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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Research Article

Differentiation of Endometriomas from Hemorrhagic Cysts at Magnetic Resonance: The Role of Quantitative Signal Intensity Measurements

Author(s): Roxana-Adelina Lupean, Paul-Andrei Ștefan*, Andrei Lebovici*, Csaba Csutak, Georgeta Mihaela Rusu and Carmen Mihaela Mihu

Volume 17, Issue 4, 2021

Published on: 27 October, 2020

Page: [524 - 531] Pages: 8

DOI: 10.2174/1573405616999201027211132

Abstract

Background: Endometriomas and functional hemorrhagic cysts (FHCs) are a common gynecological encounter.

Objective: This study aimed to assess the diagnostic efficiency of magnetic resonance imaging (MRI) using signal intensity measurements in differentiating endometriomas from FHCs.

Methods: Forty-six patients who underwent pelvic MRI examinations (endometriomas, n=28; FHCs, n=18) were retrospectively included. The “T2 shading” sign was evaluated subjectively and quantitatively by measuring the T1-T2 signal intensity difference and calculating the percentage of signal decrease between T1 and T2-weighted sequences. The resulted values, along with the measurement of the Apparent Diffusion Coefficient (ADC) and the signal intensity on three diffusion- weighted sequences (DWI) (b50, b400, and b800), were compared between groups by using the Mann–Whitney U test. Also, the receiver operating characteristic analysis was performed for the statistically significant results (P<0.016), and the area under the curve (AUC) was also calculated.

Results: The two quantitative assessment methods showed similar efficiency in detecting endometriomas (P<0.001; sensitivity, 100%; specificity, 81.82%; AUC>0.86), outperforming the classic subjective evaluation of the “T2 shading” sign (sensitivity, 92.86%; specificity, 66.67%). ADC (P=0.52) and DWI measurements (P=0.49, P=0.74, and P=0.78) failed to distinguish between the two entities.

Conclusion: The quantitative analysis and interpretation of the “T2 shading” sign can significantly improve the differential diagnosis between endometriomas and FHCs.

Keywords: Apparent Diffusion Coefficient (ADC), diffusion-weighted imaging, endometrioma, endometriosis, Magnetic Resonance Imaging (MRI), ovarian cyst.

Graphical Abstract

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