Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumour from endometriosis-related malignant ovarian tumour

Objectives: To evaluate the diagnostic performance of quantitative values and MRI findings for differentiating seromucinous borderline tumours (SMBTs) from endometriosis-related malignant ovarian tumours (MT). Methods: This retrospective study examined 19 lesions from SMBT and 84 lesions from MT. The following quantitative values were evaluated using receiver-operating characteristic analysis: overall and solid portion sizes, fluid signal intensity (SI), degree of contrast-enhancement, and mean and minimum apparent diffusion coefficient (ADC) values of the solid portion. Two radiologists independently evaluated four MRI findings characteristic of SMBT, fluid SI on the T1-weighted image and SI of the solid portion on diffusion-weighted image. The diagnostic values of these findings and interobserver agreement were assessed. Results: For diagnosing SMBT, the mean ADC value of the solid portion showed the greatest area under the curve (0.860) (cut-off value: 1.31 × 10^-3 mm²/s, sensitivity: 1.00, specificity: 0.61). The T2-weighted image (T2WI) high SI solid portion was the most useful finding, with high specificity and interobserver agreement (sensitivity, 0.58; specificity, 0.95–0.96, kappa = 0.96), followed by T2WI low SI core (sensitivity, 0.48–0.63; specificity, 0.98, kappa = 0.68). Conclusion: Mean ADC values of the solid portion, T2WI high SI solid portion, and T2WI low SI core were useful for differentiating SMBT from MT. Key Points: • SMBT is a newly categorised ovarian tumour often associated with endometriosis. • Differentiation of SMBT from endometriosis-related malignant ovarian tumour is clinically important. • Diagnostic performances of quantitative values and MRI findings were evaluated. • Mean ADC value of the solid portion was the most useful value. • “T2WI high SI solid portion” was the most useful MRI finding.