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Current Medical Imaging


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

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


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
Dias JL, Veloso Gomes F, Lucas R, Cunha TM. The shading sign: is it exclusive of endometriomas? Abdom Imaging 2015; 40(7): 2566-72.
[] [PMID: 26063071]
Lee NK, Kim S, Kim KH, et al. Diffusion-weighted magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts in the ovary. Acta Radiol 2016; 57(8): 998-1005.
[] [PMID: 26543051]
Abbas AM, Amin MT, Tolba SM, Ali MK. Hemorrhagic ovarian cysts: Clinical and sonographic correlation with the management options. Middle East Fertil Soc J 2016; 21: 41-5.
Jain KA. Sonographic spectrum of hemorrhagic ovarian cysts. J Ultrasound Med 2002; 21(8): 879-86.
[] [PMID: 12164573]
Kim H-J, Lee S-Y, Shin YR, Park CS, Kim K. The Value of Diffusion-Weighted Imaging in the Differential Diagnosis of Ovarian Lesions: A Meta-Analysis. PLoS One 2016; 11(2)e0149465
[] [PMID: 26907919]
Foti PV, Attinà G, Spadola S, et al. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging 2016; 7(1): 21-41.
[] [PMID: 26671276]
Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol 2006; 16(2): 285-98.
[] [PMID: 16155722]
Glastonbury CM. The shading sign. Radiology 2002; 224(1): 199-201.
[] [PMID: 12091683]
Siegelman ES, Outwater EK. Tissue characterization in the female pelvis by means of MR imaging. Radiology 1999; 212(1): 5-18.
[] [PMID: 10405714]
Togashi K, Nishimura K, Kimura I, et al. Endometrial cysts: diagnosis with MR imaging. Radiology 1991; 180(1): 73-8.
[] [PMID: 2052726]
Corwin MT, Gerscovich EO, Lamba R, Wilson M, McGahan JP. Differentiation of ovarian endometriomas from hemorrhagic cysts at MR imaging: utility of the T2 dark spot sign. Radiology 2014; 271(1): 126-32.
[] [PMID: 24475842]
Outwater E, Schiebler ML, Owen RS, Schnall MD. Characterization of hemorrhagic adnexal lesions with MR imaging: blinded reader study. Radiology 1993; 186(2): 489-94.
[] [PMID: 8421756]
Kanso HN, Hachem K, Aoun NJ, et al. Variable MR findings in ovarian functional hemorrhagic cysts. J Magn Reson Imaging 2006; 24(2): 356-61.
[] [PMID: 16791858]
Balaban M, Idilman IS, Toprak H, Unal O, Ipek A, Kocakoc E. The utility of diffusion-weighted magnetic resonance imaging in differentiation of endometriomas from hemorrhagic ovarian cysts. Clin Imaging 2015; 39(5): 830-3.
[] [PMID: 25986161]
Levine D, Brown DL, Andreotti RF, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2010; 256(3): 943-54.
[] [PMID: 20505067]
Kaponis A, Taniguchi F, Azuma Y, et al. Current treatment of endometrioma. Obstet Gynecol Surv 2015; 70(3): 183-95.
[] [PMID: 25769433]
Mulvany NJ. Aspiration cytology of ovarian cysts and cystic neoplasms. A study of 235 aspirates. Acta Cytol 1996; 40(5): 911-20.
[] [PMID: 8842166]
Guo S-W, Ding D, Shen M, Liu X. Dating Endometriotic Ovarian Cysts Based on the Content of Cyst Fluid and its Potential Clinical Implications. Reprod Sci 2015; 22(7): 873-83.
[] [PMID: 25676579]
Bradley WG Jr. MR appearance of hemorrhage in the brain. Radiology 1993; 189(1): 15-26.
[] [PMID: 8372185]
Scoutt LM, McCarthy SM, Lange R, Bourque A, Schwartz PE. MR evaluation of clinically suspected adnexal masses. J Comput Assist Tomogr 1994; 18(4): 609-18.
[] [PMID: 8040448]
Brosens I, Puttemans P, Campo R, Gordts S, Brosens J. Non-invasive methods of diagnosis of endometriosis. Curr Opin Obstet Gynecol 2003; 15(6): 519-22.
[] [PMID: 14624220]
Woodward PJ, Sohaey R, Mezzetti TP. Endometriosis: radiologic-pathologic correlation. Radiographics 2001; 21: 193-216.
Koh D-M, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 2007; 188(6): 1622-35.
[] [PMID: 17515386]

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