New possibilities for assessing the magnetic resonance characteristics of endometrioid ovarian cysts and their response to dienogest therapy

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Objective: To evaluate the dynamics of changes in the size of ovarian endometriomas (OMA) in patients receiving the dienogest (DNG) therapy and determine the significant parameters of magnetic resonance imaging (MRI) that affect their reduction.

Materials and methods: This was a prospective study which was conducted at the Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Moscow, in the period from 2021 to 2023. The study included 24 patients with 37 OMA (average age is 33.54 (7.08) years). The patients received DNG (drug "Zafrilla") at daily dosage 2 mg in a continuous mode. Before the start of therapy and after 6 months of its administration, an MRI of the pelvic organs was conducted with a simultaneous calculation of a number of parameters: the size and volume of cysts with the calculation of the reduction coefficient, the measured diffusion coefficient (MDC), the ratio between the maximum and minimum values of MDC, signal intensity on T2-weighted images. The initial and subsequent levels of AMH and CA-125 were determined in the blood serum.

Results: The analysis of the data showed that DNG therapy leads to a decrease in the volume of OMA by 50% or more in 73% of cases, by 75% or more in every 2nd case of the disease. The full effect of the therapy was noted in every 10th case (100%). The reduction coefficient was significantly influenced by the initial MDC values (r=0.559, p=0.068), the degree of uniformity of the cyst contents (r=0.5491, p=0.0081), the time until its detection (r=-0.4432, p=0.0077), as well as its initial dimensions (<2 cm in diameter, p=0.0015). The higher the initial MDC values correlated with more pronounced effect of therapy. It was shown that at an MDC value of ≥0.792, a decrease in OMA volume by 75% or more with a sensitivity of 90.0% and a specificity of 78.57% can be expected (AUC 0.814 (0.093) [95% CI 0.604;0.942], p=0.0007).

Conclusion: DNG suppressive hormone therapy helps to reduce the volume of OMA by an average of 78.91%. MRI of the pelvic organs is not only a method of diagnosing OMA, but it is also a tool for evaluating the effectiveness of therapy with MDC. MDC value of ≥0.792 may indicate a potential decrease in the volume of OMA by 75% or more, which is important for making a decision about the patient’s management tactics.

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Sobre autores

Galina Chernukha

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Autor responsável pela correspondência
Email: c-galina1@yandex.ru
ORCID ID: 0000-0002-9065-5689

Dr. Med. Sci., Professor, Chief Researcher, obstetrician-gynecologist at the Department of Gynecological Endocrinology

Rússia, Moscow

Alina Solopova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_solopova@oparina4.ru
ORCID ID: 0000-0003-4768-115X

Dr. Med. Sci., Associate Professor, Leading Researcher at the Department of Radiology

Rússia, Moscow

Veronika Pronina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: ver22595@yandex.ru
ORCID ID: 0000-0003-4566-4065

obstetrician-gynecologist, PhD student

Rússia, Moscow

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2. Fig. 1. Algorithm for inclusion of patients in a prospective study

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3. Fig. 2. Percentage reduction in endometrioma volume during therapy

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4. Fig. 3. Threshold value of IDC (*103 mm2/s) with a decrease in EC volume by 75% or more during DNG therapy

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