The Value of Diffusion-Weighted Imaging in the Differential Diagnosis of Ovarian Lesions: A Meta-Analysis

Abstract

Objectives: The ability of contrast-enhanced MRI to distinguish between malignant and benign ovarian masses is limited. The aim of this meta-analysis is to evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in differentiating malignant from benign ovarian masses.

Methods: A comprehensive literature search was performed in several authoritative databases to identify relevant articles. The weighted mean difference (WMD) and corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze study heterogeneity, and evaluated publication bias.

Results: The meta-analysis is based on 21 studies, which reported the findings for 731 malignant and 918 benign ovarian masses. There was no significant difference in apparent diffusion coefficient (ADC) values for DWI between benign and malignant lesions (WMD = 0.22, 95% CI = -0.02-0.47, p = 0.08). Subgroup analysis by benign tumor type revealed higher ADC values (or a trend toward higher values) for cysts, cystadenomas and other benign tumors compared to malignant masses (cyst: WMD = 0.54, 95% CI = -0.05-1.12, p = 0.07; cystadenoma: WMD = 0.73, 95% CI = 0.38-1.07, p < 0.0001; other benign tumor: WMD = 0.16, 95% CI = -0.13-0.46, p = 0.28). On the other hand, lower ADC values (or a trend toward lower values) were observed for endometrioma and teratoma compared to malignant masses (endometrioma: WMD = -0.09, 95% CI = -0.47-0.29, p = 0.64; teratoma: WMD = -0.49, 95% CI = -0.85-0.12, p = 0.009). Subgroup analysis by mass property revealed higher ADC values in cystic tumor types than in solid types for both benign and malignant tumors. Significant study heterogeneity was observed. There was no notable publication bias.

Conclusions: Quantitative DWI is not a reliable diagnostic method for differentiation between benign and malignant ovarian masses. This knowledge is essential in avoiding misdiagnosis of ovarian masses.

Fig 1. Flow chart describing the study selection process.

From: www.prisma-statement.org. Used with permission.

Fig 2. Forest plot for the diagnostic significance of diffusion-weighted MRI between benign and malignant ovarian tumors; apparent diffusion coefficient (ADC) values.

(A) Overall, (B) Subgroup analysis according to benign tumor type.

Fig 3. Forest plots of subgroup analyses according to malignant tumor type and tumor property.

(A) Epithelial malignant tumors, (B) Non-epithelial malignant tumors, (C and D) Solid and cystic tumors.

Fig 4. Hierarchical summary receiver operating characteristic (HSROC) curves of diffusion-weighted MRI and coupled forest plot.