Epithelial ovarian tumors: Value of dynamic contrast-enhanced MR Imaging and correlation with tumor angiogenesis

Purpose: To retrospectively evaluate the diagnostic performance of dynamic contrast material-enhanced magnetic resonance (MR) imaging for the characterization of ovarian epithelial tumors, by using histologic findings as the reference standard, and to correlate dynamic contrast-enhanced MR imaging findings with angiogenesis biomarkers. Materials and Methods: Ethics committee approval was obtained, with waiver of informed consent. Patients consented to having their data used for future retrospective research. Forty-one women (age range, 22-73 years) with 48 epithelial ovarian tumors underwent dynamic contrast-enhanced MR imaging before surgical excision. In case of bilateral tumors (n = 7), only the most complex tumor was analyzed. Thus, 41 tumors (12 benign, 13 borderline, and 16 invasive) were examined with dynamic contrast-enhanced MR imaging and immunohistochemical methods. Dynamic contrast-enhanced MR imaging parameters (enhancement amplitude [EA], time of half rising [T1/2(max)], and maximal slope [MS]) were analyzed according to histopathologic findings, microvessel density, pericyte coverage index (PCI), and vascular endothelial growth factor receptor 2 (VEGFR-2) expression. Statistical analyses were performed by using Kruskal-Wallis, Fisher exact, and Spearman tests and receiver operating curve analysis. Results: EA was higher for invasive tumors than for benign (P <.001) and borderline (P <.05) tumors. T1/2(max) was longer for benign tumors than for borderline (P <.05) and invasive (P <.01) tumors. MS was steeper for invasive tumors than for benign (P <.001) and borderline (P <.001) tumors. PCI was lower in invasive tumors than in borderline (P <.05) and benign (P <.05) tumors. Microvessels showed stronger immunohistochemical VEGFR-2 expression in invasive tumors than in benign or borderline tumors (P <.05). MS correlated with a lower PCI (r = -0.34, P=.04) and stronger VEGFR-2 expression by using both epithelial (r=0.41, P <.01) and endothelial (r = 0.66, P <.001) cells. Conclusion: The early enhancement patterns of ovarian epithelial tumors on dynamic contrast-enhanced MR images can help distinguish among benign, borderline, and invasive tumors and were found to correlate with tumoral angiogenic status. (c) RSNA, 2008.