Dynamic contrast-enhanced MRI in endometrial carcinoma identifies patients at increased risk of recurrence
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To study the feasibility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for assessment of tumour microvasculature in endometrial carcinoma patients, and to explore correlations with histological subtype, clinical course and microstructural characteristics based on apparent diffusion coefficient (ADC) values.
Diffusion-weighted imaging (DWI) and three-dimensional DCE-MRI (1.5 T) with high temporal resolution (2.49 s) were acquired preoperatively in 55 patients. Quantitative modelling allowed the calculation of four independent parameters describing microvasculature: blood flow (Fb), extraction fraction (E), capillary transit time (Tc) and transfer constant from the extravascular extracellular space [EES] to blood (Kep); and four derived parameters: blood volume (Vb), volume of EES (Ve), capillary permeability surface area product (PS) and transfer from blood to EES (Ktrans).
Endometrial carcinoma tissue exhibited reduced Fb, E, Vb, Ve, PS and Ktrans compared with normal myometrium. Non-endometrioid carcinomas (n = 12) had lower Fb, and E than endometrioid carcinomas (n = 43; P < 0.05). Tumour Ve positively correlated with tumour ADC value (r = 0.29, P = 0.03). Reduced survival was observed in patients with low tumour Fb and high tumour Tc (P < 0.05).
We demonstrate the feasibility of DCE-MRI in reflecting histological subtype and clinical course in primary endometrial carcinomas. DCE-MRI may potentially provide future biomarkers for preoperative risk stratification in endometrial carcinomas.
• Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) offers new information about endometrial carcinoma.
• Pelvic DCE-MRI with subsequent quantitative modelling seems feasible in endometrial carcinoma patients.
• Low tumour perfusion is a feature of a more aggressive tumour subtype.
• DCE-MRI provides potential biomarkers for preoperative risk stratification in endometrial carcinoma patients.
KeywordsEndometrial carcinoma Magnetic resonance imaging Dynamic contrast-enhanced MRI Diffusion MRI Prognosis
extravascular extracellular space
transfer constant from EES to blood
transfer from blood to EES
capillary permeability surface area product
intravascular/capillary transit time
fractional volume of EES
This work was supported by The Western Norway Regional Health Authority, Research Funds at the Department of Radiology, Haukeland University Hospital, MedViz, Norwegian Research Council, The University of Bergen, The Meltzer Foundation, and The Norwegian Cancer Society (The Harald Andersen’s legacy).
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