Qualitative and quantitative analysis of diffusion-weighted imaging of gestational trophoblastic disease: Can it predict progression of molar pregnancy to persistent form of disease?

•The incidence of GTD in Iran is significantly higher than America and Europe.•ADC value of GTD is (1.96 ± 0.32 × 10−3 mm2/s).•GTD in T1 and T2-weighted images shows heterogeneous “snow-storm” appearance.•Focal intratumoral hemorrhage is bright in DWI and low signal in the ADC map.•ADC value and DWI are not helpful to predict progression of HM to persistent disease.

PurposeTo describe the diffusion-weighted imaging (DWI) appearance of gestational trophoblastic disease (GTD) and to determine its apparent diffusion coefficient (ADC) values. To evaluate the feasibility of DWI to predict progression of hydatidiform mole (HM) to persistent disease.MethodsDuring a period of 6 months, women with preliminary diagnosis of GTD, based on ultrasound and ßhCG levels, underwent 1.5T MRI (T2 high-resolution and DWI; b values 50, 400, 800; sagittal and perpendicular to the endometrium; and T1, T2 Turbo Spin Echo [TSE] axial images). Patients were followed for 6-12 months to monitor progression to persistent form of the disease. ADC values and image characteristics were compared between HM and persistent neoplasia and between GTD and non-molar pregnancy using Mann-Whitney U and Fisher's exact tests, respectively.ResultsAmong the 23 studied patients, 19 (83%) were classified as molar and 4 (17%) as non-molar, based on pathology reports. After 6-12 months of follow-up, 5 (26%) cases progressed to persistent disease and 14 (74%) cases were benign HM. There was no significant difference between ADC values for HM (1.93 ± 0.33 × 10−3 mm2/s) and persistent neoplasia (2.03 ± 0.28 × 10−3 mm2/s) (P = 0.69). The ADC of non-molar pregnancies was (0.96 ± 0.46 × 10−3 mm2/s), which was significantly different from GTD (1.96  ± 0.32 × 10−3 mm2/s) (P = 0.001). Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity were more common in GTD compared to non-molar pregnancy (P < 0.05).ConclusionHeterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity are among the imaging characteristics of GTD. We cannot use ADC values to predict progression to persistent disease.