Endometrial cancer: the role of MRI quantitative assessment in preoperative staging and risk stratification

Abstract

Background New methods to reduce subjectivity in preoperative magnetic resonance imaging (MRI) staging of endometrial cancer are needed. Purpose To investigate the role of MRI quantitative assessment in staging and risk stratification of endometrial cancer. Material and Methods Preoperative T2-weighted (T2W) images and diffusion-weighted imaging of 42 patients were analyzed retrospectively by two radiologists. Tumor area ratio (TAR) and tumor volume ratio (TVRseg) were calculated by semi-automatic segmentation of the tumor and uterus on T2W imaging and apparent diffusion coefficient (ADC). TVR was also calculated by the 3D metric method (TVRmetric). Mean ADCtumor was calculated. The patients were allocated to risk groups regarding the stage, grade, and lymphovascular invasion (LVI) status. Results TAR, TVRmetric, T2W TVRseg, and ADC TVRseg showed a significant difference between the superficial and deep myometrial invasion groups ( P < 0.001). All of these parameters showed a good diagnostic performance for detecting deep myometrial invasion (AUC>0.82), the highest accuracy rate (85%) was found with T2W TVRseg. LVI was significantly associated with TAR ( P = 0.002) and T2W TVRseg ( P = 0.014), while the cervical invasion was associated with TAR ( P = 0.03). ADCtumor was significantly lower in high-grade tumors ( P = 0.002). There was a significant difference in ADCtumor ( P = 0.002), TAR ( P = 0.004), and T2W TVRseg ( P = 0.038) between the low- and high-risk groups. AUC of TAR and T2W TVRseg for detecting high-risk groups were 0.80 and 0.77, respectively, while AUC of ADCtumor for the low-risk group was 0.75. Conclusion MRI quantitative assessments such as TAR, TVR, and ADCtumor may improve the accuracy of preoperative staging and can help in risk stratification of endometrial cancer.

Feasibility of accelerated T2 mapping for the preoperative assessment of endometrial carcinoma

“…This study showed that the diagnostic accuracy of the T2 and ADC values in distinguishing EA and non-EA tumors is comparable. However, we did not observe significant differences in the T2 and ADC values between types I and II EMCs, and between superficial and deep myometrial invasion, which was consistent with previous studies ( 6 ).…”

Magnetic Fields and Cancer: Epidemiology, Cellular Biology, and Theranostics

“…MRI with DWI and DCE sequences can help establish a correct diagnosis [502,503], while 3.0 T multimodal MRI is an important imaging tool for preoperative endometrial cancer staging [504]. MRI quantitative assessments such as tumor area ratio (TAR), tumor volume ratio (TVR), MRI-based wholetumor radiomic signatures, and ADC were found to improve the accuracy of preoperative staging, helping in the risk stratification of endometrial cancer [505][506][507]. The combination of MRI and immunohistochemical examination is a powerful tool for preoperative risk stratification to assist in clinical decision-making for endometrial cancer patients [508].…”

A MRI-based nomogram to preoperatively predict histologic grades in stage I endometrial carcinoma

“…There was no difference in the size of the lesion between two different pathological grades in the study, which may be related to the fact that the patients included in this study were all I stage patients with relatively small lesions con ned to the uterus. Fasmer et al also found that tumor volume yielded signi cantly lower AUC compared to the whole-tumor radiomic signatures for highgrade endometrioid tumors 27 .…”