Utility of structural MRI and DWI in evaluation of uterine and adnexal lesions

Background: In females, uterine and adnexal pathologies have been the common cause of morbidity. Accurate diagnosis is of utmost importance for timely intervention, which can be done with good accuracy by Magnetic Resonance Imaging (MRI).Diffusion weighted imaging (DWI) is a functional imaging sequence which works on the principle of random mobility of water molecules within the tissues. MRI with DW Imaging emerged as an optimistic tool in detection and characterization of various uterine and adnexal lesions, their anatomical extension, understanding the pathophysiology by ADC values which further helps in differentiation of benign from malignant lesions. Methods: This was a prospective, observational study conducted at a tertiary center for over a period of 2 years with 100 patients of all age groups suspected of uterine and adnexal lesions, examined under Siemens Avanto Magnetic Resonance Imaging (1.5 Tesla). The mean differences in ADC between benign and malignant were compared using a student t-test. Accuracy of ADC Cut off value to differentiate benign from malignant lesions were assessed by Kappa statistic. Results: The mean ADC value for benign uterine lesions was 1.33 + 0.18 ×10-3 mm2/s and for malignant lesions was 0.77 + 0.08 ×10-3 mm2/s with an ADC cut off value of 0.92×10-3mm2/s was suggested for differentiating benign from malignant uterine lesions. The mean ADC value for benign adnexal lesions was 1.35 +78 ×10-3 mm2/s and for malignant lesions was 0.91 + 0.03 ×10-3 mm2/s. Few benign lesions showed ADC values lower than malignant lesions. The mean ADC value for endometriomas was 0.69 + 0.03 ×10-3 mm2/s and the mean ADC value for tubo-ovarian abscess was 0.46+ 0.06 x×10-3 mm2/s. Hence statistically, ADC cut off value of 0.96×10-3mm2/s was not significant in differentiating benign from malignant adnexal lesions with a kappa value of 0.3 and p-value of 0.37.From our study, the sensitivity, specificity, positive predictive, negative predictive value and accuracy of MRI in detecting and differentiating benign and malignant uterine and adnexal lesions was 95%, 100%, 100%, 98.72% and 99% respectively with a strong kappa value. Conclusion: From our study we have concluded that diffusion weighted imaging has a notable role in differentiating benign from malignant uterine lesions rather than adnexal lesions. However, irrespective of ADC values, a complete analysis of the lesions utilizing all sequences we had observed that MRI had a sensitivity, specificity and accuracy in detecting uterine and adnexal lesions