Detection of lymph node metastasis in cervical and uterine cancers by diffusion‐weighted magnetic resonance imaging at 3T

Lin, Gigin; Ho, Keang-Po; Wang, Jiun‐Jie; Ng, Koon‐Kwan; Wai, Yau‐Yau; Chen, Yen‐Ting; Chang, Chee‐Jen; Ng, Shu‐Hang; Lai, Chyong‐Huey; Yen, Tzu‐Chen

doi:10.1002/jmri.21412

Cited by 207 publications

(122 citation statements)

References 14 publications

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“…Other studies have also evaluated the accuracy of DW-MRI in assessment of myometrial invasion [20][21][22] and have shown similar results. Shen at al.…”

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confidence: 68%

“…Improvements in sensitivity have been reported at 3 T by Lin et al [22]. In patients with cervical or uterine cancer, they found that a combination of nodal size and the relative tumour to node ADC resulted in an increase in sensitivity compared with size criteria from 25 to 83%, whilst maintaining very high specificities.…”

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confidence: 88%

“…DW-MRI was also useful in detection of drop metastases in the cervix or metastatic foci outside the uterus, such as adnexa or peritoneum [20]. Lin et al [22] demonstrated an accuracy of 88% in determining the depth of myometrial invasion using fused T2W and DW images at 3.0 T.…”

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confidence: 99%

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Advances in magnetic resonance imaging of endometrial cancer

Sala

Rockall

2010

Eur Radiol

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Endometrial cancer is the most commonly diagnosed gynaecological malignancy in affluent societies [1]. It occurs most frequently in white women, with peak incidence between ages 55 and 65. Risk factors include unopposed oestrogen intake, use of tamoxifen, nulliparity, obesity, and diabetes. The incidence of endometrial cancer in the United Kingdom has increased by more than 40% between 1993 and 2007. This significant rise is predominantly due to a large increase in incidence in women aged 60-79 [1]. These trends are very similar for most European countries [2]. The increase in prevalence of obesity and decreases in fertility may partly account for the observed rapid increase in incidence and imply that endometrial cancer in postmenopausal women will become a more substantial public health problem in the future.Prognosis depends on a number of factors, including stage, depth of myometrial invasion, lymphovascular invasion, nodal status and histological grade. Depth of myometrial invasion is the single most important morphologic prognostic factor, correlating with tumour grade, lymph node metastases and overall patient survival. Incidence of lymph node metastases increases from 3% with superficial myometrial invasion (stage IA) to 46% with deep myometrial invasion (stage IB) [3]. Preoperative knowledge of these factors is crucial in tailoring the surgical approach. The histological grade can be determined at endometrial sampling, whereas depth of myometrial invasion can only be assessed preoperatively by MRI. Therefore, MRI can assist in preoperative assessment and treatment planning by accurately predicting depth of myometrial invasion, cervical stromal invasion and lymph node involvement. This information allows selection of patients for pelvic or para-aortic lymph node sampling whilst obviating the need for surgery in patients with low risk disease. MRI can also provide additional useful information such as uterine size, tumour volume, ascites and adnexal pathology which in turn may determine whether the surgical approach is transabdominal, transvaginal or laparoscopic.Lymphadenectomy in early (stage I) endometrial cancer remains a controversial issue. Two large prospective multicentre studies investigated whether pelvic lymphadenectomy could improve survival of women with endometrial cancer [4,5]. Both studies reported no benefit in overall or recurrence free survival in the patients randomized to lymphadenectomy. Conversely, the SEPAL study [6] showed that in patients with intermediate or high risk of endometrial cancer recurrence, combined pelvic and paraaortic lymphadenectomy reduced the risk of death compared with pelvic lymphadenectomy alone. The authors acknowledged that MRI is an important factor for predicting lymph node metastasis, and in combination with tumour grade and histology could be helpful to discriminate patients with very low risk of recurrence. Therefore,

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“…Other studies have also evaluated the accuracy of DW-MRI in assessment of myometrial invasion [20][21][22] and have shown similar results. Shen at al.…”

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confidence: 68%

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confidence: 88%

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Advances in magnetic resonance imaging of endometrial cancer

Sala

Rockall

2010

Eur Radiol

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“…Because ADC values vary according to numerous factors, such as MR acquisition parameters and magnetic field, the use of relative ADC can improve the diagnostic accuracy of DWI for detecting metastatic lymph nodes (130-132). Lin et al (132) found that the combination of size and relative ADC values resulted in better sensitivity (25% vs. 83%) and similar specificity (98% vs. 99%) compared with conventional MRI. Primary tumor type (adenocarcinoma vs. adenosquamous carcinoma), focal infiltration with micrometastasis and associated necrosis also affect ADC values, and overlap between hyperplastic and metastatic lymph nodes could occur (119,(129)(130)(131)(132)(133)(134).…”

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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“…These modalities include diffusion-weighted imaging (DWI) of MRI, MRI with ultrasmall superparamagnetic iron oxide (USPIO) [13,21,22] , and positron emission tomography and CT (PET/CT) using 18 F-fluorodeoxyglucose (FDG). To date, there have been three reports on apparent diffusion coefficient (ADC) obtained with DWI for the detection of LN metastasis [23][24][25] and several on PET/CT [20,[26][27][28][29][30][31] for uterine cancer. To the best of our knowledge, there have been no studies comparing the diagnostic accuracy of DWI and PET/CT for preoperative evaluation of LNs in patients with uterine cancer.…”

Section: Introductionmentioning

confidence: 99%

Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer

Kitajima

Yamasaki²,

Kaji³

et al. 2012

WJR

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AIM:To investigate diffusion-weighted imaging (�WI) and positron emission tomography and computed tomography (�ET/CT) with Ⅳ contrast for the preoperative evaluation of pelvic lymph node (LN) metastasis in uterine cancer. METHODS:Twenty-five patients with endometrial or cervical cancer who underwent both �WI and �ET/CT before pelvic lymphadenectomy were included in this study. For area specific analysis, LNs were divided into eight regions: both common iliac, external iliac, internal iliac areas, and obturator areas. The classification for malignancy on �WI was a focally abnormal signal intensity in a location that corresponded to the LN chains on the T1WI and T2WI. The criterion for malignancy on �ET/CT images was increased tracer uptake by the LN. RESULTS:A total of 36 pathologically positive LN areas were found in 9 patients. With �WI, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detecting metastatic LNs on an LN area-by-area analysis were 83.3%, 51.2%, 27.3%, 93.3% and 57.0%, respectively, while the corresponding values for �ET/CT were 38.9%, 96.3%, 70.0%, 87.8% and 86.0%. Differences in sensitivity, specificity and accuracy were significant (� < 0.0005).CONCLUSION: �WI showed higher sensitivity and lower specificity than PET/CT. Neither DWI nor PET/CT were sufficiently accurate to replace lymphadenectomy.

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Detection of lymph node metastasis in cervical and uterine cancers by diffusion‐weighted magnetic resonance imaging at 3T

Cited by 207 publications

References 14 publications

Advances in magnetic resonance imaging of endometrial cancer

Advances in magnetic resonance imaging of endometrial cancer

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

Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer

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