Inchworm sign of endometrial cancer on diffusion-weighted MRI: radiology–pathology correlation

Kawaguchi, Masaya; Kato, Hiroki; Hatano, Yuichiro; Mizuno, Nozomi; Furui, Tatsuro; Morishige, Ken‐ichirou; Hara, Akira; Goshima, Satoshi

doi:10.1016/j.crad.2018.05.017

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…The inchworm sign is a well-known feature of non–muscle-invasive bladder cancer, characterized by an arch-like hyperintense signal with a hypointense submucosal stalk on DWI 27 . In endometrial cancer, a similar sign has been reported as a hypointense myometrial stalk connecting the hyperintense endometrial cancer on DWI 28 . Patients with the inchworm sign tended to exhibit superficial myometrial invasion (Fig.…”

Section: Endometrial Cancermentioning

confidence: 91%

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Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging

2023

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Diffusion-weighted imaging (DWI) is an increasingly valuable sequence in daily clinical practice, providing both functional and morphological information. The use of DWI can help quantify diffusion using the apparent diffusion coefficient, which reflects the physiological features of the tissue and tumor microcirculation. This knowledge is crucial for understanding and interpreting gynecological imaging. This article reviews the clinical utility of DWI for gynecological imaging, highlighting its ability to aid in the detection of endometrial and cervical cancers, as well as tumor extension and metastasis. In addition, DWI can easily detect the solid components of ovarian cancer (including dissemination), assist in the diagnosis of adnexal torsion, and potentially show bone marrow status. Apparent diffusion coefficient measurement is useful for differentiating between endometrial lesions, uterine leiomyomas, and sarcomas, and may provide important information for predicting the prognosis of gynecological cancers.

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Section: Endometrial Cancermentioning

confidence: 91%

“…27 In endometrial cancer, a similar sign has been reported as a hypointense myometrial stalk connecting the hyperintense endometrial cancer on DWI. 28 Patients with the inchworm sign tended to exhibit superficial myometrial invasion (Fig. 7).…”

Section: Endometrial Cancermentioning

confidence: 97%

Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging

2023

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ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer

Gyn¹,

Imaging

Reinhold

et al. 2020

Journal of the American College of Radiology

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High resolution diffusion-weighted imaging with readout segmentation of long variable echo-trains for determining myometrial invasion in endometrial carcinoma

et al. 2020

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Background We assessed the image quality of endometrial cancer lesions by readout segmentation of long variable echo-trains (RESOLVE) diffusion-weighted imaging (DWI) compared with that by single-shot echo-planar imaging (SS-EPI) DWI, aimed to explore the value of RESOLVE DWI for determining myometrial invasion and clinical stage in endometrial cancer. Materials and methods From April 2017 to March 2018, a total of 30 endometrial cancer patients (mean age 52.8 ± 9.0 years), who had undergone RESOLVE DWI and SS-EPI DWI, were included in the study. The image quality of endometrial carcinoma by two kinds of DWI scanning methods was compared qualitatively and quantitatively. The Spearman rank correlation test was used to assess the correlation of qualitative image quality scores between two readers. The accuracy of two DWI methods in detecting myometrial invasion and staging of endometrial carcinoma was calculated according to postoperative pathological results. The indexes were analyzed including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results The qualitative score of RESOLVE DWI group was superior to SS-EPI DWI group in every aspect of five aspects (all P < 0.001). Interobserver agreement of depiction was good or excellent in two DWI sequences. Signal to noise ratio and contrast to noise ratio values in RESOLVE DWI group were both higher than those in SS-EPI DWI group (P<0.001). No statistical difference of apparent diffusion coefficient value was observed between two DWI groups (P = 0.261). The specificity, accuracy, PPV, and NPV of estimating myometrial invasion by RESOLVE DWI in three cases (intramucosal lesion, <50% superficial invasion and ≥ 50% deep invasion) were all higher than those by SS-EPI DWI for endometrial carcinoma. Especially RESOLVE DWI was valuable in judging <50% superficial invasion (95%CI:0.586, 0.970). No significant difference in accuracy staging was between the two DWI groups (P = 0.125). Conclusion RESOLVE DWI can provide higher quality images of endometrial carcinoma than SS-EPI DWI. The high-quality images are helpful for precise assessment of myometrial invasion in endometrial cancer.

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Inchworm sign of endometrial cancer on diffusion-weighted MRI: radiology–pathology correlation

Cited by 3 publications

References 24 publications

Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging

Clinical Utility of Diffusion-Weighted Imaging in Gynecological Imaging

ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer

High resolution diffusion-weighted imaging with readout segmentation of long variable echo-trains for determining myometrial invasion in endometrial carcinoma

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