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Background  Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the usefulness of apparent diffusion coefficients (ADC) for characterizing complex solid and cystic adnexal masses.    Methods  One-hundred and 91 patients underwent diffusion-weighted (DW) magnetic resonance (MR) imaging of 202 ovarian masses. The mean ADC value of the solid components was measured and assessed for each ovarian mass. Differences in ADC between ovarian masses were tested using the Student’s  t -test. The receiver operating characteristic (ROC) was used to assess the ability of ADC to differentiate between benign and malignant complex adnexal masses.    Results  Eighty-five patients were premenopausal, and 106 were postmenopausal. Seventy-four of the 202 ovarian masses were benign and 128 were malignant. There was a significant difference between the mean ADC values of benign and malignant ovarian masses (p < 0.05). However, there were no significant differences in ADC values between fibrothecomas, Brenner tumors and malignant ovarian masses. The ROC analysis indicated that a cutoff ADC value of 1.20 x10 -3  mm 2 /s may be the optimal one for differentiating between benign and malignant tumors.    Conclusions  A high signal intensity within the solid component on T2WI was less frequently in benign than in malignant adnexal masses. The combination of DW imaging with ADC value measurements and T2-weighted signal characteristics of solid components is useful for differentiating between benign and malignant ovarian masses.

Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T