Differentiation of Seromucinous Borderline Tumor from Serous Borderline Tumor on MR Imaging

PURPOSE: Seromucinous borderline tumor (SMBT) is a newly categorized ovarian tumor in the 2014 revised World Health Organization (WHO) classification. SMBT is similar to serous borderline tumor (SBT) on MRI reflecting their pathological findings. This study was conducted to demonstrate the usefulness of MRI findings and quantitative values for differentiating SMBT from SBT. METHODS: This retrospective study examined 23 lesions (20 patients) from SMBT and 26 lesions (22 patients) from SBT. The following quantitative values were evaluated using receiver-operating characteristics analysis: overall and solid portion sizes, intracystic fluid signal intensity (SI) ratio compared with skeletal muscle on T(1)weighted image (T(1)WI) and T(2)weighted image (T(2)WI), contrast enhancement (CE) ratio, and mean and minimum apparent diffusion coefficient values of the solid portion. Two radiologists evaluated the prevalence of MRI finding characteristics of SMBT and SBT. The SI of the intracystic fluid on T(1)WI and T(2)WI and the association with endometriosis were evaluated visually. RESULTS: The CE ratio was significantly higher in SBT (P = 0.007). It achieved the highest area under the curve (AUC) (0.739). The fluid SI ratio on T(1)WI was higher in SMBT (P = 0.036, AUC = 0.676). Exophytic growth of the solid portion was observed only in SBT (P = 0.011). Intracystic fluid SI of SMBT was higher on T(1)WI and lower on T(2)WI in visual evaluation (P = 0.008 and 0.007, respectively). Findings suggesting endometriosis were observed more frequently in SMBT patients (P = 0.019). CONCLUSION: Higher CE ratio of the solid portion and exophytic growth were findings suggesting SBT. Higher intracystic fluid SI on T(1)WI and lower SI on T(2)WI suggested SMBT. MRI findings suggesting endometriosis favored the diagnosis of SMBT.