OVARY

Technique

Level of
evidence1!

Single centre/
Multicentre/
metaanalysis

Indication

Patient prep

Data acquisition
requirements

Image processing
algorithm

Recommended
biomarkers/
primary end-point

RECIST 1.1 combined with CA 125

 

 

511!

Consensus

Response to systemic treatment

No

CE-CT

Manual documentation by trained observer

Recommended biomarkers/
secondary end-point

Morphology (solid-cystic mass, papillary projections, etc.)

12-3!

Multicentre-IOTA

Differentiate benign from malignant

IM antiperistaltic agent

High resolution T2, standard T1 and T1 FS, T1 FS with gadolinium

Manual documentation by trained observer

Dynamic contrast uptake pattern

34-7!

Single centre

Differentiate benign from malignant

IM anitperistaltic agent

Temporal resolution < 15 sec

Construction of time-intensity-curves comparing

DWI (visual)

38!

Single centre

Diagnosis and staging

1L pineapple juice
IM antiperistaltic agent

At least 2 b-values (b=0-50 and b=800-1000 s/mm2)

Manual documentation by trained observer

Multiparametric model
(ADNEXMRscore)

19-10!

Single centre

Differentiate benign from malignant

IM antiperistaltic agent

Conventional MRI + DWI + DCE

Visual interpretation of mass characteristics and TICs

             

Biomarkers in development/
exploratory/ not
recommended

ADC

112-13!

Single centre

Differentiate benign from malignant, histopathological tumour features

IM antiperistaltic agent

At least 2 b-values (b=0-50 and b=800-1000 s/mm2)

Considerable overlap8

ADC histogram analysis

114!

Single centre

Response to systemic treatment

IM antiperistaltic agent

At least 2 b-values (b=0-50 and b=800-1000 s/mm2)

First order histogram parameters

Multiparametric MRI (ADC, ve, MRS)

115!

Single centre

Response to systemic treatment

IM anitperistaltic agent

Multiple b-values

Monoexponential data fit, Tofts model

Radiomics (CT)

316!

Single centre

Outcome prediction

No

CE-CT

No consensus available

  1. Schweitzer ME. Evidence level. J Magn Reson Imaging. 2016;43(3):543-543. doi:10.1002/jmri.25187
  2. Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) group. Ultrasound Obstet Gynecol. 2000;16(5):500-505. doi:10.1046/j.1469-0705.2000.00287.x
  3. Meys EMJ, Kaijser J, Kruitwagen RFPM, et al. Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis. Eur J Cancer. 2016;58:17-29. doi:10.1016/j.ejca.2016.01.007
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  5. Thomassin-Naggara I, Bazot M, Daraï E, Callard P, Thomassin J, Cuenod CA. Epithelial Ovarian Tumors: Value of Dynamic Contrast-enhanced MR Imaging and Correlation with Tumor Angiogenesis. Radiology. 2008;248(1):148-159. doi:10.1148/radiol.2481071120
  6. Thomassin-Naggara I, Balvay D, Aubert E, Daraï E, Rouzier R, Cuenod CA, Bazot M. Quantitative dynamic contrast-enhanced MR imaging analysis of complex adnexal masses: a preliminary study. Eur Radiol. 2012 Apr;22(4):738-45. doi: 10.1007/s00330-011-2329-6. Epub 2011 Nov 23. PubMed PMID: 22105841.
  7. Thomassin-Naggara I, Soualhi N, Balvay D, Darai E, Cuenod CA. Quantifying tumor vascular heterogeneity with DCE-MRI in complex adnexal masses: A preliminary study. J Magn Reson Imaging. 2017 Dec;46(6):1776-1785. doi: 10.1002/jmri.25707. Epub 2017 Apr 3. PubMed PMID: 28370815.
  8. Thomassin-Naggara I, Toussaint I, Perrot N, et al. Characterization of Complex Adnexal Masses: Value of Adding Perfusion- and Diffusion-weighted MR Imaging to Conventional MR Imaging. Radiology. 2011;258(3):793-803. doi:10.1148/radiol.10100751
  9. Thomassin-Naggara I, Aubert E, Rockall A, et al. Adnexal Masses: Development and Preliminary Validation of an MR Imaging Scoring System. Radiology. 2013;267(2):432-443. doi:10.1148/radiol.13121161
  10. Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, Guerra A, Fournier LS, Stojanovic S, Millet I, Bharwani N, Juhan V, Cunha TM, Masselli G, Balleyguier C, Malhaire C, Perrot NF, Sadowski EA, Bazot M, Taourel P, Porcher R, Darai E, Reinhold C, Rockall AG. Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) Score for Risk Stratification of Sonographically
    Indeterminate Adnexal Masses. JAMA Netw Open. 2020 Jan 3;3(1):e1919896. doi: 10.1001/jamanetworkopen.2019.19896. PubMed PMID: 31977064; PubMed Central PMCID: PMC6991280.
  11. Rustin GJS, Vergote I, Eisenhauer E, et al. Definitions for Response and Progression in Ovarian Cancer Clinical Trials Incorporating RECIST 1.1 and CA 125 Agreed by the Gynecological Cancer Intergroup (GCIG). Int J Gynecol Cancer. 2011;21(2):419-423. doi:10.1097/IGC.0b013e3182070f17
  12. Kim H-J, Lee S-Y, Shin YR, Park CS, Kim K. The Value of Diffusion-Weighted Imaging in the Differential Diagnosis of Ovarian Lesions: A Meta-Analysis. Cao C, ed. PLoS One. 2016;11(2):e0149465. doi:10.1371/journal.pone.0149465
  13. Lindgren A, Anttila M, Rautiainen S, et al. Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI. Eur Radiol. 2017;27(9):4002-4012. doi:10.1007/s00330-017-4786-z
  14. Kyriazi S, Collins DJ, Messiou C, et al. Metastatic Ovarian and Primary Peritoneal Cancer: Assessing Chemotherapy Response with Diffusion-weighted MR Imaging—Value of Histogram Analysis of Apparent Diffusion Coefficients. Radiology. 2011;261(1):182-192. doi:10.1148/radiol.11110577
  15. Sala E, Kataoka MY, Priest AN, et al. Advanced Ovarian Cancer: Multiparametric MR Imaging Demonstrates Response- and Metastasis-specific Effects. Radiology. 2012;263(1):149-159. doi:10.1148/radiol.11110175
  16. Rizzo S, Botta F, Raimondi S, et al. Radiomics of high-grade serous ovarian cancer: association between quantitative CT features, residual tumour and disease progression within 12 months. Eur Radiol. May 2018. doi:10.1007/s00330-018-5389-z