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Differentiation of Endometriomas from Hemorrhagic cysts at Magnetic Resonance: The Role of Quantitative Signal Intensity Measurements

Author(s):

Roxana-Adelina Lupean*, Paul-Andrei Ștefan, Andrei Lebovici, Csaba Csutak, Georgeta Mihaela Rusu and Carmen Mihaela Mihu   Pages 1 - 9 ( 9 )

Abstract:


Background: Endometriomas and functional hemorrhagic cysts (FHCs) are a common gynecological encounter.

Objective: To assess the diagnostic efficiency of magnetic resonance imaging (MRI) using signal intensity measurements in differentiating endometriomas from FHCs.

Methods: Forty-six patients who underwent pelvic MRI examinations (endometriomas, n=28; FHCs, n=18) were retrospectively included. The “T2 shading” sign was evaluated subjectively and quantitatively by measuring the T1-T2 signal intensity difference and by calculating the percentage of signal decrease between T1 and T2-weighted sequences. The resulted values, along with the measurement of the apparent diffusion coefficient (ADC) and the signal intensity on three diffusion-weighted sequences (DWI) (b50, b400 , and b800), were compared between groups by consuming the Mann–Whitney U test. Also, the receiver operating characteristic analysis was performed for the statistically significant results (P<0.016), and the area under the curve (AUC) was calculated.

Results: The two quantitative assessment methods showed similar efficiency in detecting endometriomas (P<0.001; sensitivity, 100%; specificity, 81.82%; AUC>0.86), outperforming the classic subjective evaluation of the “T2 shading” sign (sensitivity, 92.86%; specificity, 66.67%). ADC (P=0.52) and DWI measurements (P=0.49, P=0.74, and P=0.78) failed to distinguish between the two entities.

Conclusion: The quantitative analysis and interpretation of the "T2 shading" sign can significantly improve the differential diagnosis between endometriomas and FHCs.

Keywords:

apparent diffusion coefficient (ADC), diffusion-weighted imaging, endometrioma, endometriosis, magnetic resonance imaging (MRI), ovarian cyst.

Affiliation:

Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy; Louis Pasteur street, number 4, Cluj-Napoca, 400349, Cluj,, Anatomy and Embryology, Morphological Sciences Department, “Iuliu Haţieganu” University of Medicine and Pharmacy; Victor Babeș street, number 8, Cluj-Napoca, 400012, Cluj,, Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj,, Radiology, Surgical Specialties Department, “Iuliu Haţieganu” University of Medicine and Pharmacy; Clinicilor street, number 3-5, Cluj- Napoca, 400006, Cluj,, Radiology, Surgical Specialties Department, “Iuliu Haţieganu” University of Medicine and Pharmacy; Clinicilor street, number 3-5, Cluj- Napoca, 400006, Cluj,, Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy; Louis Pasteur street, number 4, Cluj-Napoca, 400349, Cluj



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