Endometrial Cancer: Correlation of Apparent Diffusion Coefficient With Tumor Grade, Depth of Myometrial Invasion, and Presence of Lymph Node Metastases

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

doi:10.2214/ajr.10.5584

Cited by 107 publications

(103 citation statements)

References 26 publications

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“…In patients with endometrial cancer, DWI has shown promising results (8,27,28) for prediction of deep myometrial invasion, but discordant results have been reported for prediction of tumor grade (29)(30)(31). Most studies (29)(30)(31) have been focused on selected regions of interest (ROIs) placed on a representative image of the tumor for analysis.…”

Section: Author Contributionsmentioning

confidence: 99%

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Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Nougaret¹,

Reinhold²,

AlSharif³

et al. 2015

Radiology

143

114

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Purpose:To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. Materials and Methods:The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. Results:No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P , .0001).There was no significant difference in the ADCs between grades 1 and 2 tumors (P . .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P , .02). Conclusion:The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.q RSNA, 2015

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Section: Author Contributionsmentioning

confidence: 99%

“…Most studies (29)(30)(31) have been focused on selected regions of interest (ROIs) placed on a representative image of the tumor for analysis. Thus, these techniques do not allow assessment of the problems of ROI size and positioning variations.…”

Section: Author Contributionsmentioning

confidence: 99%

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Nougaret¹,

Reinhold²,

AlSharif³

et al. 2015

Radiology

143

114

View full text Add to dashboard Cite

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“…DWI, as a functional MRI technique, provides non-invasive and high-resolution information on tissue characteristics based on molecular water diffusion properties, and the imaging output is useful to determine tissue microstructure, density, microcirculation and cellular organization (9,11,33). Several studies describe a close association between cell density and ADC values (16,(33)(34)(35). High ADC values are present in benign lesions, including primary neoplasms that contain low cell densities, while low ADC values are typically observed in malignant neoplasms, due to high cell densities and altered membrane permeability (15,16).…”

Section: Discussionmentioning

confidence: 99%

Diffusion weighted imaging for the differential diagnosis of benign vs. malignant ovarian neoplasms

et al. 2016

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Abstract. In order to assess the diagnostic accuracy of diffusion weighted imaging (DWI) in differentiating between benign and malignant ovarian neoplasms, a systemic meta-analysis was conducted. Relevant studies were retrieved from scientific literature databases, including the PubMed, Wiley, EBSCO, Ovid, Web of Science, Wanfang, China National Knowledge Infrastructure and VIP databases. Following a multi-step screening and study selection process, the relevant data was extracted for use in the present study. Statistical analyses were performed using Meta-disc software version 1.4 and STATA statistical software version 12.0. A total of 285 articles were retrieved from the database searches. Following a careful screening process, 10 case-control studies were selected for the present meta-analysis. The 10 studies investigated the efficacy of DWI in diagnosing ovarian neoplasms, and included a combined total of 1,159 subjects, of which 559 patients had malignant lesions and 600 had benign lesions. The results showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio (DOR) and area under the curve of the summary receiver operating characteristics curve of DWI for differentiating between benign and malignant ovarian neoplasms were 0. 93, 0.89, 7.58, 0.10, 85.33 and 0.95, respectively

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“…The temporal and spatial resolutions of FLASH-3D are also enhanced. 4,10,11 In addition to the speed of imaging, the high signal-to-noise ratio aids the detection of small lesions and early endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

“…FLASH-3D is also able to detect signal foci or small lesions on T2WI, thus providing clearer information for the early diagnosis of muscular invasion, and cervical and lymph node metastases in patients with endometrial carcinoma. [11][12][13] Based on the detection of endometrial damage, junctional zone disruption and the extent of myometrial invasion, FLASH-3D can assess the degree of tumour infiltration and FIGO staging, which have great clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Application of FLASH-3D dynamic contrast-enhanced imaging for diagnosis of endometrial carcinoma

Xiao-hu

Qiu

et al. 2016

BJR

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The authors Lixin Du and Xiaohu Li contributed equally to this article.Objective: To investigate the application and value of fast low-angle shot three-dimensional (FLASH-3D) dynamic contrast-enhanced MRI for the pre-operative staging of endometrial carcinoma. Methods: This prospective study enrolled 48 patients with complete clinical data and pathologically confirmed endometrial carcinoma from July 2012 to March 2014. After routine MRI examination, subjects underwent FLASH-3D dynamic contrast-enhanced examination. The dynamically enhanced features of the uterine wall and tumours were analyzed. FLASH-3D pre-operative staging and findings in relation to myometrial invasion were compared with post-operative pathological results in a double-blind manner. Results: There were 48 cases of pathologically proven endometrial carcinoma, including 34 patients with Stage I (Stage Ia 22 cases and Stage Ib 12 cases), 9 with Stage II, 3 with Stage III and 2 with Stage IV. The staging accuracy for endometrial carcinoma was 81% (39/48) using FLASH-3D dynamic contrast-enhanced sequences. The sensitivity, specificity and accuracy for the determination of deep myometrial invasion were 84%, 90% and 88%, respectively. There was no significant difference compared with the results of post-operative pathology (p . 0.05). Conclusion: FLASH-3D dynamic contrast-enhanced imaging may be valuable for the early diagnosis and preoperative staging of endometrial carcinoma. Its high accuracy for assessing deep myometrial invasion makes FLASH-3D imaging an important tool for selecting the optimal therapeutic protocol and for prognosis estimation. Advances in knowledge: FLASH-3D can significantly improve the accurate assessment of the depth of tumour invasion into the myometrium and may thus help to guide clinical surgical choices and post-operative evaluation. FLASH-3D is thus a promising technique for the routine examination of female pelvic tumours.

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Endometrial Cancer: Correlation of Apparent Diffusion Coefficient With Tumor Grade, Depth of Myometrial Invasion, and Presence of Lymph Node Metastases

Abstract: ADC values allow normal endometrium to be differentiated from endometrial carcinoma; however, they do not correlate with histologic tumor grade, the depth of myometrial invasion, or whether lymph node metastases are present.

Cited by 107 publications

References 26 publications

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

Diffusion weighted imaging for the differential diagnosis of benign vs. malignant ovarian neoplasms

Application of FLASH-3D dynamic contrast-enhanced imaging for diagnosis of endometrial carcinoma

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