Does amide proton transfer-weighted MRI have diagnostic and differential value in ovarian cystic and predominantly cystic lesion?

Objectives: This study aims to evaluate the diagnostic value of amide proton transfer-weighted (APTw) imaging in distinguishing cystic or predominantly cystic ovarian lesions.

Materials and methods: 49 patients underwent APTw imaging at 3T-MR before surgery, with 20 volunteers serving as the control group. Participants were divided into the following groups: solid components of normal ovaries (Group A, n = 29), solid components of malignant lesions (Group B, n = 7), cystic fluid of follicles (Group C, n = 31), cystic fluid of benign lesions (Group D, n = 46), functional cysts (Group d1, n = 8), endometriomas (Group d2, n = 28), cystadenomas (Group d3, n = 10), and cystic fluid of malignant lesions (Group E, n = 12). Independent t-tests or Mann-Whitney U tests and one-way ANOVA were used to compare group differences. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficacy in distinguishing between different lesions.

Results: For solid components, significant differences in MTRasym values were observed between Groups A and B (P < 0.001). For cystic components, significant differences were found between Groups C and D, C and E, d1 and d2, d2 and d3, d1 and d3, C and d2, C and d3, E and d1, and E and d2 (all P < 0.01). ROC analysis of these results showed high AUC values (ranging from 0.813 to 1.0), all P < 0.05.

Conclusions: APTw can reveal differences in MTRasym values between normal and diseased ovarian tissues, demonstrating high clinical value in differentiating functional cysts, endometriomas, and cystadenomas, as well as distinguishing benign lesions (functional cysts or endometriomas) from malignant tumors.