Prognostic value of preoperative dynamic contrast-enhanced magnetic resonance imaging in epithelial ovarian cancer

Objectives: To investigate whether semi-quantitative and pharmacokinetic perfusion dynamic contrast-enhanced (DCE) parameters are associated with traditional prognostic factors and can predict clinical outcome in ovarian cancer (OC). Methods: This prospective study, approved by local ethical committee, enrolled 38 patients with primary OC, 2011-2014. After preoperative DCE-MRI (3.0 T), two observers measured perfusion (K-trans, K-ep, V-e, V-p) and semi-quantitative parameters (area under the curve, peak, time-to-peak) by drawing regions of interest (ROIs) covering the large solid lesion (L-ROI) and the most enhancing small area (S-ROI) (NordicICE platform). Kruskal-Wallis was used to analyze associations between MRI parameters and classified prognostic factors. Results: Mean K-trans values were higher in high-grade serous OC than in other types (L-ROI, P = 0.041; S-ROI, P = 0.018), and lower mean K-trans values predicted residual tumor (L-ROI P = 0.030; S-ROI, P = 0.012). Higher minimum V-p values were associated with higher International Federation of Gynecology and Obstetrics (FIGO) stage (S-ROI, P = 0.023). Shorter recurrence-free survival was predicted by higher V-e (minimum L-ROI, P = 0.035; maximum S-ROI, P = 0.046), V-p (maximum S-ROI, P = 0.033), and lower time-to-peak (maximum S-ROI, P = 0.047) in Kaplan-Meier analysis. Multiparametric MRI variables combining DCE and diffusion weighted data were also predictive for survival. Conclusion: DCE-MRI parameters may represent imaging biomarkers for predicting tumor aggressiveness and prognosis in OC. Higher K-trans levels were associated with better results in cytoreductive surgery but with earlier recurrence.