The Value of Magnetic Resonance Diffusion-Weighted Imaging and Dynamic Contrast Enhancement in the Diagnosis and Prognosis of Treatment Response in Patients with Epithelial Serous Ovarian Cancer

Simple Summary Epithelial ovarian cancer is one of the greatest challenges for a gynecologist and oncologist both in terms of diagnosis and treatment. Modern imaging techniques such as DWI or DCE MRI allow for better planning of the treatment strategy. This is related not only to a more precise localization of lesions, but also to the relationship between the values of DWI and DCE parameters and specific histological types of ovarian cancer. In our study, we demonstrated the previously suggested relationships between the values of DWI parameters and the types of ovarian cancer. We described the relationship with the results of immunohistochemical tests. We also showed a correlation between DWI and DCE values with time to relapse. We have made an attempt to describe such correlations in the group of patients treated with bevacizumab. Background. The aim of our study was to describe the selected parameters of diffusion-weighted imaging (DWI) and perfusion dynamic contrast enhancement (DCE) MRI in primary tumors in patients with serous epithelial ovarian cancer (EOC), as well as in disease course prognosis and treatment response, including bevacizumab maintenance therapy. Materials and Methods. In total, 55 patients with primary serous EOC were enrolled in the study. All patients underwent MR imaging using a 1.5 T clinical whole-body MR system in preoperative DWI and DCE MRI selected parameters: apparent diffusion coefficients (ADC), time to peek (TTP) and perfusion maximum enhancement (Perf. Max. En.) were measured. The data were compared with histopathological and immunochemistry results (with Ki67 and VEGF expression) and clinical outcomes. Results. Higher mean ADC values were found in low-grade EOC compared to high-grade EOC: 1151.27 vs. 894,918 (p < 0.0001). A negative correlation was found between ADC and Ki67 expression (p = 0.027), and between ADC and VEGF expression (p = 0.042). There was a negative correlation between TTP and PFS (p = 0.0019) and Perf. Max. En. and PSF (p = 0.003). In the Kaplan-Meier analysis (log rank), a longer PFS was found in patients with ADC values greater than the median; p = 0.046. The Kaplan-Meier analysis showed a longer PFS (p = 0.0126) in a group with TTP below the mean value for this parameter in patients who received maintenance treatment with bevacizumab. Conclusions. The described relationships between PFS and DCE and DWI allow us to hope to include these parameters in the group of EOC prognostic factors. This aspect seems to be of particular interest in the case of the association of PFS with DCE values in the group of patients treated with bevacizumab.

Automated summary

This study describes the application of diffusion-weighted imaging (DWI) and perfusion dynamic contrast enhancement (DCE) MRI in patients with serous epithelial ovarian cancer (EOC), as well as their relationship with disease course prognosis and treatment response. The results show correlations between DWI parameters and ovarian cancer types, Ki67 and VEGF expression, as well as negative correlations between time to peek (TTP) and perfusion maximum enhancement (Perf. Max. En.) with progression-free survival (PFS). Additionally, in patients receiving maintenance treatment with bevacizumab, ADC values and TTP are associated with PFS. These parameters may be included as prognostic factors for EOC.