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DW-MRI Lights up Small Ovarian Lesions like Light Bulbs

By MedImaging International staff writers
Posted on 12 Mar 2024

Image: Diffusion-weighted MRI (DW-MRI) has been found to have value in ovarian cancer treatment planning (Photo courtesy of 123RF)

Radiologists face a significant challenge in identifying peritoneal disease on CT scans, which have a mere 11% sensitivity rate for lesions under 5 mm. However, MRI, particularly diffusion-weighted imaging (DW-MRI), shows these lesions much more clearly, illuminating them as if they were light bulbs. This suggests DW-MRI's potential value in the treatment planning of ovarian cancer. Researchers, including those from the Netherlands Cancer Institute (Amsterdam, Netherlands), engaged in the multicenter MISSION trial which focuses not only on the feasibility of achieving complete debulking surgery but also examines the cost-effectiveness of DW-MRI in the diagnostic process of advanced ovarian cancer. The prospective study was designed to follow a routine care pathway and also assess surgical outcomes, interobserver agreement, and MRI’s ability to detect small lesions not identified during initial surgical examination.

The study enrolled 220 patients with advanced-stage (FIGO III/IV) ovarian cancer, aged 65 to 67, scheduled for primary (27 patients) or interval (193 patients) debulking surgery between 2018 and 2023. Exclusions were made for those with debulking or MRI contraindications and any prior malignancy within the last five years. Significantly, surgeons were unaware of preoperative MRI findings and were only exposed to MRI results after completing a thorough abdominal inspection and estimating a Peritoneal Carcinomatosis Index (PCI) score. The study’s results demonstrated that MRI could predict complete primary and interval debulking surgeries with considerable accuracy (AUC 0.9 for primary and AUC 0.83 for interval). However, the researchers noted limitations in detecting lesions smaller than 4 mm.

Additionally, there was strong interobserver agreement, with a score of 0.81. Additionally, surgeons confirmed MRI findings that were initially overlooked during surgical inspection upon reviewing the DW-MRI data. The study also found that MRI was budget-neutral, offsetting the need for diagnostic laparoscopy in certain cases. Although diagnostic laparoscopy effectively predicts complete debulking, it is not an ideal method. The study’s significance lies in its contribution to managing patients with advanced ovarian cancer, who typically have a poor five-year prognosis due to late-stage detection at diagnosis.

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92 (55.789947509766): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

93 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

94 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

95 (318.05038452148): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

96 (536.91864013672): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

97 (300.16899108887): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

98 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

99 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

100 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

101 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

102 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

103 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

104 (214.0998840332): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

105 (!!!!! 21267.175674438): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

106 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

107 (52.213668823242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

108 (365.9725189209): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800528 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800528 AND type='deeppockets_item' AND published='1' LIMIT 1

109 (!!!!! 410970.21102905): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

110 (108.95729064941): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

111 (211.00044250488): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

112 (62.942504882812): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

113 (133.99124145508): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

114 (48.87580871582): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

115 (106.0962677002): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

116 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

117 (285.86387634277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

118 (133.03756713867): SELECT name FROM jos_deeppockets WHERE id=212

119 (34.093856811523): SELECT name FROM jos_deeppockets WHERE id=212

120 (444.88906860352): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

121 (370.97930908203): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

122 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

123 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

124 (!!!!! 8594.9897766113): TRUNCATE TABLE jos_trademed_module

125 (92.029571533203): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

126 (669.00253295898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

127 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

128 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

129 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

130 (!!!!! 1179.2182922363): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

131 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

132 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

133 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800528 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800528 AND type='deeppockets_item' AND published='1' LIMIT 1

134 (39.100646972656): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

135 (28.848648071289): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

136 (30.994415283203): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

137 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

138 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800528 AND published='1' LIMIT 1

139 (144.00482177734): select jos_twitters.link from jos_twitters where cat=10

140 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

141 (26.941299438477): select jos_google_plus.link from jos_google_plus where cat=10

142 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

143 (294.92378234863): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

144 (!!!!! 1245.0218200684): insert into jos_banners_delta values (14615,'2025-04-29 16:18:50','3.22.216.30','view'),(14202,'2025-04-29 16:18:50','3.22.216.30','view'),(14203,'2025-04-29 16:18:50','3.22.216.30','view')

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