Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging

Abstract

BackgroundThe age of onset of endometrial carcinoma has been decreasing in recent years. In endometrial carcinoma, it is important to accurately assess invasion depth and preoperative staging. Fusion of T2-weighted magnetic resonance imaging (T2WI) and diffusion-weighted magnetic resonance imaging (DWI) may contribute to the improvement of anatomical localization of lesions.Materials and methodsIn our study, a total of 58 endometrial carcinoma cases were included. Based on the revised 2009 International Federation of Gynecology and Obstetrics staging system, a fusion of T2WI and DWI was utilized for the evaluation of invasion depth and determination of the overall stage. Postoperative pathologic assessment was considered as the reference standard. The consistency of T2WI image staging and pathologic staging, and the consistency of fused T2WI and DWI and pathologic staging were all analyzed using Kappa statistics.ResultsCompared with the T2WI group, a significantly higher diagnostic accuracy was observed for myometrial invasion with fusion of T2WI and DWI (77.6% for T2WI; 94.8% for T2WI-DWI). For the identification of deep invasion, we calculated values for diagnostic sensitivity (69.2% for T2WI; 92.3% for T2WI-DWI), specificity (80% for T2WI; 95.6% for T2WI-DWI), positive predictive value (50% for T2WI; 85.7% for T2WI-DWI), and negative predictive value (90% for T2WI; 97.7% for T2WI-DWI). In summary, T2WI-DWI fusion exhibits higher diagnostic accuracy with respect to staging relative to T2WI only (81.0% for T2WI; 94.8% for T2WI-DWI).ConclusionFused T2WI-DWI may represent a noninvasive, lower cost approach for the effective assessment of myometrial invasion and staging of endometrial carcinoma.

The apparent diffusion coefficient (ADC) on 3-T MRI differentiates myometrial invasion depth and histological grade in patients with endometrial cancer

“…Although the exact mechanisms remain under discussion, it may be theorized that this reflects the increased cell densities in a larger and presumably faster-growing tumor (31). It is interesting to note that this finding contrasts with that in some previous studies conducted with 1.5-T MRI (13), but confirms in part the results other authors who also used a 3.0-T MRI system for DWI reported previously (20,32), which is consistent Fig. 4.…”

Tumoral volume measured preoperatively by magnetic resonance imaging is related to survival in endometrial cancer

“…A recent study found a higher performance using fusion of T2-weighted magnetic with diffusion-weighted MR images, with a sensitivity of 92.3% and specificity of 95.5% for deep myometrial invasion detection. 21 In relation to ultrasound, we obtained a poor result in order to detect the deep myometrial invasion. A recent study analyzing 210 women with proven EC found that both subjective assessment and objective ratios were significant predictors of the myometrial invasion, but subjective assessment was confirmed as the most reliable method to assess myometrial invasion (sensitivity 79% and specificity 73%).…”

Combination Assessment of Diffusion-Weighted Imaging and T2-Weighted Imaging Is Acceptable for the Differential Diagnosis of Lung Cancer from Benign Pulmonary Nodules and Masses

“…Diagnostic possibilities would be increased after fused T2WI and DWI for lung cancers and BPNMs. T2WI combined with DWI may be a valuable tool for detecting prostate cancer in the overall evaluation of prostate cancer [ 33 , 34 ], and myometrial invasion and staging of endometrial carcinoma [ 35 , 36 ]. Adding DWI to T2WI is helpful for detecting viable tumors after neoadjuvant chemoradiation therapy compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer [ 37 ].…”