Role of MRI in Differentiating Benign and Malignant Ovarian Tumors

Abstract

 Introduction: Ovarian cancer is a major health challenge globally and ranks as the third most common cancer among women in India. Despite advancements in diagnostics, its poor prognosis persists due to late-stage diagnosis. Early and accurate differentiation between benign and malignant ovarian tumors is essential for improving management and outcomes. Magnetic resonance imaging (MRI) has emerged as a superior modality for characterizing ovarian tumors, offering high sensitivity and specificity compared to ultrasound and computed tomography. Aim: This study aimed to determine the sensitivity and specificity of contrast-enhanced MRI in differentiating benign and malignant ovarian tumors, using histopathology as the gold standard. Additionally, the study evaluated MRI imaging characteristics of individual ovarian neoplasm types confirmed by histopathology. Methods: This prospective study was conducted over 18 months at Pushpagiri Medical College, including 74 patients with suspected ovarian neoplasms. MRI was performed using a 1.5 Tesla scanner with T1W, T2W, T2 FS, and post-contrast T1 FS sequences. Lesions were classified as benign or malignant based on size, cystic or solid, wall and septal thickness, internal contents and enhancement patterns, with histopathology serving as the reference standard. Results: Of the 74 cases, 62 were benign and 12 were malignant. Benign lesions exhibited thin walls, unilocular or multiloculated morphology, and peripheral enhancement. Malignant lesions demonstrated irregular thick walls, thick septae, solid components, and ancillary features like ascites, lymphadenopathy, peritoneal or omental deposits. MRI achieved a sensitivity of 100 % and specificity of 97 % in differentiating these lesions. Conclusion: MRI is a useful preoperative test for predicting the diagnosis of ovarian masses. The differentiation of benign from malignant ovarian tumours is of great value because the therapeutic approach is different for each entity. Benign ovarian masses can be managed with more conservative approaches, either with close observation or with laparoscopic surgery. On the contrary, when a tumor is malignant, there is a need for urgent laparotomy.