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Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T

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Abstract

Objective

To determine the diagnostic accuracy of diffusion-weighted (DW) magnetic resonance (MR) imaging in the preoperative assessment of myometrial invasion by endometrial cancer.

Materials and methods

In this prospective study, 47 patients with histologically confirmed endometrial cancer underwent preoperative MR imaging and total hysterectomy. The MR protocol included spin-echo multishot T2-weighted, dynamic T1-weighted and DW images acquired with b-values of 0 and 500 s/mm2. Myometrial tumour spread was classified as superficial (<50%) or deep (≥50% myometrial thickness). Postoperative histopathological findings served as a reference standard. Indices of diagnostic performance were assessed for each sequence.

Results

At histopathological examination, superficial myometrial invasion was found in 34 patients and deep myometrial invasion in 13. In the assessment of tumour invasion, sensitivity, specificity, positive and negative predictive values of T2-weighted images were 92.3%, 76.5%, 60.0% and 96.3%, respectively. The corresponding values for dynamic images were 69.2%, 61.8%, 40.9% and 84.0%, and for DW images 84.6%, 70.6%, 52.4% and 92.3%. T2-weighted and DW imaging proved to be the most accurate techniques for tumour spread determination.

Conclusion

DW imaging proved to be accurate in assessing myometrial invasion, and it could replace dynamic imaging as an adjunct to routine T2-weighted imaging for preoperative evaluation of endometrial cancer.

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References

  1. Shen SH, Chiou YY, Wang JH, Yen MS, Lee RC, Lai CR, Chang CY (2008) Diffusion-weighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. AJR Am J Roentgenol 190:481–488

    Article  PubMed  Google Scholar 

  2. Medverd JR, Dubinsky TJ (2002) Cost analysis model: US versus endometrial biopsy in evaluation of peri- and postmenopausal abnormal vaginal bleeding. Radiology 222:619–627

    Article  PubMed  Google Scholar 

  3. Dubinsky TJ, Parvey HR, Maklad N (1997) The role of transvaginal sonography and endometrial biopsy in the evaluation of peri- and postmenopausal bleeding. AJR Am J Roentgenol 169:145–149

    CAS  PubMed  Google Scholar 

  4. Tamai K, Koyama T, Saga T, Umeoka S, Mikami Y, Fujii S, Togashi K (2007) Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 26:682–687

    Article  PubMed  Google Scholar 

  5. Boronow RC (1990) Advances in diagnosis, staging, and management of cervical and endometrial cancer, stages I and II. Cancer 65(Suppl.3):648–659

    Article  CAS  PubMed  Google Scholar 

  6. Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK (1996) Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol 88:394–398

    Article  CAS  PubMed  Google Scholar 

  7. Piver MS, Lele SB, Barlow JJ, Blumenson L (1982) Paraaortic lymph node evaluation in stage I endometrial carcinoma. Obstet Gynecol 59:97–100

    CAS  PubMed  Google Scholar 

  8. Hardesty LA, Sumkin JH, Nath ME, Edwards RP, Price FV, Chang TS, Johns CM, Kelley JL (2000) Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology 215:45–49

    CAS  PubMed  Google Scholar 

  9. Takahashi S, Murakami T, Narumi Y, Kurachi H, Tsuda K, Kim T, Enomoto T, Tomoda K, Miyake A, Murata Y, Nakamura H (1998) Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging. Radiology 206:539–547

    CAS  PubMed  Google Scholar 

  10. Saez F, Urresola A, Larena JA, Martín JI, Pijuán JI, Schneider J, Ibáñez E (2000) Endometrial carcinoma: assessment of myometrial invasion with plain and gadolinium-enhanced MR imaging. J Magn Reson Imaging 12:460–466

    Article  CAS  PubMed  Google Scholar 

  11. Lee EU, Byun JY, Kim B, Koong SE, Shinn KS (1999) Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging. Radiographics 19:937–945

    CAS  PubMed  Google Scholar 

  12. Chung HH, Kang SB, Cho JY, Kim JW, Park NH, Song JS, Kim SH, Lee HP (2007) Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol 104:654–659

    Article  PubMed  Google Scholar 

  13. Scoutt LM, McCarthy SM, Flynn SD, Lange RC, Smith RC, Chambers SK, Kohorn E, Schwartz P, Chambers JT (1995) Clinical stage I endometrial carcinoma: pitfalls in preoperative assessment with MR imaging, Work in progress. Radiology 194:567–572

    CAS  PubMed  Google Scholar 

  14. Ortashi O, Jain S, Emannuel O, Henry R, Wood A, Evans J (2008) Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre. Eur J Obstet Gynecol Reprod Biol 137:232–235

    Article  PubMed  Google Scholar 

  15. Nasu K, Kuroki Y, Kuroki S, Murakami K, Nawano S, Moriyama N (2004) Diffusion-weighted single shot echo planar imaging of colorectal cancer using a sensitivity-encoding technique. Jpn J Clin Oncol 34:620–626

    Article  PubMed  Google Scholar 

  16. Koyama T, Togashi K (2007) Functional MR imaging of the female pelvis. J Magn Reson Imaging 25:1101–1112

    Article  PubMed  Google Scholar 

  17. Inada Y, Matsuki M, Nakai G, Fuminari T, Masato T, Isamu N, Takashi Y, Motomu T (2007) Body diffusion-weighted MR imaging of uterine endometrial cancer: is it helpful in the detection of cancer in nonenhanced MR imaging? Eur J Radiol 17:201–204

    Article  Google Scholar 

  18. Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Yen TC, Wu TI, Wang CC, Chen YR, Huang YT, Ng SH, Jung SM, Chang TC, Lai CH (2009) Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging - initial experience. Radiology 250(3):784–792

    Article  PubMed  Google Scholar 

  19. Fujii S, Matsusue E, Kigawa J, Sato S, Kanasaki Y, Nakanishi J, Sugihara S, Kaminou T, Terakawa N, Ogawa T (2008) Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results. Eur Radiol 18:384–389

    Article  PubMed  Google Scholar 

  20. Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, Jacobs I, Reznek RH (2007) Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer 17:188–196

    Article  CAS  PubMed  Google Scholar 

  21. Barwick TD, Rockall AG, Barton DP, Sohaib SA (2006) Imaging of endometrial adenocarcinoma. Clin Radiol 61(7):545–555

    Article  CAS  PubMed  Google Scholar 

  22. Messiou C, Spencer JA, Swift SE (2006) MR staging of endometrial carcinoma. Clin Radiol 61:822–832

    Article  CAS  PubMed  Google Scholar 

  23. Utsunomiya D, Notsute S, Hayashida Y, Lwakatare F, Katabuchi H, Okamura H, Awai K, Yamashita Y (2004) Endometrial carcinoma in adenomyosis: assessment of myometrial invasion on T2-weighted Spin-Echo and Gadolinium-Enhanced T1-weighted images. AJR Am J Roentgenol 182:399–404

    PubMed  Google Scholar 

  24. Brown LD, Cai TT, DasGupta A (2001) Interval estimation for a binomial proportion. Stat Sci 16(2):101–133

    Google Scholar 

  25. Kinkel K, Kaji Y, Yu K, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718

    CAS  PubMed  Google Scholar 

  26. Savci G, Ozyaman T, Tutar M, Bilgin T, Erol O, Tuncel E (1998) Assessment of depth of myometrial invasion by endometrial carcinoma: comparison of T2-weighted SE and contrast-enhanced dynamic GRE MR imaging. Eur Radiol 8:218–223

    Article  CAS  PubMed  Google Scholar 

  27. Bammer R (2003) Basic principles of diffusion-weighted imaging. Eur J Radiol 45:169–184

    Article  PubMed  Google Scholar 

  28. Colagrande S, Pallotta S, Vanzulli A, Napolitano M, Villari N (2005) The diffusion parameter in Magnetic Resonance: physics, techniques and semeiotics. Radiol Med 109:1–16

    CAS  PubMed  Google Scholar 

  29. Manfredi R, Gui B, Maresca G, Fanfani F, Bonomo L (2005) Endometrial cancer: magnetic resonance imaging. Abdom Imaging 30:626–636

    Article  CAS  PubMed  Google Scholar 

  30. Kinkel K (2006) Pitfalls in staging uterine neoplasm with imaging: a review. Abdom Imaging 31:164–173

    Article  CAS  PubMed  Google Scholar 

  31. Joja I, Asakawa M, Asakawa T, Nakagawa T, Kanazawa S, Kuroda M, Togami I, Hiraki Y, Akamatsu N, Kudo T (1996) Endometrial carcinoma: dynamic MRI with turbo-FLASH technique. J Comput Assist Tomogr 20:878–887

    Article  CAS  PubMed  Google Scholar 

  32. Seki H, Kimura M, Sakai K (1997) Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted images. Clin Radiol 52:18–23

    Article  CAS  PubMed  Google Scholar 

  33. ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373(9658):125–136

    Article  CAS  PubMed  Google Scholar 

  34. Larson DM, Johnson K, Olson KA (1992) Pelvic and para-aortic lymphadenectomy for surgical staging of endometrial cancer: morbidity and mortality. Obstet Gynecol 79:998–1001

    CAS  PubMed  Google Scholar 

  35. Sironi S, Taccagni G, Garancini P, Belloni C, Del Maschio A (1992) Myometrial invasion by endometrial carcinoma: assessment by MR imaging. AJR Am J Roentgenol 158:565–569

    CAS  PubMed  Google Scholar 

  36. Hricak H, Stern JL, Fisher ML, Shapeero LG, Winkler ML, Lacey CG (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305

    CAS  PubMed  Google Scholar 

  37. Kinkel K, Forstner R, Danza FM, Oleaga L, Cunha TM, Bergman A, Barentsz JO, Balleyguier C, Brkljacic B, Spencer JA (2009) Staging of endometrial cancer with MRI: guidelines of the European Society of urogenital imaging. Eur Radiol 19(7):1565–1574

    Article  CAS  PubMed  Google Scholar 

  38. Manfredi R, Mirk P, Mareska G, Margariti PA, Testa A, Zannoni GF, Giordano D, Scambia G, Marano P (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231(2):372–378

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Medicine, University of Milano-Bicocca, Milan, Italy

    Gilda Rechichi, Stefania Galimberti, Mauro Signorelli, Patrizia Perego, Maria Grazia Valsecchi & Sandro Sironi

  2. Department of Diagnostic Radiology, H S. Gerardo Monza, Via Pergolesi 33, 20052, Milan, Italy

    Gilda Rechichi & Sandro Sironi

  3. Department of Clinical Medicine and Prevention—Centre of Biostatistics and Clinical Epidemiology, University of Milano-Bicocca, Milan, Italy

    Stefania Galimberti & Maria Grazia Valsecchi

  4. Department of Gynaecology and Obstetrics, H S. Gerardo Monza, Milan, Italy

    Mauro Signorelli

  5. Department of Pathology, H S. Gerardo Monza, Milan, Italy

    Patrizia Perego

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  1. Gilda Rechichi
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Correspondence to Sandro Sironi.

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Rechichi, G., Galimberti, S., Signorelli, M. et al. Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 20, 754–762 (2010). https://doi.org/10.1007/s00330-009-1597-x

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