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THE ROLE OF DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING IN ASSESSMENT OF THE DEPTH OF MYOMETRIAL INVASION AND PREDICTION OF HISTOLOGICAL GRADE ENDOMETRIAL CANCER
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Abstract
Background/Objectives: To compare the diagnostic performance of diffusion weighted (DWI) magnetic resonance (MR) imaging with that of dynamic contrast material–enhanced (DCE) MR imaging in evaluating the depth of myometrial invasion in patients with endometrial cancer (EC). The second purpose was to determine whether ADC values of the tumor and peritumoral zone in EC diverge according to the tumor’s histologic grade and myometrial invasion depth. Methods: We conducted a retrospective study in 53 patients with endometrial cancer who underwent preoperative. Three Tesla Mri include T2-weighted (T2W), DWI (b=0 and 1000s/mm2) and dynamic contrast material-enhanced (DCE) MRI imaging in sagittal planes. The depth of myometrial invasion on MRI was correlated with surgical pathology results. A radiologist evaluates the ADCmean of the tumor and peritumoral zone and compared with the definitive histogical grade (G1-G2; G3) using Mann Whitney tests. Results: The 53 endometrial cancers included 27 superficial and 26 deep tumors. The combination of DWI or DCE imaging readings with T2W imaging improved the assessment of myometrial invation. For assessing the depth of myometrial invasion, sensitivity (Se), specificity (Sp), accuracy (Acc), Positive predictive value (PPV), Negative predictive value (NPV), and Area under the ROC curve (AZ), respectively, were as follows: T2W-DWI / T2W-DCE imaging, 96,15%/92,31%; 85,19%/85,19%; 90,57%/86,68%; 86,21%/85,71%; 95,81%/92%; 0,91/0,89. ADCmean provided useful and reliable information for predicting the histological grade of tumors. In our series, the Se, Sp, Acc, PPV, NPV, and Az, were 57,89%; 91,17%; 79,25%; 78,57%; 79,48%, 0,754 respectively, for a cut off value of 0,59 x 10-3mm2/s. The ADC valules of the tumor and peritumoral zone were not useful for evaluating the depth of myometrial invasion. Conclusions: The combination of T2W and DWI has high diagnosis accuracy in the assessment of the depth of myometrial invasion, indicating that T2W-DWI is a potential replacement for DCE in the assessment of the depth of myometrial invasion of endometrial cancer, especially for patients in whom contraindicated with contrast agents. The tumor ‘s ADC value has ability to differentiate between low grade tumor (G1-G2) and high grade tumor (G3).
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