الفهرس 
Uterine tube (Fallopian tube)Only 14 pages are availabe for public view
 |  | from | 281 |  |  |
| | | from | 281 | | |
Abstract
Gynecological masses are often a dilemma of differentiating malignant tumors from benign in patients presenting with pelvic mass and to differentiate diagnosis of pelvic mass is quite variable because abnormality may arise from gynecological or non gynecological origin. MRI has the advantage of exquisite soft-tissue contrast, enabling distinction of tumor from normal tissue. Although conventional pelvic MRI is commonly used modality in the evaluation of gynecological masses because of the cost-effectiveness and safety, their findings are occasionally inconclusive or insufficient for choosing the proper management. Functional MRI is becoming established in the evaluation of gynecologic malignancies. Parameters derived from functional MRI may be used to examine tumor vascularity, tissue microarchitecture, features that may be exploited for tumor characterization and help to differentiate the benign from malignant tumors, functional MRI including diffusion weighted MRI, dynamic contrast enhanced MRI and Susceptibility weighted. The aim of this study was to assess the role of new functional magnetic resonance imaging in evaluation of the different types of gynecological masses. This prospective study was conducted on 70 females with different gynecological masses referred from Gynecology and Obstetrics Department with ultrasound suggestion of presence of pelvic mass and collected starting from May 2017 to May 2019. The study was approved by the Research Ethical Committee, Faculty of Medicine, Tanta University. All patients were subjected to the following: • Written informed consents were obtained from all patients after full explanation of benefits. Any expected riskswas appeared during the course of this study as claustrophobia, will be dealed by reassurance of the patient and informing her about the benefits of MRI examination. • Utrasonography and MRI evaluation. In the present study the patient’s age ranged from 20 to 70 years with a mean of age was 45.91 ± 13.75 years, the most common age group ranged from 50 to less than 60 years included 17 patients representing 24.3%. In the present study there was predominance of adenxal masses represented 34 cases (48.6%) followed by uterine masses which were 25 (35.7%) then cervical masses 6 cases (8.6%) and 5 recurrent tumor (7.1%) In this study DWI helped in discrimination between benign and malignant lesions, increases the contrast between lesions and surrounding tissues, and improves the detection and delineation of peritoneal implants. Moreover, diffusion-weighted imaging provided quantitative information about tissue cellularity that may be used to distinguish viable tumors from treatment-related changes. Malignant lesions have shown lower ADC values. Increasing ADC values is noted in benign lesions, it was used as a biomarker for tumoral recurrence. In the current study we reported accuracy of DWI and ADC values for differentiation between benign and malignant uterine lesions as we found that the ADC values of benign lesions were ranged from (0.80 – 1.70 x 10-3 mm2/s) with mean ADC 1.23 ± 0.24, while ADC values of malignant lesions were ranged from (0.63 – 1.16 x 10-3 mm2/s) with mean ADC 0.98 ± 0.29 with cut off value of ADC for uterine lesions was ≤1.14 to be considered malignant lesions. In the current study we reported high accuracy of DWI and ADC values in differentiating benign and malignant myometrial lesions, ADC of ordinary lieomyomas ranged from 1.2-1.4 x 10-3 mm2/sec , cellular lieomyomas was 0.80 x 10-3 mm2/s, degenerative lieomyomas 1.7 x 10-3 mm2/s while in lieomyosarcomas ranged from 0.98 - 1.17 x 10-3 mm2/s and choriocarcinomas ranged from 0.63 & 0.72 x 10-3 mm2/s, also DWI and ADC values had accuracy in differentiating uterine adenomyosis and uterine lieomyomas, ADC of uterine adenomyosis was higher compared to lieomyomas with mean ADC values 0.88-1.5 x 10-3 mm2/s. Also we reported high accuracy of the DWI and ADC values in differentiating benign and malignant endometrial lesions, ADC values of benign endometrial polyp 1.4 x 10-3 mm2/s, endometrial hyperplasia value was 0.72 - 1.3 x 10-3 mm2/s while ADC values of dysplastic endometrial polyp 1.1 &1.2 x 10-3 mm2/s and endometrial carcinomas ranged from 0.88 – 1.0 x 10-3 mm2/s. Also we reported its accuracy in differentiation between benign and malignant cervical masses as the ADC values of benign lesions ranged from 1.2-1.6 x 10-3 mm2/sec with mean ADC 1.43 ± 0.21 x10-3 mm2/sec were while ADC values of malignant lesions ranged from 0.89 – 0.92 x 10-3 mm2/sec with mean ADC 0.90 ± 0.01x10-3mm2/sec with cut of ≤1.1 to be considered malignant cervical lesions. In the present study DWI and ADC showed accuracy in differentiation between benign and malignant adenxal lesions as ADC value of benign lesions ranged from ranged between 0.81 – 3 x 10-3 mm2/sec with mean ADC 1.68 ± 0.65, while ADC value of malignant looking lesions ranged between 0.64 – 1.20 x 10-3 mm2/sec with mean ADC 0.91± 0.16 and ADC value of the border line ovarian tumor was 1.20 with cut off value ≤1.2 to be considered in adenxal malignant lesions.