuracy of 91 % for peritoneal staging compared with CT (75 %) and FDG-PET/CT (71 %). WB-DWI/MRI and FDG-PET/CT showed higher accuracy of 87 % for detecting retroperitoneal lymphadenopathies compared with CT (71 %). WB-DWI/MRI showed excellent correlation with FDG-PET/CT (κ = 1.00) for detecting distant metastases compared with CT (κ = 0.34). Interobserver agreement was moderate to almost perfect (κ = 0.58–0.91).

Conclusions

WB-DWI/MRI shows high accuracy for characterising primary tumours, peritoneal and distant staging compared with CT and FDG-PET/CT and may be valuable for assessing operability in ovarian cancer patients.

Key Points

• Whole-body MRI with diffusion weighting (WB-DWI/MRI) helps to assess the operability of suspected ovarian cancer.

• Interobserver agreement is good for primary tumour characterisation, peritoneal and distant staging.

• WB-DWI/MRI improves mesenteric/serosal metastatic spread assessment compared with CT and FDG-PET/CT.

• Retroperitoneal/cervical-thoracic nodal staging using qualitative DWI criteria was reasonably accurate.

• WB-DWI/MRI and FDG-PET/CT showed the highest diagnostic impact for detecting thoracic metastases.

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Abbreviations

WB-DWI/MRI:

whole-body MRI with diffusion-weighted sequence

DOL:

diagnostic open laparoscopy

PC:

peritoneal carcinomatosis

FIGO:

International Federation of Gynaecology and Obstetrics

NACT:

neoadjuvant chemotherapy

CA:

cancer antigen

MPR:

multiplanar reformatting

TSE:

turbo spin-echo

SI:

signal intensity

PPV:

positive predictive value

NPV:

negative predictive value

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Acknowledgments

This research was supported by the Belgian Foundation against Cancer (Stichting Tegen Kanker – Fondation Contre le Cancer).

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Authors and Affiliations

  1. Department of Radiology, Medical Imaging Research Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Katrijn Michielsen, Katya Op de beeck, Steven Dymarkowski, Frederik De Keyzer & Vincent Vandecaveye

  2. Department of Obstetrics and Gynaecology, Leuven Cancer Institute, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Ignace Vergote, Frederic Amant & Karin Leunen

  3. Department of Morphology and Molecular Pathology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Philippe Moerman

  4. Department of Nuclear Medicine, Medical Imaging Research Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Christophe Deroose

  5. Department of Radiology, Jessa Ziekenhuis – Campus Virga Jessa, Stadsomvaart 11, 3500, Hasselt, Belgium

    Geert Souverijns

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  1. Katrijn Michielsen
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Correspondence to Vincent Vandecaveye.

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Supplementary Table

Comparative per-site accuracy for WB-DWI/MRI, CT and FDG-PET/CT (DOCX 36.8 kb)

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Michielsen, K., Vergote, I., Op de beeck, K. et al. Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol 24, 889–901 (2014). https://doi.org/10.1007/s00330-013-3083-8

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  • DOI: https://doi.org/10.1007/s00330-013-3083-8

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