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Epithelial Ovarian Tumors: Value of Dynamic Contrast-enhanced MR Imaging and Correlation with Tumor Angiogenesis¹

¹ From the Departments of Radiology (I.T., M.B.), Obstetrics and Gynecology (E.D.), and Anatomic Pathology (P.C., J.T.), Hôpital Tenon, Assistance Publique Hôpitaux de Paris (APHP), 4 rue de la Chine, 75020 Paris, France; Laboratoire de Recherche en Imagerie (LRI-EA 4062), Université Paris V-René Descartes, Paris, France (I.T., C.A.C.); and Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France (C.A.C.). Received June 26, 2007; revision requested August 30; revision received October 2; accepted December 17; final version accepted February 5, 2008. Address correspondence to I.T. (e-mail: isabelle.thomassin{at}tnn.aphp.fr).

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 [T_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. T_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.

© RSNA, 2008