Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results
Our purpose is to evaluate the diagnostic accuracy of apparent diffusion coefficient (ADC) measurement in differentiating malignant from benign uterine endometrial cavity lesions. We retrospectively evaluated 25 uterine endometrial cavity lesions in 25 female patients: endometrial carcinoma (n = 11), carcinosarcoma (n = 2), submucosal leiomyoma (n = 8), and endometrial polyp (n = 4). Diffusion-weighted images were performed at 1.5 T with b factors of 0–1,000/mm2. The region of interest was defined within the tumor on T2-weighted EPI image and then manually copied to an ADC map. Thereby, the ADC value was obtained. We compared ADC values between malignant and benign lesions using Student’s t-test. The mean and standard deviation of ADC values (×10−3 mm2/s) were as follows: endometrial carcinoma, 0.98±0.21; carcinosarcoma, 0.97±0.02; submucosal leiomyoma, 1.37±0.28; and endometrial polyp, 1.58±0.45. The ADC values differed significantly between malignant (0.98±0.19) and benign lesions (1.44±0.34) (P < 0.01). We defined malignant tumors as cases with an ADC value less than 1.15 × 10−3 mm2/s for obtaining the highest accuracy. Sensitivity, specificity, and accuracy were 84.6%, 100%, and 92%, respectively. ADC measurement can provide useful information in differentiating malignant from benign uterine endometrial cavity lesions.
KeywordsMagnetic resonance imaging Diffusion-weighted imaging Uterus Diagnostic accuracy Sensitivity Specificity
We are grateful to Eiji Yamashita, B.S., Naoki Iwata, B.S., Takuro Tanaka, B.S., and Hiroki Katayama, B.S., for their technical support in obtaining the high-quality MR images used in this study.
- 17.Hayashida Y, Hirai T, Morishita S, Kitajima M, Murakami R, Korogi Y, Makino K, Nakamura H, Ikushima I, Yamura M, Kochi M, Kuratsu JI, Yamashita Y (2006) Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. AJNR Am J Neuroradiol 27:1419–1425PubMedGoogle Scholar
- 22.Park BK, Kim B, Park JM, Ryu JA, Kim MS, Bae DS, Ahn GH (2006) Differentiation of the various lesions causing an abnormality of the endometrial cavity using MR imaging: emphasis on enhancement patterns on dynamic studies and late contrast-enhanced T1-weighted images. Eur Radiol 16:1591–1598PubMedCrossRefGoogle Scholar
- 25.Nakayama T, Yoshimitsu K, Irie H, Aibe H, Tajima T, Nishie A, Asayama Y, Matake K, Kakihara D, Matsuura S, Nakano H, Honda H (2005) Diffusion-weighted echo-planar MR imaging and ADC mapping in the differential diagnosis of ovarian cystic masses: usefulness of detecting keratinoid substances in mature cystic teratomas. J Magn Reson Imaging 22:271–278PubMedCrossRefGoogle Scholar
- 27.Shimada K, Ohashi I, Kasahara I, Watanabe H, Ohta S, Miyasaka N, Itoh E, Shibuya H (2004) Differentiation between completely hyalinized uterine leiomyomas and ordinary leiomyomas: three-phase dynamic magnetic resonance imaging (MRI) vs. diffusion-weighted MRI with very small b-factors. J Magn Reson Imaging 20:97–104PubMedCrossRefGoogle Scholar
- 31.Young RH, Scully RE (2002) Sex cord-stromal, steroid cell, and other ovarian tumor. In: Kurman RJ (ed) Blaustein’s pathology of the female genital tract, 5th edn. Springer, Berlin Heidelberg New York, pp 907–925Google Scholar
- 33.Silverberg SG, Kurman RJ (2002) Tumors of the uterine corpus and gestational trophoblastic disease. In: Rosai J, Aovin L (eds) Atlas of tumor pathology. Vol 3. Armed Forces Institute of Pathology, Washington, DC, pp 113–151Google Scholar