Staging of Endometrial Cancer Using Fusion T2-Weighted Images with Diffusion-Weighted Images: A Way to Avoid Gadolinium?

Abstract

Endometrial cancer is the eighth most common cancer worldwide, and its prognosis depends on various factors, with myometrial invasion having a major impact on prognosis. Optimizing MRI protocols is essential, and it would be useful to improve the diagnostic accuracy without the need for other sequences. We conducted a retrospective, single-center study, which included a total of 87 patients with surgically confirmed primary endometrial cancer, and who had undergone a pre-operative pelvic MRI. All exams were read by an experienced radiologist dedicated to urogenital radiology, and the depth of myometrial invasion was evaluated using T2-Weighted Images (T2WI) and fused T2WI with Diffusion-Weighted Images (DWI). Both results were compared to histopathological evaluations. When comparing both sets of imaging (T2WI and fused T2WI-DWI images) in diagnosing myometrial invasion, the fused images had better accuracy, and this difference was statistically significant (p < 0.001). T2WI analysis correctly diagnosed 82.1% (70.6–88.7) of cases, compared to 92.1% correctly diagnosed cases with fused images (79.5–97.2). The addition of fused images to a standard MRI protocol improves the diagnostic accuracy of myometrial invasion depth, encouraging its use, since it does not require more acquisition time.

Tumor Area Highlighting Using T2WI, ADC Map, and DWI Sequence Fusion on bpMRI Images for Better Prostate Cancer Diagnosis

“…Nevertheless, they obtained higher diagnostic accuracies. Neves et al (2022) [20] had a sample of 87 patients and revealed a statistically significantly higher capacity of fused images to evaluate the degree of myometrial invasion compared to standard MRI evaluation with T2WI, DWI, and DCE sequences. Mongula et al (2019) [21] found that fusion of T2W with DWI showed a significant increase in diagnostic performance for the assessment of parametrial invasion in early-stage cervical carcinoma.…”

Application value of cardiac magnetic resonance image fusion technique in patients with acute myocardial infarction

“…Image fusion technique can fuse two groups of different images at the same location to achieve complementary advantages, which is conducive to the diagnosis and evaluation of diseases. A study of endometrial cancer showed that the image fusion technique based on T2WI and DWI could improve the diagnostic accuracy, sensitivity, and speci city of the depth of myometrium invasion [14]. In a CMR study, Okune et al [15] found that the fusion image analysis of 18 F-uorodeoxyglucose positron emission tomography and LGE improved the diagnostic agreement and accuracy of cardiac sarcoidosis.…”

“…Recently, several studies demonstrated the image fusion technique can combine the two different images to improve the diagnostic accuracy for diseases [14,15]. This technique can retain the advantages of two images simultaneously through post-processing, without the need for additional image scanning.…”

Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article

“…Given the high DWI signal of endometrial cancer and hypointensity of adjacent myometrium, DWI has also been useful for accurate determination of the depth of myometrial invasion [ 1 ]. The combined use of T2-weighted and DWI images increases the sensitivity for accurately detecting myometrial invasion from endometrial cancer [ 38 ]. DWI improves the sensitivity of detection of metastatic lymph nodes by using the size and ADC values in conjunction, and it is comparable to dynamic contrast-enhanced MRI for detecting nodal metastasis from endometrial cancer in some studies and [ 39 , 40 ].…”