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Ayatullah Gharib Mostafa Fatma Mohamed Awad Ahmed Abd El Karim Abd EL Salam Fayed Hassan Mostafa Gaafar Tarek M. Zaghloul Yasmin Essam Khalifa Soha Talaat Hamed

Abstract

Background: Characterization of borderline ovarian lesion represents a diagnostic challenge; it is of great importance in the preoperative assessment to plan adequate therapeutic procedures, especially in women in the childbearing period aiming to preserve fertility. Objective: to evaluate the utility of ultrasound, Doppler, and multiparametric MRI in the assessment of borderline ovarian masses. As well as the detection of different significant diagnostic criteria in differentiating borderline from malignant ovarian masses. Methods: The study included 72 ovarian masses in 68 patients. Their final pathological results were 29 borderline and 43 malignant lesions. All patients underwent preoperative ultrasound, Doppler and contrast-enhanced MRI, and images were retrospectively reviewed and compared between the 2 pathologies. Results: Borderline ovarian masses were significantly more observed in younger pre-menopausal women compared to their malignant counterparts. No significant difference was noted in CA-125 level between both patient groups. In this study, we identified eight significant imaging features that can be used to differentiate borderline from malignant ovarian masses: maximum lesion diameter, lesion shape, number of papillary projections/solid parts, size of the largest solid part, cystic-solid interface, ovarian crescent sign, and ascites. No significant difference was found in the size of the septations, site and degree of vascularity, resistivity index, the pattern of post-contrast enhancement, or diffusion/apparent diffusion coefficient. Conclusion: Imaging findings of these 2 pathologies overlapped considerably. Compared with BOTs, MOTs exhibited larger tumor size, irregular shape, larger solid parts, lower RI, unclear solid cystic interface, effaced ovarian tissue, and a larger amount of ascites. A combination of clinical data including age, and menopausal status with different imaging criteria can improve the diagnostic performance.

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Keywords

ultrasound, Doppler, MRI, borderline ovarian lesions, malignant ovarian lesions.

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