Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI
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CitationLindgren A. Anttila M. Rautiainen S. Arponen O. Kivelä A. Mäkinen P. Härmä K. Hämäläinen K. Kosma V-M. Ylä-Herttuala S. Vanninen R. Sallinen H. (2017). Primary and metastatic ovarian cancer: Characterization by 3.0T diffusion-weighted MRI. EUROPEAN RADIOLOGY, 27 (9) , 4002–4012. 10.1007/s00330-017-4786-z.
We aimed to investigate whether apparent diffusion coefficients (ADCs) measured by 3.0T diffusion-weighted magnetic resonance imaging (DWI) associate with histological aggressiveness of ovarian cancer (OC) or predict the clinical outcome. This prospective study enrolled 40 patients with primary OC, treated 2011-2014.
DWI was performed prior to surgery. Two observers used whole lesion single plane region of interest (WLsp-ROI) and five small ROIs (S-ROI) to analyze ADCs. Samples from tumours and metastases were collected during surgery. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) were used to measure the expression of vascular endothelial growth factor (VEGF) and its receptors.
The interobserver reliability of ADC measurements was excellent for primary tumours ICC 0.912 (WLsp-ROI). Low ADCs significantly associated with poorly differentiated OC (WLsp-ROI P = 0.035). In primary tumours, lower ADCs significantly associated with high Ki-67 (P = 0.001) and low VEGF (P = 0.001) expression. In metastases, lower ADCs (WLsp-ROI) significantly correlated with low VEGF receptors mRNA levels. ADCs had predictive value; 3-year overall survival was poorer in patients with lower ADCs (WLsp-ROI P = 0.023, S-ROI P = 0.038).
Reduced ADCs are associated with histological severity and worse outcome in OC. ADCs measured with WLsp-ROI may serve as a prognostic biomarker of OC.
• Reduced ADCs correlate with prognostic markers: poor differentiation and high Ki-67 expression
• ADCs also significantly correlated with VEGF protein expression in primary tumours
• Lower ADC values are associated with poorer survival in ovarian cancer
• Whole lesion single plane-ROI ADCs may be used as a prognostic biomarker in OC