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Abstract：
BACKGROUND: Endometrial cancer (EC) is the most common gynecological malignancy. Accurate preoperative staging is essential for guiding treatment. The depth of myometrial invasion is a key prognostic factor. This prospective study aimed to evaluate the added benefit of diffusion-weighted imaging (DWI) compared to T2-weighted imaging (T2WI) and dynamic contrast-enhanced MRI (DCE-MRI) for the preoperative assessment of myometrial invasion in EC.
OBJECTIVE: The aim of this prospective study was to evaluate the added benefit of DWI in the preoperative assessment of myometrial invasion in EC, in comparison with T2WI and DCE-MRI. The objectives were to assess the imaging characteristics of endometrial carcinoma on T2WI, DCE, and DW MR, to assess the depth of myometrial invasion and overall stage in EC patients, to compare the diagnostic performance of DCE-MRI with that of DW-MRI combined with T2WI, to describe how MR imaging findings can be combined with tumor histologic features and grading to guide treatment planning, and to evaluate the pitfalls and limitations of DCE and DW MR in the assessment of EC.
METHODS: Thirty-one patients with histologically confirmed EC underwent preoperative pelvic MRI on a 1.5T scanner. T2WI, DWI (b-values 0, 1000 s/mm2), and DCE-MRI were performed. Two radiologists independently assessed myometrial invasion on T2WI, T2WI + DWI, and T2WI + DCE-MRI. Histopathology after hysterectomy was the reference standard. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each MRI protocol, with separate analyses for superficial (<50%) and deep (≥50%) myometrial invasions.
RESULTS: The accuracy for assessing superficial invasion was 61.3% for T2WI, 87.1% for T2WI + DWI, and 87.1% for T2WI + DCE-MRI. For deep invasion, accuracy was 64.5% for T2WI, 90.3% for T2WI + DWI, and 90.3% for T2WI + DCE-MRI. Sensitivity, specificity, PPV, and NPV for T2WI + DWI and T2WI + DCE-MRI were high and comparable (88.9-91.7%) for both superficial and deep invasions. T2WI had markedly lower sensitivity and specificity. The differences between T2WI and the functional MRI protocols were statistically significant (p < 0.01).
CONCLUSIONS: DWI and DCE-MRI significantly improve the diagnostic performance of MRI for the preoperative assessment of myometrial invasion depth in EC compared to T2WI alone. DWI + T2WI and DCE-MRI + T2WI demonstrate comparable high accuracy. DWI may be preferable since it is faster and avoids contrast administration.
OBJECTIVE: The aim of this prospective study was to evaluate the added benefit of DWI in the preoperative assessment of myometrial invasion in EC, in comparison with T2WI and DCE-MRI. The objectives were to assess the imaging characteristics of endometrial carcinoma on T2WI, DCE, and DW MR, to assess the depth of myometrial invasion and overall stage in EC patients, to compare the diagnostic performance of DCE-MRI with that of DW-MRI combined with T2WI, to describe how MR imaging findings can be combined with tumor histologic features and grading to guide treatment planning, and to evaluate the pitfalls and limitations of DCE and DW MR in the assessment of EC.
METHODS: Thirty-one patients with histologically confirmed EC underwent preoperative pelvic MRI on a 1.5T scanner. T2WI, DWI (b-values 0, 1000 s/mm2), and DCE-MRI were performed. Two radiologists independently assessed myometrial invasion on T2WI, T2WI + DWI, and T2WI + DCE-MRI. Histopathology after hysterectomy was the reference standard. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each MRI protocol, with separate analyses for superficial (<50%) and deep (≥50%) myometrial invasions.
RESULTS: The accuracy for assessing superficial invasion was 61.3% for T2WI, 87.1% for T2WI + DWI, and 87.1% for T2WI + DCE-MRI. For deep invasion, accuracy was 64.5% for T2WI, 90.3% for T2WI + DWI, and 90.3% for T2WI + DCE-MRI. Sensitivity, specificity, PPV, and NPV for T2WI + DWI and T2WI + DCE-MRI were high and comparable (88.9-91.7%) for both superficial and deep invasions. T2WI had markedly lower sensitivity and specificity. The differences between T2WI and the functional MRI protocols were statistically significant (p < 0.01).
CONCLUSIONS: DWI and DCE-MRI significantly improve the diagnostic performance of MRI for the preoperative assessment of myometrial invasion depth in EC compared to T2WI alone. DWI + T2WI and DCE-MRI + T2WI demonstrate comparable high accuracy. DWI may be preferable since it is faster and avoids contrast administration.
摘要：
背景：子宫内膜癌（EC）是最常见的妇科恶性肿瘤。准确的术前分期对指导治疗至关重要。肌层浸润深度是一个关键的预后因素。这项前瞻性研究旨在评估与T2加权成像（T2WI）和动态对比增强MRI（DCE-MRI）相比，弥散加权成像（DWI）在术前评估EC肌层浸润方面的额外益处。
目的：这项前瞻性研究的目的是评估DWI在子宫肌层侵犯术前评估中的额外益处。与T2WI和DCE-MRI比较。目的评估子宫内膜癌T2WI的影像学特征，DCE,和DWMR，评估EC患者的肌层浸润深度和总体分期，为了比较DCE-MRI与DW-MRI联合T2WI的诊断性能，描述如何将MR成像结果与肿瘤组织学特征和分级相结合，以指导治疗计划，并评估DCE和DWMR在评估EC中的缺陷和局限性。
方法：31例经组织学证实的EC患者在1.5T扫描仪上接受了术前盆腔MRI检查。T2WI,DWI（b值0，1000s/mm2），进行DCE-MRI检查。两名放射科医生独立评估了T2WI的子宫肌层浸润，T2WI+DWI,和T2WI+DCE-MRI.子宫切除术后的组织病理学是参考标准。诊断准确性,灵敏度,特异性，阳性预测值(PPV)，并计算每个MRI方案的阴性预测值（NPV），对浅层(<50%)和深层(≥50%)子宫肌层浸润进行单独分析。
结果：T2WI评估表面侵袭的准确度为61.3%，T2WI+DWI为87.1%，T2WI+DCE-MRI为87.1%。对于深度入侵，T2WI的准确度为64.5%，T2WI+DWI为90.3%，T2WI+DCE-MRI为90.3%。灵敏度,特异性，PPV,T2WIDWI和T2WIDCE-MRI的NPV很高，对于浅表和深层侵入均具有可比性（88.9-91.7％）。T2WI的敏感性和特异性明显较低。T2WI和功能性MRI方案之间的差异具有统计学意义（p<0.01）。
结论：与单纯T2WI相比，DWI和DCE-MRI可显著提高MRI术前评估子宫肌层浸润深度的诊断效能。DWI+T2WI和DCE-MRI+T2WI表现出相当高的准确性。DWI可能是优选的,因为它更快并且避免了造影剂施用。
目的：这项前瞻性研究的目的是评估DWI在子宫肌层侵犯术前评估中的额外益处。与T2WI和DCE-MRI比较。目的评估子宫内膜癌T2WI的影像学特征，DCE,和DWMR，评估EC患者的肌层浸润深度和总体分期，为了比较DCE-MRI与DW-MRI联合T2WI的诊断性能，描述如何将MR成像结果与肿瘤组织学特征和分级相结合，以指导治疗计划，并评估DCE和DWMR在评估EC中的缺陷和局限性。
方法：31例经组织学证实的EC患者在1.5T扫描仪上接受了术前盆腔MRI检查。T2WI,DWI（b值0，1000s/mm2），进行DCE-MRI检查。两名放射科医生独立评估了T2WI的子宫肌层浸润，T2WI+DWI,和T2WI+DCE-MRI.子宫切除术后的组织病理学是参考标准。诊断准确性,灵敏度,特异性，阳性预测值(PPV)，并计算每个MRI方案的阴性预测值（NPV），对浅层(<50%)和深层(≥50%)子宫肌层浸润进行单独分析。
结果：T2WI评估表面侵袭的准确度为61.3%，T2WI+DWI为87.1%，T2WI+DCE-MRI为87.1%。对于深度入侵，T2WI的准确度为64.5%，T2WI+DWI为90.3%，T2WI+DCE-MRI为90.3%。灵敏度,特异性，PPV,T2WIDWI和T2WIDCE-MRI的NPV很高，对于浅表和深层侵入均具有可比性（88.9-91.7％）。T2WI的敏感性和特异性明显较低。T2WI和功能性MRI方案之间的差异具有统计学意义（p<0.01）。
结论：与单纯T2WI相比，DWI和DCE-MRI可显著提高MRI术前评估子宫肌层浸润深度的诊断效能。DWI+T2WI和DCE-MRI+T2WI表现出相当高的准确性。DWI可能是优选的,因为它更快并且避免了造影剂施用。
