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Ota T, Tsuboyama T, Onishi H, Nakamoto A, Fukui H, Yano K, Honda T, Kiso K, Tatsumi M, Tomiyama N. Diagnostic accuracy of MRI for evaluating myometrial invasion in endometrial cancer: a comparison of MUSE-DWI, rFOV-DWI, and DCE-MRI. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01635-4. [PMID: 37120661 DOI: 10.1007/s11547-023-01635-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES To compare the image quality of high-resolution diffusion-weighted imaging (DWI) using multiplexed sensitivity encoding (MUSE) versus reduced field-of-view (rFOV) techniques in endometrial cancer (EC) and to compare the diagnostic performance of these techniques with that of dynamic contrast-enhanced (DCE) MRI for assessing myometrial invasion of EC. METHODS MUSE-DWI and rFOV-DWI were obtained preoperatively in 58 women with EC. Three radiologists assessed the image quality of MUSE-DWI and rFOV-DWI. For 55 women who underwent DCE-MRI, the same radiologists assessed the superficial and deep myometrial invasion using MUSE-DWI, rFOV-DWI, and DCE-MRI. Qualitative scores were compared using the Wilcoxon signed-rank test. Receiver operating characteristic analysis was performed to compare the diagnostic performance. RESULTS Artifacts, sharpness, lesion conspicuity, and overall quality were significantly better with MUSE-DWI than with rFOV-DWI (p < 0.05). The area under the curve (AUC) of MUSE-DWI, rFOV-DWI, and DCE-MRI for the assessment of myometrial invasion were not significantly different except for significantly higher AUC of MUSE-DWI than that of DCE-MRI for superficial myometrial invasion (0.76 for MUSE-DWI and 0.64 for DCE-MRI, p = 0.049) and for deep myometrial invasion (0.92 for MUSE-DWI and 0.80 for DCE-MRI, p = 0.022) in one observer, and that of rFOV-DWI for deep myometrial invasion in another observer (0.96 for MUSE-DWI and 0.89 for rFOV-MRI, p = 0.048). CONCLUSION MUSE-DWI exhibits better image quality than rFOV-DWI. MUSE-DWI and rFOV-DWI shows almost equivalent diagnostic performance compared to DCE-MRI for assessing superficial and deep myometrial invasion in EC although MUSE-DWI may be helpful for some radiologists.
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Affiliation(s)
- Takashi Ota
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takahiro Tsuboyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiromitsu Onishi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsushi Nakamoto
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideyuki Fukui
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keigo Yano
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toru Honda
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kengo Kiso
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Mitsuaki Tatsumi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Wu C, Tai Y, Shih I, Chiang Y, Chen Y, Hsu H, Cheng W. Preoperative magnetic resonance imaging predicts clinicopathological parameters and stages of endometrial carcinomas. Cancer Med 2022; 11:993-1004. [PMID: 34967506 PMCID: PMC8855918 DOI: 10.1002/cam4.4486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/16/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We investigated the agreement and accuracy of preoperative magnetic resonance imaging (MRI) with postoperative pathological characteristics and stages of endometrial endometrioid carcinoma (EEC). METHODS We recruited 527 women with EEC who underwent staging surgery at a single medical institution. The preoperative MRI, stages, and clinical and pathological parameters, including myometrial invasion (MI), cervical invasion (CI), adnexal metastasis (AM), intra-abdominal metastasis, and pelvic and/or para-aortic nodal metastasis, were recorded and analyzed. The agreement and accuracy between the preoperative MRI findings and these parameters and stages were assessed. RESULTS The rate of the preoperative MRI-based clinical stage matching the postoperative surgical stage was 85.2% in International Federation of Gynecology and Obstetrics stage IA, 51.9% in stage IB, 35.5% in stage II, 5.3% in stage IIIA, 33.3% in stage IIIB, 28.6% in stage IIIC1, 64.3% in stage IIIC2, and 93.8% in stage IVB. The consistency between radiologists and pathologists was 80.5% for deep MI, 91.5% for cervical invasion, 92.2% for adnexal metastasis, 98.9% for intra-abdominal metastasis, and 87.5% and 92.2% for pelvic and para-aortic nodal metastases, respectively. The negative predictive value of intra-abdominal metastasis was the highest with 99.8%. CONCLUSIONS Preoperative MRI could be an excellent tool for routine preoperative assessment to predict pathological parameters and stages of EEC, especially in excluding intra-abdominal metastatic disease.
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Affiliation(s)
- Chia‐Ying Wu
- Department of Obstetrics and GynecologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Yi‐Jou Tai
- Department of Obstetrics and GynecologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Obstetrics and GynecologyNational Taiwan University HospitalTaipeiTaiwan
| | - I‐Lun Shih
- Department of Medical ImagingCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Ying‐Cheng Chiang
- Department of Obstetrics and GynecologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Graduate Institute of Clinical MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Yu‐Li Chen
- Department of Obstetrics and GynecologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Heng‐Cheng Hsu
- Department of Obstetrics and GynecologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Obstetrics and GynecologyNational Taiwan University HospitalXin‐Chu CityTaiwan
| | - Wen‐Fang Cheng
- Department of Obstetrics and GynecologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Obstetrics and GynecologyNational Taiwan University HospitalTaipeiTaiwan
- Graduate Institute of OncologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
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Wang LJ, Tseng YJ, Wee NK, Low JJH, Tan CH. Diffusion-weighted imaging versus dynamic contrast-enhanced imaging for pre-operative diagnosis of deep myometrial invasion in endometrial cancer: A meta-analysis. Clin Imaging 2021; 80:36-42. [PMID: 34224952 DOI: 10.1016/j.clinimag.2021.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigates the differences in diagnostic performance between diffuse-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE), either alone or in combination with T2-weighted imaging (T2WI), for diagnosing deep myometrial invasion (dMI) of endometrial cancers (EC). METHODS We performed a comprehensive search for published studies comparing DWI and DCE for preoperatively diagnosing dMI of EC. The overall diagnostic accuracy of each test was calculated using the areas under the summary receiver operating characteristic curves (AUCs). The sensitivities and specificities were compared using bivariate meta-regression. RESULTS Pooled analysis of nineteen studies with 961 patients (main group) showed that DWI had a larger AUC (0.943, 95% confidence interval (CI) = 0.921-0.967) than DCE (0.922, 95% CI = 0.893-0.953). For the subgroup comprising 7 studies, DWI combined with T2WI and DCE combined with T2WI showed AUCs of 0.959 (95% CI, 0.932-0.986) and 0.929 (95% CI, 0.847-1.000), respectively. None of the differences in AUCs were statistically significant. All comparisons of the sensitivities and specificities of the main group and subgroup also showed no significant differences. CONCLUSION This meta-analysis found no significant difference in diagnostic performance between DWI and DCE for diagnosis of dMI in EC. DWI may be preferred for its ease of use in clinical practice.
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Affiliation(s)
- Li-Jen Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tu Cheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing Street, Guishan, 33333 Taoyuan, Taiwan
| | - Yi-Ju Tseng
- Department of Information Management, National Central University, 300, Zhongda Rd., Zhongli District, Taoyuan City 320317, Taiwan.
| | - Nicole Kessa Wee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, National Healthcare Group, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Jeffrey Jen Hui Low
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, National University Hospital, Head of Gynaecologic Oncology, National University Cancer Institute, Singapore, 5 Lower Kent Ridge Rd, 119074, Singapore.
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, National Healthcare Group, 11 Jalan Tan Tock Seng, 308433, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Predictive value of T2-weighted imaging and dynamic contrast-enhanced MRI for assessing cervical invasion in patients with endometrial cancer: a meta-analysis. Clin Imaging 2021; 78:206-213. [PMID: 34049140 DOI: 10.1016/j.clinimag.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To obtain the diagnostic accuracy of T2-weighted imaging (T2WI), and dynamic contrast-enhanced MRI (DCE-MRI) in the preoperative assessment of cervical invasion in patients with endometrial cancer (EC). METHODS Databases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials were searched for relevant articles published from January 2000 to August 2020. Pooled estimation data were obtained by statistical analysis. RESULTS In total, 24 articles were included. For assessing cervical invasion of EC, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) for T2WI were 0.70 (0.61-0.77), 0.92 (0.89-0.94), 8.7 (6.5-11.6), 0.33 (0.25-0.43), 26 (17-41), and 0.92 (0.89-0.94), respectively. For DCE-MRI, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.75 (0.60-0.85), 0.95 (0.89-0.98), 14.7 (6.6-32.9), 0.27 (0.16-0.44), 55 (18-165), and 0.92 (0.89-0.94), respectively; for T2WI combined with DCE-MRI, they were 0.58 (0.41-0.73), 0.98 (0.95-0.99), 28.1 (12.8-62.1), 0.43 (0.30-0.63), 65 (29-146), and 0.94 (0.91-0.96), respectively. CONCLUSIONS DCE-MRI demonstrated higher diagnostic performance than T2WI in the prediction of cervical invasion in patients with EC. T2WI combined with DCE-MRI improved the pooled specificity, PLR, DOR, and AUC compared to T2WI alone or DCE-MRI alone.
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Rodríguez-Ortega A, Alegre A, Lago V, Carot-Sierra JM, Ten-Esteve A, Montoliu G, Domingo S, Alberich-Bayarri Á, Martí-Bonmatí L. Machine Learning-Based Integration of Prognostic Magnetic Resonance Imaging Biomarkers for Myometrial Invasion Stratification in Endometrial Cancer. J Magn Reson Imaging 2021; 54:987-995. [PMID: 33793008 DOI: 10.1002/jmri.27625] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Estimation of the depth of myometrial invasion (MI) in endometrial cancer is pivotal in the preoperatively staging. Magnetic resonance (MR) reports suffer from human subjectivity. Multiparametric MR imaging radiomics and parameters may improve the diagnostic accuracy. PURPOSE To discriminate between patients with MI ≥ 50% using a machine learning-based model combining texture features and descriptors from preoperatively MR images. STUDY TYPE Retrospective. POPULATION One hundred forty-three women with endometrial cancer were included. The series was split into training (n = 107, 46 with MI ≥ 50%) and test (n = 36, 16 with MI ≥ 50%) cohorts. FIELD STRENGTH/SEQUENCES Fast spin echo T2-weighted (T2W), diffusion-weighted (DW), and T1-weighted gradient echo dynamic contrast-enhanced (DCE) sequences were obtained at 1.5 or 3 T magnets. ASSESSMENT Tumors were manually segmented slice-by-slice. Texture metrics were calculated from T2W and ADC map images. Also, the apparent diffusion coefficient (ADC), wash-in slope, wash-out slope, initial area under the curve at 60 sec and at 90 sec, initial slope, time to peak and peak amplitude maps from DCE sequences were obtained as parameters. MR diagnostic models using single-sequence features and a combination of features and parameters from the three sequences were built to estimate MI using Adaboost methods. The pathological depth of MI was used as gold standard. STATISTICAL TEST Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, accuracy, positive predictive value, negative predictive value, precision and recall were computed to assess the Adaboost models performance. RESULTS The diagnostic model based on the features and parameters combination showed the best performance to depict patient with MI ≥ 50% in the test cohort (accuracy = 86.1% and AUROC = 87.1%). The rest of diagnostic models showed a worse accuracy (accuracy = 41.67%-63.89% and AUROC = 41.43%-63.13%). DATA CONCLUSION The model combining the texture features from T2W and ADC map images with the semi-quantitative parameters from DW and DCE series allow the preoperative estimation of myometrial invasion. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Alejandro Rodríguez-Ortega
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Alberto Alegre
- Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Víctor Lago
- Gynecologic Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Miguel Carot-Sierra
- Universitat Politècnica de València. Department of Applied Statistics, Operations Research and Quality, Valencia, Spain
| | - Amadeo Ten-Esteve
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Guillermina Montoliu
- Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Domingo
- Gynecologic Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain
| | - Luis Martí-Bonmatí
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Bi Q, Bi G, Wang J, Zhang J, Li H, Gong X, Ren L, Wu K. Diagnostic Accuracy of MRI for Detecting Cervical Invasion in Patients with Endometrial Carcinoma: A Meta-Analysis. J Cancer 2021; 12:754-764. [PMID: 33403033 PMCID: PMC7778546 DOI: 10.7150/jca.52797] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the preoperative assessment of cervical invasion and to analyse the influence of different imaging protocols in patients with endometrial carcinoma. Methods: An extensive search of articles about MRI for assessing cervical invasion in patients with endometrial carcinoma was performed on PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials from January 2000 to July 2020. Two reviewers independently evaluated the methodological quality of each study by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Diagnostic accuracy results and additional useful information were extracted. The pooled estimation data was obtained by statistical analysis. Results: A total of 42 eligible studies were included in the meta-analysis. Significant evidence of heterogeneity was found for detecting cervical invasion (I2 = 74.1%, P = 0.00 for sensitivity and I2 = 56.2%, P = 0.00 for specificity). The pooled sensitivity and specificity of MRI were 0.58 and 0.95 respectively. The use of higher field strength (3.0 T) demonstrated higher pooled sensitivity (0.74). Using diffusion weighted imaging (DWI) alone presented higher pooled sensitivity (0.86) than using other sequences. The studies that used dynamic contrast-enhanced MRI (DCE-MRI) alone showed higher sensitivity (0.80) and specificity (0.96) than those that used T2-weighted imaging (T2WI) alone. Conclusions: MRI shows high specificity for detecting cervical infiltration in endometrial carcinoma. Using DWI or a 3.0-T device may improve the pooled sensitivity. DCE-MRI demonstrates higher pooled sensitivity and specificity than T2WI.
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Affiliation(s)
- Qiu Bi
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Guoli Bi
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Junna Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan, China
| | - Jie Zhang
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Hongliang Li
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Xiarong Gong
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Lixiang Ren
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
| | - Kunhua Wu
- Department of MRI, the First People' s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650032, Yunnan, China
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The Diagnostic Value of MRI for Preoperative Staging in Patients with Endometrial Cancer: A Meta-Analysis. Acad Radiol 2020; 27:960-968. [PMID: 31636004 DOI: 10.1016/j.acra.2019.09.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/14/2019] [Accepted: 09/14/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the diagnostic accuracy of magnetic resonance imaging (MRI) for detecting myometrial invasion, cervical invasion, and lymph node metastases in endometrial cancer. MATERIALS AND METHODS A systematic literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, and Clinical trials. The methodological quality of each study was assessed by using the standard Quality Assessment of Diagnostic Accuracy Studies-2. Statistical analysis included evaluating publication bias, assessing threshold effect, exploring heterogeneity, pooling data, meta-regression, forest plot, and summary receiver-operating characteristics curves construction. RESULTS Fourteen studies could be analyzed. For detecting deep myometrial invasion, the pooled sensitivity and specificity were 0.79 and 0.81 respectively, and patients younger than 60 years old demonstrated higher sensitivity (0.84) and specificity (0.90). The diagnostic accuracy is highest by jointly using T2-weighted image, dynamic contrast-enhanced MRI, and diffusion weighted imaging to detect the deep myometrial invasion. There were low sensitivity and high specificity for the diagnosis of cervical invasion (0.53, 0.95), cervical stromal invasion (0.50, 0.95), pelvic or/and para-aortic lymph node metastases (0.59, 0.95), and pelvic lymph node metastases (0.65, 0.95). CONCLUSION MRI has good diagnostic performance for assessing myometrial invasion in patients with endometrial cancer, especially in patients younger than 60 years old. Dynamic contrast-enhanced MRI and diffusion weighted imaging can help improve sensitivity and specificity for detecting myometrial invasion. MRI shows high specificity for detecting cervical invasion and lymph node metastases in endometrial cancer.
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Coussoou C, Laigle-Quérat V, Loussouarn D, Vaucel E, Frampas E. [Magnetic Resonance Imaging for local preoperative staging in endometrial cancer: Nantes local experience]. ACTA ACUST UNITED AC 2020; 48:374-383. [PMID: 32058046 DOI: 10.1016/j.gofs.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for local preoperative staging in endometrial cancer in our center (Centre Hospitalier Universitaire de Nantes: CHU), since the French National Cancer Institute's surgery recommendations publication in 2010, especially for the prediction of myometrial and cervical stromal invasion. METHODS Retrospective monocentric study of consecutive women operated of endometrial cancer in gynecology department of CHU de Nantes, who underwent preoperative pelvic MRI in our Radiology department from November 2010 to November 2016. MRI data collected from initial report and compared to surgical histological findings as gold standard. RESULTS Sixty-four patients were included. Deep myometrial invasion was present in 35 patients in MRI versus 34 patients on postoperative histology (5 false positives, 4 false negatives). Cervical stromal invasion was present in 9 patients in MRI versus 19 patients on postoperative histology (2 false positives, 12 false negatives). The sensitivity and the specificity were respectively 88.23% (95% confidence intervals (CI) [0.71-0.96]) and 83.33% (CI [0.64-0.93]) for the deep myometrial invasion; 36.84% (CI [0.17-0.61]) and 95.55% (CI [0.83-0.99]) for the cervical stromal invasion. CONCLUSION Our results were comparable to the literature data, with a low sensitivity for the cervical stromal invasion detection, driving us to change our MRI protocol with optional high-resolution T2 sequences perpendicular to the cervical canal if necessary.
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Affiliation(s)
- C Coussoou
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - V Laigle-Quérat
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - D Loussouarn
- Service d'anatomie cytologie pathologique, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - E Vaucel
- Service de gynécologie-obstétrique, hôpital Femme-Enfant-Adolescent, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - E Frampas
- Service de radiologie et imagerie médicale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Gil RT, Cunha TM, Horta M, Alves I. The added value of diffusion-weighted imaging in the preoperative assessment of endometrial cancer. Radiol Bras 2019; 52:229-236. [PMID: 31435083 PMCID: PMC6696747 DOI: 10.1590/0100-3984.2018.0054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the added value of diffusion-weighted imaging (DWI) in the
preoperative assessment of myometrial invasion in endometrial cancer, in
comparison with T2-weighted imaging (T2WI) and dynamic contrast-enhanced
magnetic resonance imaging (DCE-MRI). Materials and Methods This was a retrospective study involving 44 women with endometrial cancer who
underwent preoperative 1.5 T MRI. Two radiologists, both of whom were
blinded to the histopathology reports, performed a consensus interpretation
of the depth of myometrial invasion and of the stage of the cancer,
considering three sets of sequences: T2WI, DCE-MRI+T2WI, and DWI+T2WI.
Accuracy, sensitivity, specificity, positive predictive value, and negative
predictive value were calculated for each set. The accuracy was compared
with p-value adjustment by the Benjamini-Hochberg
procedure. Results Among the 44 patients evaluated, DWI+T2WI demonstrated better diagnostic
performance in assessing deep myometrial invasion and correctly staged more
patients (n = 41) than did DCE-MRI+T2WI (n = 34) and T2WI (n = 22). The
superior diagnostic accuracy of DWI+T2WI was statistically significant in
comparison with T2WI (p < 0.05) but not in comparison
with DCE-MRI+T2WI (p > 0.05). Conclusion The addition of DWI apparently improves the diagnostic accuracy of MRI in the
preoperative assessment of the depth of myometrial invasion in endometrial
cancer, which may be particularly helpful in patients for whom contrast
agents are contraindicated.
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Affiliation(s)
- Rui Tiago Gil
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Mariana Horta
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ines Alves
- Serviço de Radiologia, Hospital. Dr. Nelio Mendonça, Funchal, Portugal
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He YL, Ding N, Qi YF, Li Y, Xiang Y, Qian TY, Liu H, Lin CY, Yuan L, Zhou HL, Jin ZY, Xue HD. Visualising the boundary sharpness of uterine zonal structures using high-resolution T2-weighted images during the menstrual cycle. Clin Radiol 2019; 74:81.e19-81.e24. [DOI: 10.1016/j.crad.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
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Rizzo S, Femia M, Buscarino V, Franchi D, Garbi A, Zanagnolo V, Del Grande M, Manganaro L, Alessi S, Giannitto C, Ruju F, Bellomi M. Endometrial cancer: an overview of novelties in treatment and related imaging keypoints for local staging. Cancer Imaging 2018; 18:45. [PMID: 30514387 PMCID: PMC6280395 DOI: 10.1186/s40644-018-0180-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
Endometrial cancer is the most common gynaecologic malignancy in developed countries and its incidence is increasing. First-level treatment, if no contraindicated, is based on surgery. Pre-operative imaging is needed for evaluation of local extent and detection of distant metastases in order to guide treatment planning. Radiological evaluation, based on transvaginal ultrasound, MR and CT, can make the difference in disease management, paying special attention to assessment of entity of myometrial invasion, cervical stromal extension, and assessment of lymph nodal involvement and distant metastases.
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Affiliation(s)
- Stefania Rizzo
- Department of Radiology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy.
| | - Marco Femia
- Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Valentina Buscarino
- Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Dorella Franchi
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy
| | - Annalisa Garbi
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy
| | - Vanna Zanagnolo
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Lucia Manganaro
- Dipartimento di Medicina Interna e Specialità mediche, Università degli Studi di Roma La Sapienza, Roma, Italy
| | - Sarah Alessi
- Department of Radiology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy
| | - Caterina Giannitto
- Department of Radiology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy
| | - Francesca Ruju
- Department of Radiology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
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12
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Nougaret S, Horta M, Sala E, Lakhman Y, Thomassin-Naggara I, Kido A, Masselli G, Bharwani N, Sadowski E, Ertmer A, Otero-Garcia M, Kubik-Huch RA, Cunha TM, Rockall A, Forstner R. Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology. Eur Radiol 2018; 29:792-805. [DOI: 10.1007/s00330-018-5515-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/18/2018] [Accepted: 04/26/2018] [Indexed: 12/21/2022]
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13
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Assessment of Myometrial Invasion in Premenopausal Grade 1 Endometrial Carcinoma: Is Magnetic Resonance Imaging a Reliable Tool in Selecting Patients for Fertility-Preserving Therapy? J Comput Assist Tomogr 2018; 42:412-417. [PMID: 29189400 DOI: 10.1097/rct.0000000000000689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic ability of magnetic resonance imaging (MRI) in premenopausal women with G1 endometrial carcinoma. METHODS Twenty-six patients underwent T2W, diffusion weighted, and dynamic contrast-enhanced 3-T MRI. The degree of myometrial invasion was pathologically classified into no invasion, shallow (3 mm or less), and more. Two radiologists assessed myometrial invasion on MRI. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values, AUC, and interobserver agreement were analyzed. RESULTS For assessing myometrial invasion, mean accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and AUC, respectively, were as follows: 63%, 42%, 85%, 79%, 47%, and 0.75. Mean interobserver agreement was fair (k = 0.36). Shallow invasions were underestimated as no invasion on MRI in all 6 cases. CONCLUSIONS Magnetic resonance imaging produced false-negative result on half of patients. The misjudgments tended to happen in patients with shallow invasion.
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Guo Y, Wang P, Wang P, Gao W, Li F, Yang X, Ni H, Shen W, Guo Z. Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging. Onco Targets Ther 2017; 10:5937-5943. [PMID: 29290687 PMCID: PMC5735992 DOI: 10.2147/ott.s145763] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background The age of onset of endometrial carcinoma has been decreasing in recent years. In endometrial carcinoma, it is important to accurately assess invasion depth and preoperative staging. Fusion of T2-weighted magnetic resonance imaging (T2WI) and diffusion-weighted magnetic resonance imaging (DWI) may contribute to the improvement of anatomical localization of lesions. Materials and methods In our study, a total of 58 endometrial carcinoma cases were included. Based on the revised 2009 International Federation of Gynecology and Obstetrics staging system, a fusion of T2WI and DWI was utilized for the evaluation of invasion depth and determination of the overall stage. Postoperative pathologic assessment was considered as the reference standard. The consistency of T2WI image staging and pathologic staging, and the consistency of fused T2WI and DWI and pathologic staging were all analyzed using Kappa statistics. Results Compared with the T2WI group, a significantly higher diagnostic accuracy was observed for myometrial invasion with fusion of T2WI and DWI (77.6% for T2WI; 94.8% for T2WI-DWI). For the identification of deep invasion, we calculated values for diagnostic sensitivity (69.2% for T2WI; 92.3% for T2WI-DWI), specificity (80% for T2WI; 95.6% for T2WI-DWI), positive predictive value (50% for T2WI; 85.7% for T2WI-DWI), and negative predictive value (90% for T2WI; 97.7% for T2WI-DWI). In summary, T2WI-DWI fusion exhibits higher diagnostic accuracy with respect to staging relative to T2WI only (81.0% for T2WI; 94.8% for T2WI-DWI). Conclusion Fused T2WI-DWI may represent a noninvasive, lower cost approach for the effective assessment of myometrial invasion and staging of endometrial carcinoma.
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Affiliation(s)
- Yu Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin.,Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Ping Wang
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Penghui Wang
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Wei Gao
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Fenge Li
- Department of Gynecology, Tianjin First Center Hospital, Tianjin, People's Republic of China
| | - Xueling Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Hongyan Ni
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Wen Shen
- Department of Radiology, Tianjin First Center Hospital, The First Central Clinical College of Tianjin Medical University, Tianjin
| | - Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin
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Jiang JX, Zhao JL, Zhang Q, Qing JF, Zhang SQ, Zhang YM, Wu XH. Endometrial carcinoma: diffusion-weighted imaging diagnostic accuracy and correlation with Ki-67 expression. Clin Radiol 2017; 73:413.e1-413.e6. [PMID: 29246587 DOI: 10.1016/j.crad.2017.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/14/2017] [Indexed: 01/09/2023]
Abstract
AIM To evaluate the role of diffusion-weighted imaging (DWI) in the detection of endometrial carcinoma and to correlate the apparent diffusion coefficient (ADC) value with Ki-67 expression. MATERIALS AND METHODS Fifty-two patients with invasive cancer who underwent pelvic MRI were prospectively evaluated using DWI with b-values of 0 and 1000 s/mm2.The ADC values from standard DWI were measured. The expression of Ki-67 in histological specimens was analysed using immunohistochemistry. The ADC values of endometrial carcinoma and normal endometrial parenchyma were compared. Relationships between ADC values and Ki-67 expression were determined using Wilcoxon's signed rank test and the Kruskal-Wallis test. RESULTS Endometrial carcinoma was detected at DWI as a hyperintense area in 92.3% (48/52) of patients. There was a significant difference in the mean ADC values between endometrial carcinoma and normal endometrial parenchyma (1.39±0.27×10-3 versus 0.93±0.21×10-3 mm2/s, p<0.001). The mean ADC values of grade 1 patients were significantly higher than those of grade 3 patients (1.01±0.16×10-3 versus 0.83±0.21×10-3 mm2/s, p<0.05). The mean ADC values of stage IB patients were significantly lower than those of stage IA patients (0.86±0.16×10-3 versus 1.04±0.21×10-3 mm2/s, p<0.01). The mean ADC values of high Ki-67 expression patients were significantly lower than those of low Ki-67 expression patients (0.82±0.12×10-3 versus 1.16±0.12×10-3 mm2/s, p<0.001). There was a significant negative correlation between the mean ADC value and Ki-67 expression (r=-0.82, p<0.001). CONCLUSION The ADC value was a helpful parameter for detecting the tumour grade, stage, and proliferation of endometrial carcinoma, and may further improve patient prognosis and contribute to the development of more effective treatment programmes.
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Affiliation(s)
- J X Jiang
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - J L Zhao
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Q Zhang
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - J F Qing
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - S Q Zhang
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Y M Zhang
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - X H Wu
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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16
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Dia AA, Hori M, Onishi H, Sakane M, Ota T, Tsuboyama T, Tatsumi M, Okuaki T, Tomiyama N. Application of non-Gaussian water diffusional kurtosis imaging in the assessment of uterine tumors: A preliminary study. PLoS One 2017; 12:e0188434. [PMID: 29176867 PMCID: PMC5703480 DOI: 10.1371/journal.pone.0188434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/07/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To evaluate the interobserver reliability and value of diffusional kurtosis imaging (DKI) in the assessment of uterine tumors compared with those of conventional diffusion-weighted imaging (DWI). METHODS This retrospective study was approved by our institutional review board, which waived the requirement for informed consent. Fifty-eight women (mean age: 55.0 ± 13.6 years; range: 30-89 years) with suspected malignant uterine tumors underwent 3-T magnetic resonance imaging using DKI and DWI. Twelve had coexisting leiomyoma. Two observers analyzed region-of-interest measurements of diffusivity (D), kurtosis (K), and the apparent diffusion coefficient (ADC) of uterine lesions and healthy adjacent tissues. Interobserver agreement was evaluated using the intra-class correlation coefficient (ICC). The mean values were compared using one-way analysis of variance with a post-hoc Tukey's honestly significant difference test. The diagnostic accuracy of D and ADC in differentiating malignant tumors from benign leiomyomas was analyzed using receiver operating characteristic (ROC) analysis. RESULTS The ICCs between the two observers in evaluating D, K, and the ADC of the malignant tumors were higher than 0.84, suggesting excellent interobserver agreements. The mean D (×10-3 mm2/s) of uterine cancers (1.05 ± 0.41 and 1.09 ± 0.40 for observers 1 and 2, respectively) were significantly lower than those of leiomyoma (1.40 ± 0.37 and 1.56 ± 0.33, respectively; P < 0.05), healthy myometrium (1.72 ± 0.27 and 1.69 ± 0.30, respectively; P < 0.001), and healthy endometrium (1.53 ± 0.35 and 1.42 ± 0.37, respectively; P < 0.005). There was no significant difference in the area under the ROC curve between D and ADC. The mean K of uterine cancers (0.88 ± 0.28 and 0.90 ± 0.23, respectively) were higher than those of myometrium (0.72 ± 0.10 and 0.73 ± 0.10, respectively; P < 0.001), healthy endometrium (0.65 ± 0.13 and 0.60 ± 0.18, respectively; P < 0.001), and leiomyoma (0.76 ± 0.14 and 0.77 ± 0.16, respectively; not significant, P > 0.1). CONCLUSIONS Interobserver agreements in evaluating D, K, and ADC were moderate to excellent. D performed equally to conventional DWI in differentiating between benign and malignant uterine lesions. The mean K of malignant uterine lesions was significantly higher than that of non-tumorous myometrium or endometrium.
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Affiliation(s)
- Aliou Amadou Dia
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masatoshi Hori
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
- * E-mail:
| | - Hiromitsu Onishi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Sakane
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Ota
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahiro Tsuboyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Mitsuaki Tatsumi
- Department of Radiology, Osaka University Hospital, Suita, Japan
| | | | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
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Rodríguez-Trujillo A, Martínez-Serrano MJ, Martínez-Román S, Martí C, Buñesch L, Nicolau C, Pahisa J. Preoperative Assessment of Myometrial Invasion in Endometrial Cancer by 3D Ultrasound and Diffusion-Weighted Magnetic Resonance Imaging: A Comparative Study. Int J Gynecol Cancer 2017; 26:1105-10. [PMID: 27177278 DOI: 10.1097/igc.0000000000000724] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The prognosis of endometrial cancer depends on the correct surgical staging. In early stages, 18% to 30% rate of positive lymph nodes is reported with a myometrial invasion of 50% or more. According to this, patients with International Federation of Gynecology and Obstetrics stage Ib would benefit from staging lymphadenectomy. Therefore, it is important to classify these patients preoperatively to plan the surgery. In the recent years, 3-dimensional (3D) ultrasound and diffusion-weighted magnetic resonance imaging (DW-MRI) have been incorporated in the preoperative management of these patients. The aim of this study was to assess the usefulness of 3D ultrasound and DW-MRI as predictor of myometrial invasion in endometrial cancer. MATERIAL AND METHODS We retrospectively compared the assessment of myometrial invasion by 3D ultrasound and DW-MRI with final pathologic evaluation on hysterectomy specimens, in 98 patients diagnosed of early-stage endometrial cancer, who underwent surgery at the Hospital Clinic of Barcelona between 2012 and 2015. RESULTS Evaluation of the depth of myometrial invasion with 3D ultrasound had a sensitivity, specificity, and accuracy of 77%, 83% and 81%, respectively. Evaluation of the depth of myometrial invasion with DW-MRI had a sensitivity, specificity, and accuracy of 69%, 86%, and 81%, respectively. Association of both techniques improved all the values, showing a sensitivity, specificity, and accuracy of 87%, 93%, and 91%, respectively. In both 3D ultrasound and DW-MRI, the presence of leiomyomas was the first detectable cause of false negative (3% and 4%, respectively) and false-positive (3% and 1%, respectively). CONCLUSIONS We conclude that the implementation of the 2 studies in early-stage endometrial cancer provides low false-negatives and false-positives rates. In cases of patients with leiomyomas, adenomiosis, or intrauterine fluid collection, definitive evaluation of myometrial invasion could be better deferred to intraoperative biopsy in an attempt to reduce false-negatives and false-positives rates.
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Affiliation(s)
- Adriano Rodríguez-Trujillo
- *Department of Gynecology and Obstetrics, Hospital Clìnic i Provincial, University of Barcelona, Spain; and †Department of Radiology, Hospital Clínic i Provincial, University of Barcelona, Barcelona, Spain
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Nougaret S, Lakhman Y, Vargas HA, Colombo PE, Fujii S, Reinhold C, Sala E. From Staging to Prognostication. Magn Reson Imaging Clin N Am 2017; 25:611-633. [DOI: 10.1016/j.mric.2017.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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19
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Ota T, Hori M, Onishi H, Sakane M, Tsuboyama T, Tatsumi M, Nakamoto A, Kimura T, Narumi Y, Tomiyama N. Preoperative staging of endometrial cancer using reduced field-of-view diffusion-weighted imaging: a preliminary study. Eur Radiol 2017; 27:5225-5235. [DOI: 10.1007/s00330-017-4922-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/15/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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Du L, Yu Y, Wang Y, Xia J, Qiu X, Lei Y. The diagnostic value of multimodality MRI in endometrial carcinoma staging. Acta Radiol 2017; 58:609-616. [PMID: 28273727 DOI: 10.1177/0284185116669871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Multimodality magnetic resonance imaging (MRI) is an imaging technology that is used to integrate the structural and functional information of lesions. MRI can determine the staging of endometrial carcinoma, provide guidance for selection of surgical treatment and postoperative prognostic assessment, and has an important role in improving the survival of patients with endometrial carcinoma. Purpose To evaluate multimodality MRI staging accuracy for endometrial carcinoma based on the International Federation of Gynecology and Obstetrics (FIGO 2009) staging system. Material and Methods This is a retrospective study of the complete clinical and surgical pathology data from 83 patients with endometrial carcinoma treated between June 2011 and August 2015. Using a blind design, the preoperative clinical staging according to the current FIGO2009 MRI-based staging for each endometrial carcinoma was analyzed and corrected by postoperative histopathological results, which served as the staging standard. The role of multimodality MRI on clinical staging accuracy for endometrial carcinoma was studied. Results Based on the pathological evaluation after surgery, the 83 endometrial carcinoma patients were staged according to the current FIGO2009 staging criteria as: stage I, n = 56; stage II, n = 17; stage III, n = 7; and stage IV, n = 3. The multimodality MRI staging accuracy for endometrial carcinoma stages I-IV by FIGO2009 were 91.6% (76/83), 91.6% (76/83), 92.8% (77/83), and 97.6% (81/83), respectively. Conclusion Multimodality MRI is an important imaging tool in the pre-operative clinical staging of endometrial carcinoma. The current FIGO staging system appears to be a concise, reasonable, and practical set of criteria for the clinical management of endometrial carcinoma.
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Affiliation(s)
- Lixin Du
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
- Department of Radiology, Shenzhen Longhua New District Central Hospital, Shenzhen, Guangdong, PR China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Yuli Wang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, PR China
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, PR China
| | - Xixiong Qiu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, PR China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, PR China
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Mahajan A, Sable NP, Popat PB, Bhargava P, Gangadhar K, Thakur MH, Arya S. Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management. Semin Ultrasound CT MR 2016; 38:231-268. [PMID: 28705370 DOI: 10.1053/j.sult.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Nilesh P Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Palak B Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
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Lin G, Huang YT, Chao A, Lin YC, Yang LY, Wu RC, Lu HY, Ng SH, Ng KK, Lai CH. Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T. Eur Radiol 2016; 27:1867-1876. [DOI: 10.1007/s00330-016-4583-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 01/14/2023]
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23
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Du L, Li X, Qiu X, Liu X, Wang Y, Yu Y. Application of FLASH-3D dynamic contrast-enhanced imaging for diagnosis of endometrial carcinoma. Br J Radiol 2016; 89:20160268. [PMID: 27459248 DOI: 10.1259/bjr.20160268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the application and value of fast low-angle shot three-dimensional (FLASH-3D) dynamic contrast-enhanced MRI for the pre-operative staging of endometrial carcinoma. METHODS This prospective study enrolled 48 patients with complete clinical data and pathologically confirmed endometrial carcinoma from July 2012 to March 2014. After routine MRI examination, subjects underwent FLASH-3D dynamic contrast-enhanced examination. The dynamically enhanced features of the uterine wall and tumours were analyzed. FLASH-3D pre-operative staging and findings in relation to myometrial invasion were compared with post-operative pathological results in a double-blind manner. RESULTS There were 48 cases of pathologically proven endometrial carcinoma, including 34 patients with Stage I (Stage Ia 22 cases and Stage Ib 12 cases), 9 with Stage II, 3 with Stage III and 2 with Stage IV. The staging accuracy for endometrial carcinoma was 81% (39/48) using FLASH-3D dynamic contrast-enhanced sequences. The sensitivity, specificity and accuracy for the determination of deep myometrial invasion were 84%, 90% and 88%, respectively. There was no significant difference compared with the results of post-operative pathology (p > 0.05). CONCLUSION FLASH-3D dynamic contrast-enhanced imaging may be valuable for the early diagnosis and pre-operative staging of endometrial carcinoma. Its high accuracy for assessing deep myometrial invasion makes FLASH-3D imaging an important tool for selecting the optimal therapeutic protocol and for prognosis estimation. ADVANCES IN KNOWLEDGE FLASH-3D can significantly improve the accurate assessment of the depth of tumour invasion into the myometrium and may thus help to guide clinical surgical choices and post-operative evaluation. FLASH-3D is thus a promising technique for the routine examination of female pelvic tumours.
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Affiliation(s)
- Lixin Du
- 1 Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.,2 Department of Radiology, Shenzhen Longhua New District Central Hospital, Shenzhen, Guangdong, China
| | - Xiaohu Li
- 1 Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xixiong Qiu
- 3 Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xiaolei Liu
- 3 Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yuli Wang
- 3 Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yongqiang Yu
- 1 Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Shady MS, Bakry MA, Mazroa JA, Gadelhak BN. MR diffusion imaging in preoperative evaluation of depth of myometrial invasion in endometrial carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Downey K, Attygalle AD, Morgan VA, Giles SL, MacDonald A, Davis M, Ind TEJ, Shepherd JH, deSouza NM. Comparison of optimised endovaginal vs external array coil T2-weighted and diffusion-weighted imaging techniques for detecting suspected early stage (IA/IB1) uterine cervical cancer. Eur Radiol 2016; 26:941-50. [PMID: 26162579 PMCID: PMC4778155 DOI: 10.1007/s00330-015-3899-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare sensitivity and specificity of endovaginal versus external-array coil T2-W and T2-W + DWI for detecting and staging small cervical tumours. METHODS Optimised endovaginal and external array coil MRI at 3.0-T was done prospectively in 48 consecutive patients with stage Ia/Ib1 cervical cancer. Sensitivity/specificity for detecting tumour and parametrial extension against histopathology for a reading radiologist were determined on coronal T2-W and T2W + DW images. An independent radiologist also scored T2-W images without and with addition of DWI for the external-array and endovaginal coils on separate occasions >2 weeks apart. Cohen's kappa assessed inter- and intra-observer agreement. RESULTS Median tumour volume in 19/38 cases positive on subsequent histology was 1.75 cm(3). Sensitivity, specificity, PPV, NPV were: reading radiologist 91.3 %, 89.5 %, 91.3 %, 89.5 %, respectively; independent radiologist T2-W 82.6 %, 73.7 %, 79.1 %, 77.8 % for endovaginal, 73.9 %, 89.5 %, 89.5 %, 73.9 % for external-array coil. Adding DWI improved sensitivity and specificity of endovaginal imaging (78.2 %, 89.5 %); adding DWI to external-array imaging improved specificity (94.7 %) but reduced sensitivity (66.7 %). Inter- and intra-observer agreement on T2-W + DWI was good (kappa = 0.67 and 0.62, respectively). CONCLUSION Endovaginal coil T2-W MRI is more sensitive than external-array coil for detecting tumours <2 cm(3); adding DWI improves specificity of endovaginal imaging but reduces sensitivity of external-array imaging. KEY POINTS • Endovaginal more accurate than external-array T2-W MRI for detecting small cervical cancers. • Addition of DWI improves sensitivity and specificity of endovaginal T2-W imaging. • Addition of DWI substantially reduces sensitivity of external-array T2-W imaging.
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Affiliation(s)
- Kate Downey
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Veronica A Morgan
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Sharon L Giles
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - A MacDonald
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - M Davis
- Department of Gynaecology, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, Surrey, KT2 7QB, UK
| | - Thomas E J Ind
- Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - John H Shepherd
- Gynecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Nandita M deSouza
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK.
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He Y, Ding N, Li Y, Li Z, Xiang Y, Jin Z, Xue H. Cyclic changes of the junctional zone on 3 T MRI images in young and middle-aged females during the menstrual cycle. Clin Radiol 2016; 71:341-8. [DOI: 10.1016/j.crad.2015.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/07/2015] [Accepted: 12/07/2015] [Indexed: 01/26/2023]
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Manoharan D, Das CJ, Aggarwal A, Gupta AK. Diffusion weighted imaging in gynecological malignancies - present and future. World J Radiol 2016; 8:288-297. [PMID: 27027614 PMCID: PMC4807338 DOI: 10.4329/wjr.v8.i3.288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/07/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
The management of gynaecological malignancies has undergone a significant change in recent years with our improved understanding of cancer biogenetics, development of new treatment regimens and enhanced screening. Due to the rapid blooming of newer methods and techniques in gynaecology, surgery and oncology the scope and the role of imaging has also widened. Functional imaging in the form of diffusion weighted imaging (DWI) has been recently found to be very useful in assessing various tumours. Its ability to identify changes in the molecular level has dramatically changed the diagnostic approach of radiologists which was solely based on morphological criteria. It can improve the diagnostic accuracy of conventional magnetic resonance imaging, lend a hand in assessing tumour response to treatment regimens and detect tumour recurrence with better spatial resolution, negative radiation and diagnostic accuracy compared to positron emission tomography scan. The ability to quantify the diffusion has also lead to potential prediction of tumour aggressiveness and grade which directly correlate with the patient prognosis and management. Hence, it has become imperative for a radiologist to understand the concepts of DWI and its present and evolving role. In this article we present a brief description of the basics of DWI followed by its role in evaluation of female gynaecological malignancies.
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Abstract
Endometrial cancer is the most common gynaecological tumour in developed countries, and its incidence is increasing. The most frequently occurring histological subtype is endometrioid adenocarcinoma. Patients are often diagnosed when the disease is still confined to the uterus. Standard treatment consists of primary hysterectomy and bilateral salpingo-oophorectomy, often using minimally invasive approaches (laparoscopic or robotic). Lymph node surgical strategy is contingent on histological factors (subtype, tumour grade, involvement of lymphovascular space), disease stage (including myometrial invasion), patients' characteristics (age and comorbidities), and national and international guidelines. Adjuvant treatment is tailored according to histology and stage. Various classifications are used to assess the risks of recurrence and to determine optimum postoperative management. 5 year overall survival ranges from 74% to 91% in patients without metastatic disease. Trials are ongoing in patients at high risk of recurrence (including chemotherapy, chemoradiation therapy, and molecular targeted therapies) to assess the modalities that best balance optimisation of survival with the lowest adverse effects on quality of life.
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Affiliation(s)
- Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France; Unit INSERM U 1030, Gustave Roussy, Villejuif, France; Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France.
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Translational Research Lab U981, Gustave Roussy, Villejuif, France
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Emile Darai
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France; INSERM UMRS 938, Paris, France; Université Pierre et Marie Curie (Paris VI), Paris, France
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Preoperative Pelvic MRI and Serum Cancer Antigen–125: Selecting Women With Grade 1 Endometrial Cancer for Lymphadenectomy. AJR Am J Roentgenol 2015; 205:W556-64. [DOI: 10.2214/ajr.14.13746] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Seith F, Gatidis S, Bisdas S, la Fougère C, Schäfer J, Nikolaou K, Schwenzer N. PET/MR in Oncology. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zheng L, Zheng S, Yuan X, Wang X, Zhang Z, Zhang G. Comparison of dynamic contrast-enhanced magnetic resonance imaging with T2-weighted imaging for preoperative staging of early endometrial carcinoma. Onco Targets Ther 2015; 8:1743-51. [PMID: 26229482 PMCID: PMC4514351 DOI: 10.2147/ott.s86519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose This study aimed to compare dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with T2-weighted imaging (T2WI) for the preoperative staging of early endometrial carcinoma. Methods This retrospective study included 22 subjects with early endometrial carcinoma who underwent 3.0 T MRI examination prior to hysterectomy. DCE-MRI and T2WI were evaluated for the preoperative staging of endometrial carcinoma. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DCE-MRI and T2WI were assessed and compared using the revised International Federation of Gynecology and Obstetrics surgical staging guidelines (2009) as the reference standard. Results Out of the 22 cases of endometrial carcinoma, the use of the reference standard method led to the staging of 14 as IA and eight as IB. The sensitivity, specificity, PPV, NPV, and accuracy of DCE-MRI for preoperative staging were 100% (95% confidence interval: 0.73–1.0), 62.5% (95% CI: 0.26–0.90), 82.4% (95% CI: 0.56–0.95), 100% (95% CI: 0.46–1.0), and 86.4%, respectively, and these values were 85.7% (95% CI: 0.56–0.97), 75% (95% CI: 0.36–0.96), 85.7% (95% CI: 0.56–0.97), 75% (95% CI: 0.36–0.96), and 81.8%, respectively, for T2WI. Thus, the sensitivity and accuracy of DCE-MRI were greater than those of T2WI for preoperative endometrial carcinoma staging. Conclusion DCE-MRI was more sensitive but less specific than T2WI for the preoperative staging of early endometrial carcinoma. DCE-MRI may serve as a useful and reliable tool for the preoperative assessment of endometrial carcinoma.
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Affiliation(s)
- Linfeng Zheng
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China ; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sujuan Zheng
- Department of Obstetrics and Gynecology, Dengfeng People's Hospital, Zhengzhou, People's Republic of China
| | - Xiaochun Yuan
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xifu Wang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Guixiang Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Comparison of contrast-enhanced isotropic 3D-GRE-T1WI sequence versus conventional non-isotropic sequence on preoperative staging of cervical cancer. PLoS One 2015; 10:e0122053. [PMID: 25799021 PMCID: PMC4370849 DOI: 10.1371/journal.pone.0122053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/06/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To compare contrast-enhanced isotropic 3D-GRE-T1WI sequence vs. conventional non-isotropic sequence in terms of image quality, estimated signal-to-noise ratio (eSNR), relative tumor contrast and performance of cervical cancer staging. Methods This retrospective study was approved by the institutional review board, and informed consent was waived. Seventy-one patients (47 ± 9.4 years), with pathologically-confirmed cervical cancer underwent axial contrast-enhanced 1mm3 isotropic 3D-GRE-T1WI sequence (herein referred to Isotropy), and 3-mm-thick non-isotropic sagittal and coronal sequences. Image quality score, eSNR and relative contrast between tumor to myometrium, gluteal muscle, and fat respectively, were compared between 3-mm-thick reconstructed images from Isotropy and directly scanned non-isotropic images by paired t-test. Difference in tumor staging obtained from Isotropy and combined Three-planes including reconstructed axial images, directly scanned sagittal and coronal sequence were compared by McNemar test. Results Both sequences showed similar image quality. Reconstructed images demonstrated higher eSNR, equal or lower relative tumor contrast compared with non-isotropic images. Compared with performing diagnosis on Three-planes, both reviewers showed higher accuracy when diagnosing vaginal invasion on Isotropy (p = 0.039 and 0.003, respectively). Conclusion Compared with non-isotropic sequence, 3.0T MR isotropic 3D-GRE-T1WI sequence exhibited better eSNR, providing more reliable clinical information for preoperative staging of cervical cancer.
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Bonatti M, Stuefer J, Oberhofer N, Negri G, Tagliaferri T, Schifferle G, Messini S, Manfredi R, Bonatti G. MRI for local staging of endometrial carcinoma: Is endovenous contrast medium administration still needed? Eur J Radiol 2015; 84:208-14. [DOI: 10.1016/j.ejrad.2014.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/01/2014] [Accepted: 11/09/2014] [Indexed: 11/30/2022]
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The Combination of Diffusion- and T2-Weighted Imaging in Predicting Deep Myometrial Invasion of Endometrial Cancer. J Comput Assist Tomogr 2015; 39:661-73. [DOI: 10.1097/rct.0000000000000280] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis. Cancer Imaging 2014; 14:32. [PMID: 25608571 PMCID: PMC4331837 DOI: 10.1186/s40644-014-0032-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 10/21/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The objective of this study was to perform a systematic review and a meta-analysis in order to estimate the diagnostic accuracy of diffusion weighted imaging (DWI) in the preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma. METHODS Studies evaluating DWI for the detection of deep myometrial invasion in patients with endometrial carcinoma were systematically searched for in the MEDLINE, EMBASE, and Cochrane Library from January 1995 to January 2014. Methodologic quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies tool. Bivariate random-effects meta-analytic methods were used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and receiver operating characteristic (ROC) curves. The study also evaluated the clinical utility of DWI in preoperative assessment of deep myometrial invasion. RESULTS Seven studies enrolling a total of 320 individuals met the study inclusion criteria. The summary area under the ROC curve was 0.91. There was no evidence of publication bias (P = 0.90, bias coefficient analysis). Sensitivity and specificity of DWI for detection of deep myometrial invasion across all studies were 0.90 and 0.89, respectively. Positive and negative likelihood ratios with DWI were 8 and 0.11 respectively. In patients with high pre-test probabilities, DWI enabled confirmation of deep myometrial invasion; in patients with low pre-test probabilities, DWI enabled exclusion of deep myometrial invasion. The worst case scenario (pre-test probability, 50%) post-test probabilities were 89% and 10% for positive and negative DWI results, respectively. CONCLUSION DWI has high sensitivity and specificity for detecting deep myometrial invasion and more importantly can reliably rule out deep myometrial invasion. Therefore, it would be worthwhile to add a DWI sequence to the standard MRI protocols in preoperative evaluation of endometrial cancer in order to detect deep myometrial invasion, which along with other poor prognostic factors like age, tumor grade, and LVSI would be useful in stratifying high risk groups thereby helping in the tailoring of surgical approach in patient with low risk of endometrial carcinoma.
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Park SB, Moon MH, Sung CK, Oh S, Lee YH. Dynamic Contrast-Enhanced MR Imaging of Endometrial Cancer: Optimizing the Imaging Delay for Tumour-Myometrium Contrast. Eur Radiol 2014; 24:2795-9. [PMID: 25056550 DOI: 10.1007/s00330-014-3327-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/01/2014] [Accepted: 07/08/2014] [Indexed: 01/30/2023]
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Evaluation of myometrial invasion in endometrial cancer: comparison of diffusion-weighted magnetic resonance and intraoperative frozen sections. ACTA ACUST UNITED AC 2014; 39:1021-6. [DOI: 10.1007/s00261-014-0134-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. Eur Radiol 2014; 24:1327-38. [PMID: 24668009 DOI: 10.1007/s00330-014-3139-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/27/2014] [Accepted: 02/19/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. KEY POINTS 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.
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