Use of enhanced T2 star-weighted angiography (ESWAN) and R2* values to distinguish ovarian cysts due to endometriosis from other causes

Purpose To evaluate the feasibility of enhanced T2 star-weighted angiography (ESWAN) in differentiating endometrial from non-endometrial cysts.

Forty-nine patients with 60 histopathologically proven ovarian cystic lesions underwent pelvic MRI including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), liver acquisition with volume acceleration, and ESWAN. Ovarian cystic lesions were divided into endometrial cysts (group 1; n = 28), pyosalpinx and hydrosalpinx (group 2; n = 13), and ovarian cystic and cystic-solid tumors (group 3; n = 19). R2* (effective transverse relaxation rate) values were measured and pairwise comparison of the R2* values among the three groups was made using Kruskal–Wallis test. Receiver operating characteristic curves were used to calculate cutoff values and performance of R2* values for distinguishing among groups. T1WI signal intensity and R2* value were also compared using area under curve values.

R2* values for group 1 were statistically higher than groups 2 and 3 (15.37, 1.40, and 1.79 Hz, respectively; P < 0.001). The cutoff value for R2* was 7.43 Hz with a sensitivity, specificity, PPV, NPV, and accuracy of 96.43, 87.50, 87.10, 96.55, and 91.67%, respectively. There was no significant difference between the R2* value and T1WI in diagnosing endometrial cysts.

The R2* value provides an effective way to discriminate endometrial cysts from other ovarian cystic lesions. Similar content being viewed by others

Ma C-Y, Wang Z-G (2013) The current status of and progress in treatment for endometriosis. Chin J Clin 7(1):293–295 Nishimura K, Togashi K, Itoh K, et al. (1987) Endometrial cysts of the ovary: MR imaging. Radiology 162(2):315–318 Saba L, Sulcis R, Melis GB, et al. (2014) Diagnostic confidence analysis in the magnetic resonance imaging of ovarian and deep endometriosis: comparison with surgical results. Eur Radiol 24(2):335–343 Motoshima S, Irie H, Nakazono T, Kamura T, Kudo S (2011) Diffusion-weighted MR imaging in gynecologic cancers. J Gynecol Oncol 22(4):275–287 Thomassin-Naggara I, Daraï E, Cuenod CA, et al. (2009) Contribution of diffusion weighted MR imaging for predicting benignity of complex adnexal masses. Eur Radiol 19:1544–1552 Takeuchi M, Matsuzaki K, Nishitani H (2010) Diffusion weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J Comput Assist Tomogr 34:173–176 Zhang H, Zhang GF, He ZY, et al. (2012) Evaluation of primary adnexal masses by 3T MRI: categorization with conventional MR imaging and diffusion-weighted imaging. J Ovarian Res 5(1):33 Verit FF, Yucel O (2013) Endometriosis, leiomyoma and adenomyosis: the risk of gynecologic malignancy. Asian Pac J Cancer Prev 14(10):5589–5597 Takeuchi M, Matsuzaki K, Uehara H, Nishitani H (2006) Malignant transformation of pelvic endometriosis: MR imaging findings and pathologic correlation. Radiographics 26(2):407–417 Denk C, Rauscher A (2010) Susceptibility weighted imaging with multiple echoes. J Magn Reson Imaging 31(1):185–191 Haddar D, Haacke E, Sehgal V, et al. (2004) Susceptibility weighted imaging. Theory and applications. J Radiol 85(11):1901–1908 Ogawa S, Lee TM, Kay AR, Tank DW (1990) Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA 87(24):9868–9872 Baudelet C, Gallez B (2002) How does blood oxygen level-dependent (BOLD) contrast correlate with oxygen partial pressure (pO2) inside tumors? Magn Reson Med 48(6):980–986 Reichenbach JR, Haacke EM (2001) High-resolution BOLD venographic imaging: a window into brain function. NMR Biomed 14(7–8):453–467 Huang P, Chen CH, Lin WC, et al. (2012) Clinical applications of susceptibility weighted imaging in patients with major stroke. J Neurol 259(7):1426–1432 Beauchamp MH, Beare R, Ditchfield M, et al. (2013) Susceptibility weighted imaging and its relationship to outcome after pediatric traumatic brain injury. Cortex 49(2):591–598 Rumzan R, Wang JJ, Zeng C, et al. (2013) Iron deposition in the precentral grey matter in patients with multiple sclerosis: a quantitative study using susceptibility-weighted imaging. Eur J Radiol 82:e95–e99 Chen X, Zeng C, Luo T, et al. (2012) Iron deposition of the deep grey matter in patients with multiple sclerosis and neuromyelitis optica: a control quantitative study by 3D-enhanced susceptibility-weighted angiography (ESWAN). Eur J Radiol 81(4):e633–e639 Takeuchi M, Matsuzaki K, Nishitani H (2008) Susceptibility-weighted MRI of endometrioma: preliminary results. Am J Roentgenol 191(5):1366–1370 Solak A, Sahin N, Genç B, et al. (2013) Diagnostic value of susceptibility-weighted imaging of abdominal wall endometriomas during the cyclic menstrual changes: a preliminary study. Eur J Radiol 82(9):e411–e416 Dyvorne H, Knight-Greenfield A, Jajamovich G, et al. (2014) Abdominal 4D flow MR imaging in a breath hold: combination of spiral sampling and dynamic compressed sensing for highly accelerated acquisition. Radiology 15:140973 Togashi K, Nishimura K, Kimura I, et al. (1991) Endometrial cysts: diagnosis with MR imaging. Radiology 180(1):73–78 Zawin M, McCarthy S, Scoutt LM, Comite F (1989) Endometriosis: appearance and detection at MR imaging. Radiology 171:693–696 Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT (1985) Intracranial hematomas: imaging by high-field MR. Radiology 157:87–93 Gomori JM, Grossman RI, Hackney DB, et al. (1987) Variable appearance of subacute intracranial hematomas on high-field spin-echo MR. AJNR 8:1019–1026 Bradley WG (1993) MR appearance of hemorrhage in the brain. Radiology 189(1):15–26 Dillon WP, Som PM, Fullerton GD (1990) Hypointense MR signal in chronically inspisated sinonasal secretions. Radiology 174:73–78 Hayman LA, Taber KH, Ford JJ, et al. (1989) Effect of clot formation and retraction on spin-echo MR images of blood: an in vitro study. AJNR 10:1155–1158 Jones HW Jr, Jones GS (1975) Novak’s textbook of gynecology, 9th edn. Baltimore: Williams & Wilkins, pp 542–565 Berlanda N, Vercellini P, Somigliana E, et al. (2013) Role of surgery in endometriosis-associated subfertility. Semin Reprod Med 31(2):133–143 Corwin MT, Gerscovich EO, Lamba R, Wilson M, McGahan JP (2014) Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology 271(1):126–132 Author information Authors and Affiliations Corresponding author Electronic supplementary material Below is the link to the electronic supplementary material. 261_2014_314_MOESM1_ESM.tif (download TIF ) Figure S1. The box-plot of R2* value among 3 disease groups. Group 1: ovarian endometrial cysts; Group 2: pyosalpinx and hydrosalpinx; Group 3: Ovarian cystic tumor and ovarian mixed solid-cystic tumor. *P < 0.05 compared to Group 1, Mann-Whitey U test with Bonferroni approach (TIFF 1484 kb) 261_2014_314_MOESM2_ESM.tif (download TIF ) Figure S2. The receiver operating characteristic (ROC) curves of using R2* value and T1WI signal to distinguish ovarian endometrial cysts from ovarian non-endometrial cysts. The area under the curve (AUC) is 0.931 (95% CI: 0.857 to 1.000) and 0.853 (95% CI: 0.762 to 0.944) for R2* value and T1WI signal, respectively. No significant difference in AUC is observed between R2* value and T1WI signal (P = 0.106) (TIFF 2037 kb) Rights and permissions About this article Cite this article Li, Y., Song, QW., Sun, MY. et al. Use of enhanced T2 star-weighted angiography (ESWAN) and R2* values to distinguish ovarian cysts due to endometriosis from other causes. Abdom Imaging 40, 1733–1741 (2015). https://doi.org/10.1007/s00261-014-0314-7 Published: Issue date: DOI: https://doi.org/10.1007/s00261-014-0314-7