• Hai Ming Li, Shu Hui Zhao, QiangJin WeiJWDepartment of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China., Guo Fu Zhang, Feng Feng, Feng Hua Ma, Yong Ai Li, and Wei Yong Gu.
• Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
• J Magn Reson Imaging. 2017 Nov 1; 46 (5): 1499-1506.

PurposeTo investigate the use of diffusion kurtosis imaging (DKI) in differentiating borderline from malignant epithelial ovarian tumors (MEOTs) and to correlate DKI parameters with Ki-67 expression.Materials And MethodsFifty-two consecutive patients with epithelial ovarian tumors (17 borderline epithelial ovarian tumors, BEOTs; 35 MEOTs) were prospectively evaluated using DKI with b values of 0, 500, 1000, 1500, 2000, and 2500 s/mm2 and standard diffusion-weighted imaging (DWI) with b values of 0 and 1000 s/mm2 using a 1.5T magnetic resonance imaging (MRI) unit. The kurtosis (K) and diffusion coefficient (D) from DKI and apparent diffusion coefficient (ADC) from standard DWI were measured, compared, and correlated with Ki-67 expression between the two groups. Statistical analyses were performed using the Mann-Whitney U-test, receiver operating characteristic (ROC) curves, and Spearman's correlation.ResultsThe K value was significantly lower in BEOTs than in MEOTs (0.55 ± 0.09 vs. 0.9 ± 0.2), while the D and ADC values were significantly higher in BEOTs than in MEOTs (2.27 ± 0.35 vs. 1.39 ± 0.37 and 1.72 ± 0.36 vs. 1.1 ± 0.25, respectively) (P < 0.001). For differentiating between BEOTs and MEOTs, the sensitivity, specificity, and accuracy were 88.2%, 94.3%, and 92.3% for K value; 88.2%, 91.4%, and 90.4% for D value; and 88.2%, 88.6%, and 88.5% for ADC value, respectively. However, there were no differences in the diagnostic performances among the three parameters above (K vs. ADC, P = 0.203; D vs. ADC, P = 0.148; K vs. D, P = 0.904). The K value was positively correlated with Ki-67 expression (r = 0.699), while the D and ADC values were negatively correlated with Ki-67 expression (r = -0.680, -0.665, respectively).ConclusionPreliminary findings demonstrate that DKI is an alternative tool for differentiating BEOTs from MEOTs, and is correlated with Ki-67 expression. However, no added value is found for DKI compared with standard DWI.Level Of Evidence1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1499-1506.© 2017 International Society for Magnetic Resonance in Medicine.

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