MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis
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To compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MR imaging in detecting deep myometrial invasion in endometrial cancer, using surgical-pathological staging as reference standard.
After searching a wide range of electronic databases and screening titles/abstracts, we obtained full papers for potentially eligible studies and evaluated according to predefined inclusion criteria. Quality assessment was conducted by adapting the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. From each study, we extracted information on diagnostic performance of DW and DCE sequences. After exploring heterogeneity, we adopted a bivariate generalized linear mixed model to compare the effect of the two MR sequences jointly on sensitivity and specificity.
Nine studies (442 patients) were considered. Significant evidence of heterogeneity was found only for specificity, both in DW and DCE imaging (I 2 = 70.8 % and 70.6 %). Pooled sensitivity of DW and DCE was 0.86 and specificity did not significantly differ (p = 0.16) between the two sequences (DW = 0.86 and DCE = 0.82). No difference was found between 3-T and 1.5-T MR. There was no evidence of publication bias.
MR diagnostic accuracy in presurgical detection of deep myometrial infiltration in endometrial cancer is high. DCE and DW imaging do not differ in sensitivity and specificity.
• Myometrial invasion is the most important morphological prognostic feature of endometrial cancer
• MR diagnostic accuracy in presurgical detection of deep myometrial infiltration is high
• MR examination including T2 and DCE imaging is considered the reference standard
• DW imaging has been increasingly employed with heterogeneous results
• This meta-analysis shows that DCE and DW do not differ in diagnostic accuracy
KeywordsEndometrial neoplasms Magnetic resonance imaging Diffusion magnetic resonance imaging Meta-analysis Review
Abbreviations and acronyms
apparent diffusion coefficient
Akaike information criterion
diagnostic odds ratio
effective sample size
International Federation of Gynecology and Obstetrics
generalized linear mixed model
- LR+ and LR−
positive and negative likelihood ratio
Quality Assessment of Diagnostic Accuracy Studies-2
receiver operating characteristic
signal to noise ratio
We thanks Laura Colombo for her thoughtful help during bibliographic research and Liu Xiaoqiu for her translation from Chinese.
The scientific guarantor of this publication is Maria Grazia Valsecchi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Three of the authors have significant statistical expertise. Institutional review board approval was not required because the manuscript is a meta-analysis of already published studies and there are no patient level data. Written informed consent was not required for this study because the manuscript is a meta-analysis and there are no patient level data. Methodology: meta-analysis, performed at one institution.
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