Diagnostic efficacy of diffusion-weighted MRI for pre-operative assessment of myometrial and cervical invasion and pelvic lymph node metastasis in endometrial carcinoma

• Published in: Journal of medical imaging and radiation oncology 2014-10, Vol.58 (5), p.538-546
• Main Authors: Koplay, Mustafa, Dogan, Nasuh Utku, Erdogan, Hasan, Sivri, Mesut, Erol, Cengiz, Nayman, Alaaddin, Karabagli, Pinar, Paksoy, Yahya, Celik, Cetin
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Aged; Diagnosis, Differential; Diffusion; Diffusion Magnetic Resonance Imaging - methods; diffusion-weighted imaging; endometrial carcinoma; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Humans; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Medical research; Metastasis; Middle Aged; MRI; Neoplasm Invasiveness; NMR; Nuclear magnetic resonance; Pelvic Neoplasms - pathology; Pelvic Neoplasms - secondary; Pelvic Neoplasms - surgery; Pelvis - pathology; Pelvis - surgery; Preoperative Care - methods; Reproducibility of Results; Sensitivity and Specificity; staging; Uterine Neoplasms - pathology; Uterine Neoplasms - secondary; Uterine Neoplasms - surgery
• ISSN: 1754-9477; 1754-9485
• DOI: 10.1111/1754-9485.12209

Introduction To determine the diagnostic accuracy of diffusion‐weighted magnetic resonance imaging (DW‐MRI) for the pre‐operative assessment of patients with endometrial carcinoma and to assess myometrial and cervical invasion as well as pelvic lymph node metastasis. Methods Fifty‐eight women who underwent surgery for histopathologically confirmed endometrial carcinoma were included in the current study. Prior to surgery, patients were evaluated using pelvic DW‐MRI and gadolinium‐enhanced T1‐weighted imaging (Gd‐T1WI). Gd‐T1WI was evaluated together with T2‐weighted images. DW‐MR images were obtained in the axial plane using echo‐planar spin‐echo pulse sequences with different b factors. Endometrial carcinomas were observed as areas of increased intensity on DW‐MRI images, and their intensity was compared with the surrounding hypo‐intense myometrium. Pre‐operative DW‐MRI and Gd‐T1WI results were compared with post‐operative histopathological findings that served as reference standards. Results The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and diagnostic accuracy of DW‐MRI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 89%, 81%, 92% and 88%, respectively. The sensitivity, specificity and diagnostic accuracy rates were 82%, 91% and 89.6% for cervical invasion and 100%, 96% and 96.5% for pelvic lymph node metastasis, respectively. The sensitivity, specificity, PPV and NPV, and diagnostic accuracy of Gd‐T1WI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 81.5%, 71%, 91% and 83%, respectively. The sensitivity, specificity and diagnostic accuracy were 73%, 89% and 86% for cervical invasion, respectively. Conclusions These findings suggest that DW‐MRI may be a good diagnostic tool with high sensitivity and specificity for assessing myometrial invasion and detecting tumour extension. We suggest that DW‐MRI should be considered as a routine part of the pre‐operative pelvic MRI in all patients with endometrial carcinoma.