Is the standard deviation of the apparent diffusion coefficient a potential tool for the preoperative prediction of tumor grade in endometrial cancer?

Abstract

Background The tumor histological grade is closely related to the prognosis of endometrial cancer (EC). The use of the apparent diffusion coefficient (ADC), tumor volume, and MRI-based texture analysis has allowed exciting advances in predicting EC grade before surgery. However, whether this constitutes a simple, convenient, and powerful diagnostic method remains unknown. Purpose To explore the utility of standard deviation (SD) of the ADC (ADCSD) for predicting the tumor grade in patients with EC. Material and Methods We retrospectively evaluated 138 patients with EC. All patients underwent unenhanced MRI and diffusion-weighted imaging (DWI). The mean ADC value (ADCmean) and SD were obtained using a freehand region of interest traced on the ADC map. Spearman’s linear correlation coefficients were calculated to analyze the correlations between the indexes (including ADCSD and the ADCmean) and the Ki-67 index. The Kruskal–Wallis and Mann–Whitney U tests were used to compare differences in the index results among tumor grades. Results A significant difference in ADCSD was observed among the tumor grades ( P=0.000), and the ADCSD value was significantly higher for high-grade EC than for low-grade tumors (289.7 vs. 216.3×10−6mm2 /s, P=0.000). A statistically significant positive correlation was observed between ADCSD and the Ki-67 index (r=0.364, P=0.000). According to the receiver operating characteristic curve, ADCSD ≥240.2×10−6mm2 /s predicted high-grade EC with a sensitivity, specificity, and accuracy of 73.1%, 80.2%, and 77.5%, respectively. Conclusion Based on the intratumor heterogeneity of EC, ADCSD represents a potential method for the preoperative prediction of high-grade EC, although further studies are needed.

Combination Analysis of a Radiomics-Based Predictive Model With Clinical Indicators for the Preoperative Assessment of Histological Grade in Endometrial Carcinoma

“…Previous research has also postulated that ADC images are more effective when attempting to identify tumor properties relative to the use of other morphological images such as T1WI and T2WI ( 35 , 36 ). Recently, some researchers have applied radiomic technology to deeply dig into ADC images and found that they could not only evaluate tumor grading but also predict whether the tumor had metastasised ( 37 , 38 ). This indicates that, acting as important MRI functional images, ADC images may show greater value in radiomic analysis than other sequences.…”

“…Recently, some researchers have applied radiomic technology to deeply dig into ADC images and found that they could not only evaluate tumor grading but also predict whether the tumor had metastasised (37,38). This indicates that, acting as important MRI functional images, ADC images may show greater value in radiomic analysis than other sequences.…”

Magnetic resonance spectroscopy associations with clinicopathologic features of estrogen-dependent endometrial cancer

“…The relationship between Ki-67 and ADC is controversial in patients with EC. A study has shown that Ki-67 and ADC are negatively correlated [ 14 ], while another study has indicated that there is no correlation between them [ 22 ]. In this study, we also found that there was no significant correlation between ADC m and Ki-67 SI.…”

“…In this study, we also found that there was no significant correlation between ADC m and Ki-67 SI. Both the DWI and DKI parameters provide valuable imaging biomarkers for EC diagnosis and the assessment of risk stratification in EC [ 19 – 22 ]. However, in this study, we found no significant difference in ADC m among different grades of EC, as well as different FIGO stages of EC.…”

Comparison of the diagnostic efficacy of DWI and DCE-MRI in depth of myometrial invasion, cervical invasion and FIGO staging in patients with endometrial cancer

“…For DCE-MRI, its clinical advantages are mainly to improve the diagnostic efficacy of MRI and dynamically present the specific shape of the tumor; for DWI, its clinical advantages are mainly to distinguish the infiltration status and tumor stage [6]. At present, the advantages and disadvantages of the above two solutions are applied in clinical practice, but there are few reports on comparative studies [7]. Given that, to further compare the diagnostic efficacy of DWI and DCE-MRI in the depth of myometrial invasion, cervical invasion and FIGO staging of patients with EC, patients with EC admitted to our hospital were included as the study subjects.…”