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Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T

European Radiology volume 27, pages 1867–1876 (2017)Cite this article

Abstract

Objectives

To compare the diagnostic accuracy of diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for detecting cervical stromal invasion in endometrial cancer.

Methods

Eighty-three consecutive women with endometrial cancer underwent preoperative evaluation in a 3-T unit, including T2-weighted, DW (b = 0 and 1000 s/mm2), and DCE MR imaging. Two radiologists independently assessed presence of cervical stromal invasion, with histopathological reference as gold standard.

Results

For assessing cervical stromal invasion, the diagnostic accuracy, sensitivity, and specificity, respectively for Reader 1/Reader 2, were as follows: DW MR imaging— 95.2 %/91.6 %, 91.7 %/100 %, and 95.8 %/90.1 %; DCE MR imaging— 91.6 %/88 %, 58.3 %/50 %, and 97.2 %/94.4 %. The diagnostic performance of DW MR imaging (Reader 1: areas under the receiver operating characteristic curve (AUC) = 0.98; Reader 2: AUC = 0.97) was significantly higher than that of DCE MR imaging (p = 0.009 for Reader 2) or T2-weighted MR imaging (Reader 1: p = 0.006; Reader 2: p = 0.013). Patients with cervical stromal invasion showed a significantly greater canal width (p < 0.0001) and myometrial invasion extent (p = 0.006).

Conclusions

DW MR imaging has superior diagnostic performance compared with DCE MR imaging in the detection of cervical stromal invasion.

Key Points

• DWI demonstrates a higher accuracy than DCE in detecting cervical stromal invasion.

• Tumour ADC values are similar between patients without or with cervical invasion.

• Canal widening causes false-negativity on DCE and T2W but not on DWI.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Areas under the receiver operating characteristics curve

CA-125:

Cancer antigen 125

DCE:

Dynamic contrast-enhanced

DW:

Diffusion-weighted

FIGO:

International Federation of Gynecology and Obstetrics

FOV:

Field of view

MR:

Magnetic resonance

NCCN:

National Comprehensive Cancer Network

ROI:

Region of interest

TR:

Repetition time

TE:

Echo time

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Acknowledgments

The authors thank all the members of the Cancer Center, Chang Gung Memorial Hospital, for their invaluable help. The scientific guarantor of this publication is Chyong-Huey Lai. 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. This study has received funding by Chang Gung Medical Foundation grant CMRPG-3B1923, CIRPG3E0021, National Science Council (Taiwan) 104-2314-B-182A-095-MY3. Dr Lan-Yan Yang kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Chang Gung IRB No. 101-2187B, 103-7316A3. The authors thank all the members of the Cancer Center, Chang Gung Memorial Hospital, for their invaluable help.

Some study subjects or cohorts had been previously reported to investigate the influence of menopausal status on diagnostic accuracy of MR imaging for evaluation of myometrial invasion: Lin G, Huang YT, Chao A, et al (2015) Influence of menopausal status on diagnostic accuracy of myometrial invasion in endometrial cancer: diffusion-weighted and dynamic contrast-enhanced MRI at 3 T. Clin Radiol 70:1260-1268. In the current manuscript we selected the 83 patients who had completed hysterectomy and compared the accuracy of DW and DCE MR imaging in diagnosis of cervical stromal invasion in endometrial cancer.

Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Affiliations

  1. Department of Medical Imaging and Intervention, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Gigin Lin, Yu-Ting Huang, Yu-Chun Lin, Hsin-Ying Lu, Shu-Hang Ng & Koon-Kwan Ng

  2. Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Angel Chao & Chyong-Huey Lai

  3. Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Ren-Chin Wu

  4. Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Lan-Yan Yang

  5. Clinical Phenome Center, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382

    Gigin Lin & Hsin-Ying Lu

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  1. Gigin Lin
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Correspondence to Gigin Lin.

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Lin, G., Huang, YT., Chao, A. et al. Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T. Eur Radiol 27, 1867–1876 (2017). https://doi.org/10.1007/s00330-016-4583-0

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  • DOI: https://doi.org/10.1007/s00330-016-4583-0

Keywords

  • Cervical stromal invasion
  • Diffusion weighted imaging
  • Endometrial cancer
  • Magnetic resonance imaging
  • Myometrial invasion