Purpose: To develop a one-step quantification approach that accounts for joint preprocessing and quantification of whole-range kinetics (early and late-phase washout) of dynamic contrast-enhanced (DCE) MRI of indeterminate adnexal masses.

Methods: Preoperative DCE-MRI of 43 (24 benign, 19 malignant) sonographically indeterminate adnexal masses were analyzed prospectively. A five-parameter sigmoid function was implemented to model the enhancement curves calculated within regions of interest. Diagnostic performance of five-parameter sigmoid model parameters (P1 through P5 ) was compared with pharmacokinetic (PK) modeling, semiquantitative analysis, and three-parameter sigmoid. Statistical analysis was performed using two-tailed student's t-test.

Results: The results revealed that P2 , representing the enhancement amplitude, is significantly higher, and P5 , indicating the terminal phase, is generally negative in malignant lesions (P < 0.001). P2 (sensitivity = 79%, specificity = 87.5%, accuracy = 84%, area under the receiver operating characteristic curve = 91%) outperforms classification performances of PK and semiquantitative parameters. A combination of P2 and P5 shows comparable performance (sensitivity = 79%, specificity = 87.5%, accuracy = 84%, area under the receiver operating characteristic curve = 92%) to that of the combination of PK parameters, whereas the five-parameter sigmoid function maintains fewer assumptions than PK.

Conclusions: The presented one-step quantification approach is helpful for accurate discrimination of benign from malignant indeterminate adnexal masses. Accordingly, P2 has considerably high diagnostic performance and terminal slope (P5 ), as a previously overlooked feature, contributes more than widely accepted early-enhancement kinetic features. Magn Reson Med 79:1165-1171, 2018. © 2017 International Society for Magnetic Resonance in Medicine