A one-step biomarker quantification methodology for DCE-MRI of adnexal masses: Capturing kinetic pattern from early to late enhancement

Anahita Fathi Kazerooni; Mahnaz Nabil; Hamidreza Haghighat Khah; Sara Parviz; Masoumeh Gity; Hamidreza Saligheh Rad

doi:10.1002/mrm.26743

A one-step biomarker quantification methodology for DCE-MRI of adnexal masses: Capturing kinetic pattern from early to late enhancement

Magn Reson Med. 2018 Feb;79(2):1165-1171. doi: 10.1002/mrm.26743. Epub 2017 May 7.

Authors

Anahita Fathi Kazerooni^{1

2}, Mahnaz Nabil³, Hamidreza Haghighat Khah⁴, Sara Parviz⁵, Masoumeh Gity^{5

6}, Hamidreza Saligheh Rad^{1

2}

Affiliations

¹ Quantitative MR Imaging and Spectroscopy Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Statistics, Faculty of Mathematical Sciences, University of Guilan, Rasht, Iran.
⁴ Department of Diagnostic Imaging, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁶ Department of Radiology, Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran.

PMID: 28480550
DOI: 10.1002/mrm.26743

Abstract

Purpose: To develop a one-step quantification approach that accounts for joint preprocessing and quantification of whole-range kinetics (early and late-phase washout) of dynamic contrast-enhanced (DCE) MRI of indeterminate adnexal masses.

Methods: Preoperative DCE-MRI of 43 (24 benign, 19 malignant) sonographically indeterminate adnexal masses were analyzed prospectively. A five-parameter sigmoid function was implemented to model the enhancement curves calculated within regions of interest. Diagnostic performance of five-parameter sigmoid model parameters (P₁ through P₅ ) was compared with pharmacokinetic (PK) modeling, semiquantitative analysis, and three-parameter sigmoid. Statistical analysis was performed using two-tailed student's t-test.

Results: The results revealed that P₂ , representing the enhancement amplitude, is significantly higher, and P₅ , indicating the terminal phase, is generally negative in malignant lesions (P < 0.001). P₂ (sensitivity = 79%, specificity = 87.5%, accuracy = 84%, area under the receiver operating characteristic curve = 91%) outperforms classification performances of PK and semiquantitative parameters. A combination of P₂ and P₅ shows comparable performance (sensitivity = 79%, specificity = 87.5%, accuracy = 84%, area under the receiver operating characteristic curve = 92%) to that of the combination of PK parameters, whereas the five-parameter sigmoid function maintains fewer assumptions than PK.

Conclusions: The presented one-step quantification approach is helpful for accurate discrimination of benign from malignant indeterminate adnexal masses. Accordingly, P₂ has considerably high diagnostic performance and terminal slope (P₅ ), as a previously overlooked feature, contributes more than widely accepted early-enhancement kinetic features. Magn Reson Med 79:1165-1171, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Keywords: dynamic contrast-enhanced (DCE) MRI; indeterminate adnexal masses; one-step quantification; washout.

MeSH terms

Adnexal Diseases / diagnostic imaging*
Adolescent
Adult
Biomarkers, Tumor / analysis
Contrast Media / chemistry
Contrast Media / pharmacokinetics
Female
Genital Neoplasms, Female / diagnostic imaging*
Humans
Image Interpretation, Computer-Assisted / methods*
Magnetic Resonance Imaging / methods*
Middle Aged
Prospective Studies
Young Adult

Substances

Biomarkers, Tumor
Contrast Media