Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion

Takeuchi, Mayumi; Matsuzaki, Kei; Nishitani, Hiromu

doi:10.1080/02841850903099981

Cited by 105 publications

(77 citation statements)

References 16 publications

(22 reference statements)

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“…Thus, MRI is useful for detection of deep myometrial invasion, but it is difficult to distinguish early stage EC from AEH in an endometrial lesion detected by MRI. To our knowledge, differentiation of these lesions has not been achieved, although the apparent diffusion coefficient (ADC) is effective for distinguishing EC from normal endometrium or a benign endometrial lesion (Tamai et al 2007;Takeuchi et al 2009). Use of this parameter for distinguishing early EC from AEH requires further examination.…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic Inspection and Total Curettage Are Insufficient for Discriminating Endometrial Cancer from Atypical Endometrial Hyperplasia

Kurosawa

Itō

Nikura

et al. 2012

Tohoku J. Exp. Med.

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Endometrial cancer (EC) is the most prevalent gynecologic malignancy in Japan. Atypical endometrial hyperplasia (AEH) is viewed as the premalignant lesion of EC, however it is often difficult to distinguish EC from AEH. The rate of concurrent EC in women diagnosed preoperatively with AEH based on endometrial biopsy was reported as 17-52%. Although hysteroscopic inspection and total curettage are considered as useful methods to make diagnosis of endometrial lesions, there is no report using this combined method to discriminate EC from AEH. The purpose of this study was to examine whether hysteroscopic inspection and total curettage improve the prevalence of EC among women diagnosed preoperatively with AEH. We reviewed 22 patients who underwent hysteroscopic inspection and total curettage and were diagnosed with AEH before undergoing hysterectomy between November 2001 and May 2011. The diagnosis made with the hysterectomy specimens revealed AEH in 10 patients (45.5%), endometrial hyperplasia without atypia in 3 (13.6%), and endometrioid adenocarcinoma, the most common type of EC, in 9 (40.9%). Endometrioid adenocarcinoma included 7 patients without myometrial invasion (31.8%) and 2 patients with superficial myometrial invasion (9.1%). There was no hysteroscopic finding that was specific for EC or AEH. In conclusion, about 41% of women who underwent hysterectomy under a diagnosis of AEH were found to have coexisting adenocarcinoma, although the prevalence of EC among those women was similar to that in earlier reports with endometrial biopsy. Accordingly, we must be careful in planning the therapeutic strategy for women with a preoperative diagnosis of AEH.

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Section: Discussionmentioning

confidence: 99%

Hysteroscopic Inspection and Total Curettage Are Insufficient for Discriminating Endometrial Cancer from Atypical Endometrial Hyperplasia

Kurosawa

Itō

Nikura

et al. 2012

Tohoku J. Exp. Med.

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“…Previous publications have demonstrated that endometrial carcinoma may be distinguished from normal endometrium on DW-MRI [24][25][26][27][28][29][30]. It has also been suggested that DW-MRI may be useful in the preoperative assessment of tumour grade [26,31].…”

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confidence: 99%

Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer

Bharwani

Miquel²,

Sahdev³

et al. 2011

BJR

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Objective: Endometrial cancer is the most common gynaecological malignancy in developed countries. Histological grade and subtype are important prognostic factors obtained by pipelle biopsy. However, pipelle biopsy ''samples'' tissue and a high-grade component that requires more aggressive treatment may be missed. The purpose of the study was to assess the use of diffusion-weighted MRI (DW-MRI) in the assessment of tumour grade in endometrial lesions. we obtained a sensitivity, specificity, positive predictive value and negative predictive value for malignancy of 87%, 100%, 100% and 85.7%, respectively. Conclusion: Tumour mean and minimum ADC values are not useful in differentiating histological tumour grade in endometrial carcinoma. However, mean ADC measurement can provide useful information in differentiating benign from malignant endometrial lesions. This information could be clinically relevant in those patients where pre-operative endometrial sampling is not possible.

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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%

“…DWI imaging of endometrial tumors has decreased ADC values (108)(109)(110)(111)(112)(113)(114)(115)(116). Endometrial carcinoma is clearly depicted as an area of increased signal intensity relative to the surrounding hypointense myometrium on DWI (116).…”

Section: Female Pelvis Applicationsmentioning

confidence: 99%

“…Endometrial carcinoma is clearly depicted as an area of increased signal intensity relative to the surrounding hypointense myometrium on DWI (116). ADC measurements have the potential to quantitatively differentiate Stage IA endometrial carcinoma from normal endometrium, endometrial dysplasia and benign diseases of the endometrium, such as endometrial hyperplasia, adenomyosis, submucosal leiomyoma, and endometrial polyps (108)(109)(110)(111)(112)(113)(114)(115)(116). DWI and combined DWI/T2W MRI can increase the overall detection sensitivity for endometrial carcinoma (113).…”

Section: Female Pelvis Applicationsmentioning

confidence: 99%

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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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Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion

Abstract: DWI provides helpful information in evaluating benign and malignant endometrial lesions.

Cited by 105 publications

References 16 publications

Hysteroscopic Inspection and Total Curettage Are Insufficient for Discriminating Endometrial Cancer from Atypical Endometrial Hyperplasia

Hysteroscopic Inspection and Total Curettage Are Insufficient for Discriminating Endometrial Cancer from Atypical Endometrial Hyperplasia

Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer

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

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