Update on MRI in Evaluation and Treatment of Endometrial                     Cancer

Maheshwari, Ekta; Nougaret, Stéphanie; Stein, Erica B.; Rauch, Gaiane M.; Hwang, Ken Pin; Stafford, R. Jason; Klopp, Ann H.; Soliman, Pamela T.; Maturen, Katherine E.; Rockall, Andrea; Lee, Susanna I.; Sadowski, Elizabeth A.; Venkatesan, Aradhana M.

doi:10.1148/rg.220070

Cited by 53 publications

(19 citation statements)

References 71 publications

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“…Therefore, preoperative risk assessment is crucial to the formulation of the treatment plan and selection of postoperative adjuvant treatment. MRI has superior resolution and good soft tissue identi cation ability [19]. The ADC values derived from the DWI re ect the diffusion of water molecules in different tissue microenvironments and have been shown to correlate negatively with the degree of tumor proliferation and cell density.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) has the advantage of high soft-tissue resolution and powerful functional imaging [11]. Diffusion weighted imaging (DWI), which can assess the histological type of malignancy through the Brownian motion of water molecules, has been extensively studied in the evaluation of gynecological malignancies [12]. The apparent diffusion coe cient (ADC) value shows the diffusion of extracellular water protons in the tumor tissue.…”

Section: Introductionmentioning

confidence: 99%

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Development of an apparent diffusion coefficient based on nomogram for the preoperative prediction of Ki-67 and p53 expression levels and myometrial infiltration in endometrial cancer

Zhang

Jing

Cao

et al. 2023

Preprint

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Background Endometrial cancer (EC) has been increasing in incidence and mortality rates over the years. To investigate the feasibility of ADC in preoperative non-invasive prediction of myometrial infiltration and Ki-67 and p53 expression levels in patients with EC. Methods we performed the retrospective analysis of 105 patients with EC who underwent preoperative magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) and were confirmed by pathology after operation from January 2017 to December 2021 in our hospital. Two independent radiologists measured the ADC values (ADCmax, ADCmean, and ADCmin) of EC on the ADC image by comparing the MRI enhancement and DWI images, respectively. Statistical methods were used to calculate the correlation between clinical information, ADC values and myometrial infiltration and Ki-67 and p53 expression in EC patients. A nomogram prediction model was constructed and evaluated via receiver operating characteristic (ROC) curve and calibration curve analysis. Results The ADC values were significantly correlated with the myometrial infiltration and Ki-67 and p53 expression levels in EC patients (all P < 0.05). The International Federation of Gynecology and Obstetrics (FIGO) stage only significantly associated with the myometrial infiltration and Ki-67 expression levels in EC patients (all P < 0.05). The ADCmax, ADCmean, and ADCmin were combined with the FIGO stage to construct the nomogram model. The nomogram model, ADCmax, ADCmean, ADCmin, and FIGO stage predicted AUC values of 0.809, 0.707, 0.693, 0.694, and 0.599 for myometrial infiltration, respectively; the AUC values for predicting Ki-67 expression levels were 0.897, 0.879, 0.849, 0.808 and 0.550, respectively. The nomogram model was constructed by combining the ADCmax, ADCmean, ADCmin. The AUC values predicted by the nomogram, ADCmax, ADCmean, ADCmin were 0.665, 0.615, 0.641 and 0.654, respectively. Conclusions The nomogram model based on ADC values combined with the FIGO stage could be a useful method for the preoperative non-invasive assessment of myometrial infiltration and Ki-67 and p53 expression in EC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of an apparent diffusion coefficient based on nomogram for the preoperative prediction of Ki-67 and p53 expression levels and myometrial infiltration in endometrial cancer

Zhang

Jing

Cao

et al. 2023

Preprint

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“…On dynamic multiphase contrast-enhanced MRI, deep myometrial invasion was evaluated in the equilibrium phase (2–3 min postinjection) because the tumor-to-myometrial contrast ratio was the highest at that point [ 26 , 27 ]. Cervical stromal invasion was evaluated in the delayed phase (4–5 min postinjection) [ 28 ]. Extrauterine extension was defined as disruption of the hypointense signal of the uterine serosa on T2-weighted images with irregularity of the outer smooth uterine contour and loss of the normal rim enhancement of the outer myometrium on contrast-enhanced images.…”

Section: Methodsmentioning

confidence: 99%

Predictive Value of Magnetic Resonance Imaging in Risk Stratification and Molecular Classification of Endometrial Cancer

Bae,

Rha,

Kim

et al. 2024

Cancers

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This study evaluated the magnetic resonance imaging (MRI) findings of endometrial cancer (EC) patients and identified differences based on risk group and molecular classification. The study involved a total of 175 EC patients. The MRI data were retrospectively reviewed and compared based on the risk of recurrence. Additionally, the associations between imaging phenotypes and genomic signatures were assessed. The low-risk and non-low-risk groups (intermediate, high-intermediate, high, metastatic) showed significant differences in tumor diameter (p < 0.001), signal intensity and heterogeneity on diffusion-weighted imaging (DWI) (p = 0.003), deep myometrial invasion (involvement of more than 50% of the myometrium), cervical invasion (p < 0.001), extrauterine extension (p = 0.002), and lymphadenopathy (p = 0.003). Greater diffusion restriction and more heterogeneity on DWI were exhibited in the non-low-risk group than in the low-risk group. Deep myometrial invasion, cervical invasion, extrauterine extension, lymphadenopathy, recurrence, and stage discrepancy were more common in the non-low-risk group (p < 0.001). A significant difference in microsatellite stability status was observed in the heterogeneity of the contrast-enhanced T1-weighted images (p = 0.027). However, no significant differences were found in MRI parameters related to TP53 mutation. MRI features can be valuable predictors for differentiating risk groups in patients with EC. However, further investigations are needed to explore the imaging markers based on molecular classification.

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“…MRI and transvaginal ultrasound are the main methods to evaluate the depth of MI preoperatively ( 7 ). Preoperative MRI is the first choice to determine the International Federation of Gynecology and Obstetrics (FIGO) stage of EC and has high sensitivity and specificity for the detection of DMI ( 8 ). Several meta-analyses ( 9 - 11 ) have reported that the sensitivity and specificity of MRI for assessing DMI range from 0.77 to 0.86 and 0.81 to 0.88, respectively.…”

Section: Introductionmentioning

confidence: 99%

Multiparametric magnetic resonance imaging-based assessment of the effect of adenomyosis on determining the depth of myometrial invasion in endometrial cancer

Meng,

Liu,

Yang

et al. 2024

Quant Imaging Med Surg

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Background Accurate preoperative diagnosis of endometrial cancer (EC) with deep myometrial invasion (DMI) is critical to deciding whether to perform lymphadenectomy. However, the presence of adenomyosis makes distinguishing DMI from superficial myometrial invasion (SMI) on magnetic resonance imaging (MRI) challenging. We aimed to evaluate the accuracy of multiparametric MRI (mpMRI) in diagnosing DMI in EC coexisting with adenomyosis (EC-A) compared with EC without coexisting adenomyosis and to evaluate the effect of different adenomyosis subtypes on myometrial invasion (MI) depth in EC. Methods Patients with histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stage I EC who underwent preoperative MRI were consecutively included in this 2-center retrospective study. Institution 1 was searched from January 2017 to November 2022 and institution 2 was searched from June 2017 to March 2021. Patients were divided into 2 groups: group A, patients with EC-A; group B, EC patients without coexisting adenomyosis, matched 1:2 according to age ±5 years and tumor grade. A senior radiologist assessed the MRI adenomyosis classification in group A. Then, 2 radiologists (R1/R2) independently interpreted T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), T1-weighted contrast-enhanced (T1CE), and a combination of all images (mpMRI) respectively, and then assessed MI depth. Accuracy, sensitivity, specificity, and the areas under the receiver operating curve (AUC) were calculated. The chi-square test was used to compare the accuracy of diagnosing DMI. Interobserver agreement was evaluated using the Kappa test. Results A total of 70 cases in group A and 140 cases in group B were included. The accuracy, sensitivity, and specificity of consensus were 94.3% [95% confidence interval (CI): 88.9–99.7%] vs . 92.1% (95% CI: 87.7–96.6%), 60.0% (95% CI: 17–92.7%) vs . 86.7% (95% CI: 68.4–95.6%), and 96.9% (95% CI: 88.4–95.5%) vs . 93.6% (95% CI: 86.8–97.2%) (group A vs . group B, respectively). There was no significant difference in the diagnostic accuracy of DMI on each sequence between the groups (Reviewer 1/Reviewer 2): P T2WI =0.14/0.17, P DWI =0.50/0.33, P T1CE =0.90/0.18, P mpMRI =0.50/0.37. The AUC for T2WI, DWI, T1CE, and mpMRI (Reviewer 1/Reviewer 2), respectively, were 0.54 (95% CI: 0.42–0.66)/0.78 (95% CI: 0.67–0.87), 0.63 (95% CI: 0.50–0.74)/0.77 (95% CI: 0.65–0.86), 0.69 (95% CI: 0.57–0.80)/0.79 (95% CI: 0.68–0.88), and 0.91 (95% CI: 0.82–0.97)/0.89 (95% CI: 0.79–0.95) (group A) and 0.83 (95% CI: 0.76–0.89)/0.85 (95% CI: 0.78–0.90), 0.83 (95% CI: 0.76–0.89)/0.86 (95% CI: 0.79–0.91), 0.88 (95% CI: 0.82–0.93)/0.86 (95% CI: 0.80–0.92), and 0.91 (95% CI: 0.85–0.95)/0.87 (95% CI: 0.80–0.92) (group B). Inte...

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Update on MRI in Evaluation and Treatment of Endometrial Cancer

Cited by 53 publications

References 71 publications

Development of an apparent diffusion coefficient based on nomogram for the preoperative prediction of Ki-67 and p53 expression levels and myometrial infiltration in endometrial cancer

Development of an apparent diffusion coefficient based on nomogram for the preoperative prediction of Ki-67 and p53 expression levels and myometrial infiltration in endometrial cancer

Predictive Value of Magnetic Resonance Imaging in Risk Stratification and Molecular Classification of Endometrial Cancer

Multiparametric magnetic resonance imaging-based assessment of the effect of adenomyosis on determining the depth of myometrial invasion in endometrial cancer

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