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Tissue Characteristics of Endometrial Carcinoma Analyzed by Quantitative Synthetic MRI and Diffusion-Weighted Imaging. Diagnostics (Basel) 2022; 12:diagnostics12122956. [PMID: 36552962 PMCID: PMC9776551 DOI: 10.3390/diagnostics12122956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study investigates the association of T1, T2, proton density (PD) and the apparent diffusion coefficient (ADC) with histopathologic features of endometrial carcinoma (EC). METHODS One hundred and nine EC patients were prospectively enrolled from August 2019 to December 2020. Synthetic magnetic resonance imaging (MRI) was acquired through one acquisition, in addition to diffusion-weighted imaging (DWI) and other conventional sequences using 1.5T MRI. T1, T2, PD derived from synthetic MRI and ADC derived from DWI were compared among different histopathologic features, namely the depth of myometrial invasion (MI), tumor grade, cervical stromal invasion (CSI) and lymphovascular invasion (LVSI) of EC by the Mann-Whitney U test. Classification models based on the significant MRI metrics were constructed with their respective receiver operating characteristic (ROC) curves, and their micro-averaged ROC was used to evaluate the overall performance of these significant MRI metrics in determining aggressive histopathologic features of EC. RESULTS EC with MI had significantly lower T2, PD and ADC than those without MI (p = 0.007, 0.006 and 0.043, respectively). Grade 2-3 EC and EC with LVSI had significantly lower ADC than grade 1 EC and EC without LVSI, respectively (p = 0.005, p = 0.020). There were no differences in the MRI metrics in EC with or without CSI. Micro-averaged ROC of the three models had an area under the curve of 0.83. CONCLUSIONS Synthetic MRI provided quantitative metrics to characterize EC with one single acquisition. Low T2, PD and ADC were associated with aggressive histopathologic features of EC, offering excellent performance in determining aggressive histopathologic features of EC.
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Maheshwari E, Nougaret S, Stein EB, Rauch GM, Hwang KP, Stafford RJ, Klopp AH, Soliman PT, Maturen KE, Rockall AG, Lee SI, Sadowski EA, Venkatesan AM. Update on MRI in Evaluation and Treatment of Endometrial Cancer. Radiographics 2022; 42:2112-2130. [PMID: 36018785 DOI: 10.1148/rg.220070] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endometrial cancer is the second most common gynecologic cancer worldwide and the most common gynecologic cancer in the United States, with an increasing incidence in high-income countries. Although the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer is a surgical staging system, contemporary published evidence-based data and expert opinions recommend MRI for treatment planning as it provides critical diagnostic information on tumor size and depth, extent of myometrial and cervical invasion, extrauterine extent, and lymph node status, all of which are essential in choosing the most appropriate therapy. Multiparametric MRI using a combination of T2-weighted sequences, diffusion-weighted imaging, and multiphase contrast-enhanced imaging is the mainstay for imaging assessment of endometrial cancer. Identification of important prognostic factors at MRI improves both treatment selection and posttreatment follow-up. MRI also plays a crucial role for fertility-preserving strategies and in patients who are not surgical candidates by helping guide therapy and identify procedural complications. This review is a product of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel and reflects a multidisciplinary international collaborative effort to summarize updated information highlighting the role of MRI for endometrial cancer depiction and delineation, treatment planning, and follow-up. The article includes information regarding dedicated MRI protocols, tips for MRI reporting, imaging pitfalls, and strategies for image quality optimization. The roles of MRI-guided radiation therapy, hybrid PET/MRI, and advanced MRI techniques that are applicable to endometrial cancer imaging are also discussed. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Ekta Maheshwari
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Stephanie Nougaret
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Erica B Stein
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Gaiane M Rauch
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Ken-Pin Hwang
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - R Jason Stafford
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Ann H Klopp
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Pamela T Soliman
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Katherine E Maturen
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Andrea G Rockall
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Susanna I Lee
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Elizabeth A Sadowski
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
| | - Aradhana M Venkatesan
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213 (E.M.); Department of Abdominal Imaging, Montpellier Cancer Research Institute (IRCM), Montpellier, France (S.N.); Department of Radiology, University of Michigan, Ann Arbor, Mich (E.B.S., K.E.M.); Department of Abdominal Imaging, Division of Diagnostic Imaging (G.M.R., A.M.V.), Department of Imaging Physics (K.P.H., R.J.S.), Department of Radiation Oncology (A.H.K.), and Department of Gynecologic Oncology and Reproductive Medicine (P.T.S.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Imperial College, London, United Kingdom (A.G.R.); Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); and Department of Radiology, University of Wisconsin-Madison, Madison, Wis (E.A.S.)
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The application of apparent diffusion coefficients derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer. Eur Radiol 2022; 32:5106-5118. [PMID: 35320412 DOI: 10.1007/s00330-022-08717-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/12/2022] [Accepted: 03/05/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of the apparent diffusion coefficient (ADC) derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer. MATERIALS AND METHODS One hundred forty-six patients with rectal cancer who underwent preoperative MRI were prospectively enrolled. Two radiologists independently placed free-hand regions of interest (ROIs) in the largest tumor cross section and three small ROIs on the peritumoral zone adjacent to the tumor contour. Maximum values of tumor ADC (ADCtmax), minimum values of tumor ADC (ADCtmin), mean values of tumor ADC (ADCtmean), mean values of peritumor ADC (ADCpmean), and ADCpmean/ADCtmean (ADC ratio) were obtained on ADC maps and correlated with prognostic factors using uni- and multivariate logistic regression, and receiver operating characteristic curve (ROC) analysis. RESULTS Interobserver agreement was excellent for ADCtmax and ADCtmean (intraclass correlation coefficient [ICC], 0.915-0.958), and were good for ADCtmin, ADCpmean, and ADC ratio (ICC, 0.774-0.878). The ADC ratio was significantly higher in the poor differentiation, T3-4 stage, lymph node metastasis (LNM)-positive, extranodal extension (ENE)-positive, tumor deposit (TD)-positive, and lymphovascular invasion (LVI)-positive groups than that in the well-moderate differentiation, T1-2 stage, LNM-negative, ENE-negative, TD-negative, and LVI-negative groups (p = 0.008, < 0.001, < 0.001, 0.001, < 0.001, and < 0.001, respectively). The area under the ROC curve (AUC) of the ADC ratio was the highest for assessing poor differentiation (0.700), T3-4 stage (0.707), LNM-positive (0.776), TD-positive (0.848), and LVI-positive (0.778). Both the ADC ratio (AUC = 0.677) and ADCpmean (AUC = 0.686) showed higher diagnostic performance for assessing ENE. CONCLUSION The ADC ratio could provide better predictive performance for assessing preoperative prognostic factors in resectable rectal cancer. KEY POINTS • Both the peritumor/tumor ADC ratio and ADCpmean are correlated with important prognostic factors of resectable rectal cancer. • Both peritumor ADC and peritumor/tumor ADC ratio had higher diagnostic performance than tumor ADC for assessment of prognostic factors in resectable rectal cancer. • Peritumor/tumor ADC ratio showed the most capability for the assessment of prognostic factors in resectable rectal cancer.
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Quan Q, Peng H, Gong S, Liu J, Lu Y, Chen R, Mu X. The Preeminent Value of the Apparent Diffusion Coefficient in Assessing High-Risk Factors and Prognosis for Stage I Endometrial Carcinoma Patients. Front Oncol 2022; 12:820904. [PMID: 35251987 PMCID: PMC8888536 DOI: 10.3389/fonc.2022.820904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To evaluate the role of the apparent diffusion coefficient (ADC) value in the individualized management of stage I endometrial carcinoma (EC). Methods A retrospective analysis was performed on 180 patients with stage I EC who underwent 1.5-T magnetic resonance imaging. The mean ADC (mADC), minimum ADC (minADC), and maximum ADC (maxADC) values of each group were measured and compared. We analyzed the relationship between ADC values and stage I EC prognosis by Kaplan-Meier method and Cox proportional hazards analysis. Results Patients with lower ADC values were more likely to be characterized by higher grades, specific histological subtypes and deeper myometrial invasion. The mADC, minADC and maxADC values (×10-3 mm2/s) were 1.045, 0.809 and 1.339, respectively, in grade 1/2 endometrioid carcinoma with superficial myometrial invasion, which significantly differed from those in grade 3 or nonendometrioid carcinoma or with deep myometrial invasion (0.929, 0.714 and 1.215) (P=<0.001, <0.001 and <0.001). ADC values could be used to predict these clinicopathological factors. Furthermore, the group with higher ADC values showed better disease-free survival and overall survival. Conclusions The present study indicated that ADC values were associated with the high-risk factors for stage I EC and to assess whether fertility-sparing, ovarian preservation or omission of lymphadenectomy represent viable treatment options. Moreover, this information may be applied to predict prognosis. Thus, ADC values could contribute to managing individualized therapeutic schedules to improve quality of life.
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Affiliation(s)
- Quan Quan
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Peng
- The Department of Obstetrics and Gynecology, Chongqing Wansheng Jingkai District Maternal and Child Health Hospital, Chongqing, China
| | - Sainan Gong
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiali Liu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunfeng Lu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongsheng Chen
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoling Mu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abdel-Latif M, Mosaad HS. Use of diffusion-weighted imaging and diffusion tensor imaging in assessment of myometrial invasion in patients of endometrial carcinoma and its correlation with histopathological grading (Prospective study). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00652-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endometrial cancer (EMC) is considered one of the most common gynecological cancers worldwide. In particular, the depth of myometrial invasion and histological grade of endometrial cancers (EMCs) are strong prognostic factors. Diffusion tensor measurements as mean diffusivity (MD) and fractional anisotropy (FA) values could be useful for assessing the depth of tumor invasion and its histological grade. The study aimed to evaluate the role of diffusion-weighted imaging (DWI) and diffusion tensor imaging in the detection of myometrial invasion in cases of endometrial carcinoma and prediction of its grade in vivo.
Results
This study included 50 female patients with pathologically proved endometrial carcinoma, and their ages ranged from 38 to 67 years; the mean age was 56.15 years (± 8.229 standard deviation “SD”). There was a significant statistical difference regarding the mean values of diffusion tensor fractional anisotropy (DT-FA), diffusion tensor mean diffusivity (DT-MD) and diffusion-weighted apparent diffusion coefficient(DW-ADC) values in differentiating between intact and infiltrated myometrium with (P value ≤ 0.001). The accuracy of DT-MD, DT-FA and DWI-ADC was 98%, 90% and 86%, respectively, in the detection of myometrial invasion. There was a statistically significant difference in the mean values of DT-FA, DT-MD and DW-ADC for differentiating endometrioid adenocarcinoma grades with the overall P values (˂0.001). The accuracy of DT-FA, DT- MD and DWI-ADC for differentiating grade 3 from grade 1 or 2 endometrioid adenocarcinoma was 94.9%, 84.6% and 74.4%, respectively. For differentiating grade 1 from grade 2 or 3 endometrioid adenocarcinoma, the accuracy of DT-FA, DT-MD and DWI-ADC was 90%, 89.7% and 84.6%, respectively. Mean DT-FA, DT-MD and DW-ADC values were inversely proportional to the degree of pathological grading with r = − 0.867, − 0.762 and − 0.706, respectively.
Conclusion
Diffusion tensor imaging and DWI are helpful in the assessment of myometrial invasion and have a high negative correlation with histopathological grading in patients with endometrial cancer.
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Quan Q, Lu Y, Xuan B, Wu J, Yin W, Hua Y, Chen R, Ren S, Zhou S, Zhang F, Meng Y, Rao K, Mu X. The prominent value of apparent diffusion coefficient in assessing high-risk factors and prognosis for patients with endometrial carcinoma before treatment. Acta Radiol 2021; 62:830-838. [PMID: 32702999 DOI: 10.1177/0284185120940271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To date, there are no consensus methods to evaluate the high-risk factors and prognosis for managing the personalized treatment schedule of patients with endometrial carcinoma (EC) before treatment. Apparent diffusion coefficient (ADC) is regarded as a kind of technique to assess heterogeneity of malignant tumor. PURPOSE To explore the role of ADC value in assessing the high-risk factors and prognosis of EC. MATERIAL AND METHODS A retrospective analysis was made on 185 patients with EC who underwent 1.5-T magnetic resonance imaging (MRI). Mean ADC (mADC), minimum ADC (minADC), and maximum ADC (maxADC) were measured and compared in different groups. RESULTS Among the 185 patients with EC, the mADC and maxADC values in those with high-risk factors (type 2, deep myometrial invasion, and lymph node metastasis) were significantly lower than in those without. According to receiver operating characteristic (ROC) curve analysis, the areas under the curve (AUC) were significant for mADC, minADC, and maxADC predicting high-risk factors. Furthermore, the AUCs were significant for mADC and maxADC predicting lymph node metastasis but were not significant for minADC. Patients with lower mADC were associated with worse overall survival and disease-free survival; the opposite was true for patients with higher mADC. CONCLUSION Our study showed that ADC values could be applied to assess the high-risk factors of EC before treatment and might significantly relate to the prognosis of EC. It might contribute to managing initial individualized treatment schedule and improve outcome in patients with EC.
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Affiliation(s)
- Quan Quan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Yunfeng Lu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Beibei Xuan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Jingxian Wu
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Wanchun Yin
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Yi Hua
- Children’s Hospital of Chongqing Medical University, Chongqing, PR China
| | - Rongsheng Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Siling Ren
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Shuwei Zhou
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Fenfen Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Yu Meng
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
| | - Kunying Rao
- Department of Obstetrics and Gynecology, Chongqing Yubei District People’s Hospital, Chongqing, PR China
| | - Xiaoling Mu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, PR China
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Arian A, Easa AM, Arab-Ahmadi M. Diagnostic value of diffusion-weighted magnetic resonance imaging in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer. Acta Radiol 2020; 61:1580-1586. [PMID: 32106683 DOI: 10.1177/0284185120906660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Researchers have recently focused on assessing the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting pelvic lymph node metastases in gynecological malignancies. PURPOSE To evaluate the diagnostic value of DW-MRI in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer patients. MATERIAL AND METHODS This retrospective database study was conducted with 33 women aged 30-84 years with pathologically proven endometrial cancer that had been assessed by DW-MRI before their first treatment initiation at our referral hospital from March 2016 to April 2019. The diffusion technique (b = 50, 400, and 1000 mm2/s) was used in the imaging, and continuous apparent diffusion coefficient (ADC) metrics (ADCmin, ADCmax, ADCmean, ADCSD, and rADC) were compared between the metastatic and non-metastatic lymph nodes. RESULTS In total, 48 lymph nodes from 33 patients were assessed. All metastatic lymph nodes were restricted, while among the non-metastatic lymph nodes, only 19.3% were restricted. Considering pathological reports of metastatic and non-metastatic lymph nodes as the gold standard, DWI-related restricted and non-restricted features had a sensitivity of 80.6%, a specificity of 100%, and an accuracy of 87.5% to discriminate between a metastatic and non-metastatic pattern. ADC metrics of ADCmin, ADCmax, ADCmean, ADCSD, and rADC showed high values enabling differentiation between metastatic and non-metastatic lymph nodes. The best cut-off values were 0.7 × 10-3, 1.2 × 10-3, 1.01 × 10-3, 123, and 0.78, respectively. CONCLUSION DW-MRI is a useful quantitative tool for differentiating between metastatic and benign lymph nodes in endometrial cancer patients.
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Affiliation(s)
- Arvin Arian
- Department of Radiology, Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Mohamedbaqer Easa
- Department of Technology of Radiology and Radiotherapy, Allied Medical Sciences School, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Arab-Ahmadi
- Department of Radiology, Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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8
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Reinhold C, Ueno Y, Akin EA, Bhosale PR, Dudiak KM, Jhingran A, Kang SK, Kilcoyne A, Lakhman Y, Nicola R, Pandharipande PV, Paspulati R, Shinagare AB, Small W, Vargas HA, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer. J Am Coll Radiol 2020; 17:S472-S486. [PMID: 33153558 DOI: 10.1016/j.jacr.2020.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
Abstract
To date, there is little consensus on the role of pelvic imaging in assessing local disease extent during initial staging in patients with endometrial carcinoma, with practices differing widely across centers. However, when pretreatment assessment of local tumor extent is indicated, MRI is the preferred imaging modality. Preoperative imaging of endometrial carcinoma can define the extent of disease and indicate the need for subspecialist referral in the presence of deep myometrial invasion, cervical extension, or suspected lymphadenopathy. If distant metastatic disease is clinically suspected, preoperative assessment with cross-sectional imaging or PET/CT may be performed. However, most patients with low-grade disease are at low risk of lymph node and distant metastases. Thus, this group may not require a routine pretreatment evaluation for distant metastases. Recurrence rates in patients with endometrial carcinoma are infrequent. Therefore, radiologic evaluation is typically used only to investigate suspicion of recurrent disease due to symptoms or physical examination and not for routine surveillance after treatment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Yoshiko Ueno
- Research Author, Kobe University Graduate School of Medicine, Kobe, Japan, McGill University, Montreal, Quebec, Canada
| | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | | | | | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stella K Kang
- New York University Medical Center, New York, New York
| | | | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Rajmohan Paspulati
- University Hospitals Medical Group Radiology, Cleveland, Ohio, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut; Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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9
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Reyes-Pérez JA, Villaseñor-Navarro Y, Jiménez de los Santos ME, Pacheco-Bravo I, Calle-Loja M, Sollozo-Dupont I. The apparent diffusion coefficient (ADC) on 3-T MRI differentiates myometrial invasion depth and histological grade in patients with endometrial cancer. Acta Radiol 2020; 61:1277-1286. [PMID: 31955608 DOI: 10.1177/0284185119898658] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) with apparent diffusion coefficient (ADC) measurement provides additional information about tumor microstructure with potential relevance for staging and predicting aggressive disease in patients with endometrial cancer (EC). PURPOSE To determine whether ADC values in EC diverge according to the tumor's histologic grade and myometrial invasion depth. MATERIAL AND METHODS A sample of 48 pathologically confirmed cases of EC were reviewed retrospectively. The sample was distributed as follows: G1 (n = 9); G2 (n = 18); G3 (n = 21); with myometrial invasion <50% (n = 31); and with myometrial invasion ≥50% (n = 17). DW images were performed at 3.0T with b factors of 0-1000/mm2. The region of interest (ROI) was defined within the tumor with T1-weighted and T2-weighted imaging and copied manually to an ADC map. The tumor's grade and myometrial invasion's depth were determined by postoperative histopathological tests. RESULTS The means of ADCmin and ADCmean values were significantly lower for patients with G2 and G3 endometrial tumors than G1. The same tendency was observed in myometrial invasion, as both ADCmin and ADCmean values were lower for patients with deep than for those with superficial myometrial invasion. The cut-off values of the ADCmin and ADCmean that predicted high-grade tumors were 0.69 × 10-3 mm2/s and 0.82 × 10-3 mm2/s, respectively, while those for myometrial infiltration were 0.70 × 10-3 mm2/s (ADCmin) and 0.88 × 10-3 mm2/s (ADCmean). CONCLUSION ADCmin and ADCmean values correlated with histologic tumor grade and myometrial invasion depth; therefore, it is suggested that ADC on MRI may be a useful indicator to predict malignancy of ECs.
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Affiliation(s)
| | | | | | | | - Maricela Calle-Loja
- Department of Radiology, Instituto Nacional de Cancerología, Mexico City, Mexico
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10
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Assessment of Tamoxifen-Related Endometrial Changes in Premenopausal Female Patients With Diffusion-Weighted Magnetic Resonance Imaging. J Comput Assist Tomogr 2020; 44:485-489. [PMID: 32558766 DOI: 10.1097/rct.0000000000001028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate tamoxifen-related endometrial changes in premenopausal female patients with diffusion-weighted magnetic resonance imaging (DWI). METHODS This prospective study was performed on 71 premenopausal female patients (mean age, 41 years) who were receiving tamoxifen therapy. All patients underwent magnetic resonance imaging with DWI of the pelvis and hysteroscopic-guided endometrial biopsy. The apparent diffusion coefficient (ADC) values of the endometrial plate were calculated and correlated with pathological results. RESULTS The mean ADCs of tamoxifen-related benign endometrial lesions (1.35 ± 0.19 and 1.32 ± 0.13 × 10 mm/s) were significantly higher (P = 0.001) than those of normal endometrial plate (0.95 ± 0.11 and 0.93 ± 0.11 × 10 mm/s) by both reviewers, respectively. The cutoff ADC values used to differentiate tamoxifen-related benign endometrial lesions from normal endometrium were 1.07 and 1.02 × 10 mm/s with areas under the curve of 0.94 and 0.93 and accuracy of 94.4 and 95.8 by both reviewers, respectively. The mean ADC values of endometrial polyp (EP) (1.44 ± 0.19 and 1.42 ± 0.22 × 10 mm/s) were significantly higher (P = 0.001) than those of endometrial hyperplasia (EH) (1.25 ± 0.19 and 1.23 ± 0.19 × 10 mm/s) by both reviewers, respectively. The cutoff ADC values used to differentiate EP from EH were 1.38 × 10 and 1.36 × 10 mm/s with areas under the curve of 0.81 and 0.77 and accuracy of 80% and 70% by both reviewers, respectively. There was an insignificant difference in ADC value between typical and atypical EH. The ADC values of endometrial cancer (0.80 and 0.78 × 10 mm/s) were lower than those of tamoxifen-related benign endometrial lesions. The final diagnosis was normal endometrium (n = 36), benign endometrial lesions either EH (n = 17), or EP (n = 16), and endometrial cancer in only 2 patients. CONCLUSIONS We concluded that DWI helps in detection and characterization of different tamoxifen-related endometrial changes in the premenopausal female patients.
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11
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Kettunen T, Okuma H, Auvinen P, Sudah M, Tiainen S, Sutela A, Masarwah A, Tammi M, Tammi R, Oikari S, Vanninen R. Peritumoral ADC values in breast cancer: region of interest selection, associations with hyaluronan intensity, and prognostic significance. Eur Radiol 2019; 30:38-46. [PMID: 31359124 PMCID: PMC6890700 DOI: 10.1007/s00330-019-06361-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/18/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022]
Abstract
Objectives We aimed to evaluate the differences in peritumoral apparent diffusion coefficient (ADC) values by four different ROI selection methods and to validate the optimal method. Furthermore, we aimed to evaluate if the peritumor-tumor ADC ratios are correlated with axillary lymph node positivity and hyaluronan accumulation. Methods Altogether, 22 breast cancer patients underwent 3.0-T breast MRI, histopathological evaluation, and hyaluronan assay. Paired t and Friedman tests were used to compare minimum, mean, and maximum values of tumoral and peritumoral ADC by four methods: (M1) band ROI, (M2) whole tumor surrounding ROI, (M3) clockwise multiple ROI, and (M4) visual assessment of ROI selection. Subsequently, peritumor/tumor ADC ratios were compared with hyaluronan levels and axillary lymph node status by the Mann-Whitney U test. Results No statistically significant differences were found among the four ROI selection methods regarding minimum, mean, or maximum values of tumoral and peritumoral ADC. Visual assessment ROI measurements represented the less time-consuming evaluation method for the peritumoral area, and with sufficient accuracy. Peritumor/tumor ADC ratios obtained by all methods except the clockwise ROI (M3) showed a positive correlation with hyaluronan content (M1, p = 0.004; M2, p = 0.012; M3, p = 0.20; M4, p = 0.025) and lymph node metastasis (M1, p = 0.001; M2, p = 0.007; M3, p = 0.22; M4, p = 0.015), which are established factors for unfavorable prognosis. Conclusions Our results suggest that the peritumor/tumor ADC ratio could be a readily applicable imaging index associated with axillary lymph node metastasis and extensive hyaluronan accumulation. It could be related to the biological aggressiveness of breast cancer and therefore might serve as an additional prognostic factor. Key Points • Out of four different ROI selection methods for peritumoral ADC evaluation, measurements based on visual assessment provided sufficient accuracy and were the less time-consuming method. • The peritumor/tumor ADC ratio can provide an easily applicable supplementary imaging index for breast cancer assessment. • A higher peritumor/tumor ADC ratio was associated with axillary lymph node metastasis and extensive hyaluronan accumulation and might serve as an additional prognostic factor.
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Affiliation(s)
- Tiia Kettunen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland. .,Department of Oncology, Cancer Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland.
| | - Hidemi Okuma
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.,Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland
| | - Päivi Auvinen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.,Department of Oncology, Cancer Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland
| | - Mazen Sudah
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.,Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland
| | - Satu Tiainen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.,Department of Oncology, Cancer Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland
| | - Anna Sutela
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.,Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland
| | - Amro Masarwah
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Markku Tammi
- Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Raija Tammi
- Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Sanna Oikari
- Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.,Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland
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