Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T

Rechichi, Gilda; Galimberti, Stefania; Signorelli, Mauro; Perego, Patrizia; Valsecchi, Maria Grazia; Sironi, Sandro

doi:10.1007/s00330-009-1597-x

Cited by 100 publications

(67 citation statements)

References 38 publications

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“…MRI DWI provides roughly the same level of diagnostic ability as contrast MRI, and in many cases, it further enables the evaluation of tumor spread. However, according to the studies of Rechichi et al 25 , DWI was more effective when a comparison was implemented using 1.5 TMRI between DWI and contrast MRI. In this study, endometrial cancer demonstrated higher signal intensity on DWI than normal endometrium, and the addition of diffusion-weighted imaging to the T2-enhanced axial view further improved the rate of accurate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of Diffusion-weighted Imaging in Observing Localized Extension of Endometrial Cancer

Bell

Yagi

Hatano

et al. 2014

Showa Univ J Med Sci

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: Endometrial cancer is the seventh most common human malignancy and the most common form of cancer treated in women by obstetrics and gynecology departments. Until now, magnetic resonance imaging MRI has been used for pre-surgical evaluation of endometrial cancer and evaluating the depth of myometrial invasion, in addition to being a valuable diagnostic tool. Diffusion-weighted imaging DWI has been reported as useful in distinguishing between benign and malignant tumors when observing lesions in the endometrium. Subsequent reports suggest that DWI is also effective in identifying malignancy and diagnosing local extension in a range of tissues. Based on this, we implemented a study of the effectiveness of DWI in identifying local extension of endometrial cancer. This study enrolled patients undergoing surgery at this hospital for cancer of the uterine body during the six years from January 2008 to February 2014. Cases in which images were unclear or the lesions were too small to be described by MRI examination were excluded, leaving 61 patients in the study. Using the results from pre-surgical MRI, a sequence comprising a T2-weighted axial view alone and a T2-weighted axial view to which a diffusion-weighted axial view had been added was created for each patient. Two radiologists then independently examined the image sequence to determine localized extension. Following surgery, the presurgical assessment was compared to the localized extension determined by histopathology of post-surgical samples to evaluate the effectiveness of adding diffusionweighted imaging to the process. The rst radiographic interpreter s rate of correct diagnosis using the T2-weighted axial view alone was 45 out of 55 cases 81.8 , while using the T2-weighted axial view to which a diffusion-weighted axial view had been added gave a correct diagnosis rate of 51 out of 55 cases 92.7 . The second radiographic interpreter s rate of correct diagnosis using the T2-weighted axial view alone was 41 out of 55 cases 74.5 , while using the T2-weighted axial view with diffusion-weighted axial view added gave a correct diagnosis rate of 51 out of 55 cases 92.7 . These differences were statistically signi cant based on the McNemar testing. This study con rmed that DWI is an effective means of diagnosing localized extension from images. It is anticipated that DWI will be used in the future clinical workplace to provide more accurate pre-surgical diagnoses.

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Section: Discussionmentioning

confidence: 99%

The Usefulness of Diffusion-weighted Imaging in Observing Localized Extension of Endometrial Cancer

Bell

Yagi

Hatano

et al. 2014

Showa Univ J Med Sci

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“…The addition of DWI to routine imaging may improve staging accuracy, not only with respect to myometrial invasion where accuracies of 62-90% have been reported, but for highlighting the tumormyometrial interface in cases where the tumor is isointense to myometrium on T2-W images and/or shows marked peritumoral enhancement on post contrast imaging [13,[18][19][20] In contradistinction to endometrial cancer, the use of intravenous contrast in not routine, rather it is reserved for the following situations: small lesions that are not well depicted on T2-W images (especially if patient is being considered for trachelectomy); post treatment surveillance; and aiding tumor origin in patients with adenocarcinoma involving the lower uterine segment and the cervix. The following table adapted from reference [3] summarizes the revised FIGO staging of cervical cancer with MRI correlates:…”

Section: Methodsmentioning

confidence: 99%

“…Background: Most institutions and educational texts instruct that fasting for at least 6 hours if not more is needed to perform an ultrasound scan of the abdomen to get the best quality images and make an accurate diagnosis of the clinical question being asked. 18,19,20,21 Imaging quality is affected by bowel gas and content which may obscure underlying organs. 4,5 Fasting expands the gallbladder, which when contracted can interfere with diagnosing pathology that may be present.…”

Section: Usamentioning

confidence: 99%

Thursday 17th October 2013

2013

J Med Imag Rad Onc

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“…Although lower ADC values in high-grade tumors have been reported, some studies have reported no correlation between ADC values and histological grades (115,116). DWI is accurate for differentiating stage IB from stage IC and can be used as an adjunct for routine T2W MRI during pre-operative evaluation of endometrial cancer (111,117).…”

Section: Female Pelvis Applicationsmentioning

confidence: 99%

Diffusion weighted MRI for detecting and monitoring cancer: a review of current applications in body imaging

Türkbey

Aras

Karabulut

et al. 2011

Diagn Interv Radiol

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Imaging is used to detect, characterize, and monitor cancer. Recently, diffusion-weighted magnetic resonance imaging (DWI) has become a useful adjunct for assessing tumors with magnetic resonance imaging (MRI). DWI involves the acquisition of a magnetic resonance signal related to random thermal motion (Brownian motion) or the "diffusion" of water protons in tissue. The signal obtained with DWI is a measure of the net displacement of water molecules, e.g., the water path length in the extracellular, intracellular and intravascular spaces. This motion is largely random and can be reduced by structural barriers, such as cell membranes and collagen. Restricted diffusion in biological tissues is inversely proportional to tissue cellularity and the integrity of cell membranes, and it can be quantified with apparent diffusion coefficient (ADC) measurements (1). Depending on the microarchitecture, either restricted or increased diffusion can occur in malignant tumors. For instance, diffusion is restricted in cellular portions of the tumor, but it may be increased in necrotic portions (2, 3). Other causes of enhanced diffusion include increased water content arising from intratumoral edema and cystic tumor components (4-6).Although initially used to evaluate neurological diseases, the applications of DWI have been extended to oncologic imaging throughout the body made possible by improvements in MRI hardware and new sequences. The use of DWI as a complement to conventional MRI methods has led to improvements in the detection and characterization of tumors, treatment response monitoring, and detection of recurrence in oncology patients. Basic concepts of DWIIn 1965, Stejskal and Tanner (7) proposed the application of a symmetric pair of additional gradients on either side of the 180˚ refocusing radiofrequency pulse. The Stejskal-Tanner sequence is still the basis of modern DWI. For static water molecules, the phasing effect caused by the first gradient will be reversed by the second gradient, leading to no signal loss; however, this phasing effect will not be completely reversed if the water molecules are not stationary, which results in the observed well-known diffusion signal decay. The amount of diffusion weighting is determined by the b value, which describes the amplitude, duration of the applied gradient, and time interval between the two diffusion gradients (4). The degree of signal attenuation from water molecules is cor- ABSTRACT Diffusion-weighted magnetic resonance imaging (MRI), which involves the acquisition of a magnetic resonance signal related to the Brownian motion of water protons in tissue, has become a useful technique for assessing tumors. In this article, we review the basic concepts, imaging strategies, and body applications of diffusion-weighted MRI in detecting and monitoring cancer.

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Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T

Abstract: DW imaging proved to be accurate in assessing myometrial invasion, and it could replace dynamic imaging as an adjunct to routine T2-weighted imaging for preoperative evaluation of endometrial cancer.

Cited by 100 publications

References 38 publications

The Usefulness of Diffusion-weighted Imaging in Observing Localized Extension of Endometrial Cancer

The Usefulness of Diffusion-weighted Imaging in Observing Localized Extension of Endometrial Cancer

Thursday 17th October 2013

Diffusion weighted MRI for detecting and monitoring cancer: a review of current applications in body imaging

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