The added value of diffusion-weighted imaging in the preoperative assessment of endometrial cancer

Abstract

Objective: To evaluate the added value of diffusion-weighted imaging (DWI) in the preoperative assessment of myometrial invasion in endometrial cancer, in comparison with T2-weighted imaging (T2WI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Materials and Methods: This was a retrospective study involving 44 women with endometrial cancer who underwent preoperative 1.5 T MRI. Two radiologists, both of whom were blinded to the histopathology reports, performed a consensus interpretation of the depth of myometrial invasion and of the stage of the cancer, considering three sets of sequences: T2WI, DCE-MRI+T2WI, and DWI+T2WI. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each set. The accuracy was compared with p-value adjustment by the Benjamini-Hochberg procedure. Results: Among the 44 patients evaluated, DWI+T2WI demonstrated better diagnostic performance in assessing deep myometrial invasion and correctly staged more patients (n = 41) than did DCE-MRI+T2WI (n = 34) and T2WI (n = 22). The superior diagnostic accuracy of DWI+T2WI was statistically significant in comparison with T2WI (p < 0.05) but not in comparison with DCE-MRI+T2WI (p > 0.05). Conclusion: The addition of DWI apparently improves the diagnostic accuracy of MRI in the preoperative assessment of the depth of myometrial invasion in endometrial cancer, which may be particularly helpful in patients for whom contrast agents are contraindicated.

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

“…Accurate preoperative evaluation of endometrial cancer lesions is very important for conservative treatment [ 9 ]. This also helps choose the appropriate approach of surgery and monitoring treatment effect.…”

“…Multiple studies of endometrial cancer have shown that DWI images and apparent diffusion coefficient (ADC) values are helpful to evaluate the depth of myometrial invasion [ 4 – 8 ]. The accuracy and sensitivity of assessing myometrial invasion by DWI are higher than those by DCE-MRI in endometrial cancer [ 9 ].…”

Staging of Endometrial Cancer Using Fusion T2-Weighted Images with Diffusion-Weighted Images: A Way to Avoid Gadolinium?

“…According to the Global Cancer Observatory, endometrial cancer (EC) is the eighth most common cancer worldwide and the sixth most common cancer in female patients, with an incidence of 8.7 per 100,000 women per year [ 1 , 2 ]. The majority of cases are diagnosed at an early stage (around 80% in stage I), with a 5-year survival rate of 95% [ 3 , 4 , 5 ].…”

“…Each sequence has its own limitations that may sometimes make it challenging to correctly assess the extent of the disease [ 3 , 17 ]. Morphologic imaging is achieved with T2-Weighted Imaging (T2WI) sequences, but is generally combined with functional sequences (Diffusion-Weighted Imaging (DWI) and/or Dynamic Contrast Evaluation (DCE-MRI)) to establish the local staging of EC [ 18 ].…”

“…Although the accuracy of detecting EC myometrial invasion with morphologic and functional imaging is high, there is definitely room for improvement [ 3 , 13 ]. Recently, some authors have attempted to optimize the MRI protocol for EC evaluation by fusing T2WI with functional imaging [ 19 , 20 ].…”