Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI.
OBJECTIVE
To evaluate the diagnostic accuracy of 3T MRI in preoperative staging of myometrial invasion.


METHODS
Twenty-eight women with histological diagnosis of endometrial carcinoma were included in this prospective study. After T2-W SS-TSE and DWI, dynamic series of T1-W THRIVE images were obtained (0-180 s) followed by a T1-W THRIVE sequence in the late phase (5th min). For detection of deep myometrial infiltration: sensitivity, specificity, PPV, NPV, and accuracy were calculated on T2-W, postcontrast early arterial and late phase T1-W, and DWI. For the quantitative analysis of DWI, ADC values of the tumor were calculated and correlated with histologic grade. For the quantitative evaluation of dynamic series, SI-time curves were obtained and the maximum relative enhancement, wash-in rate, time-to-peak, and wash-out rate of masses and myometrium were compared.


RESULTS
T2-W and early phase contrast-enhanced sequences obtained sensitivity 100 %, specificity 76 %, PPV 58 %, NPV 100 %, and accuracy 82 %; late-phase contrast-enhanced images obtained sensitivity 100 %, specificity 81 %, PPV 64 %, NPV 100 %, and accuracy 86 %; DWI obtained lower accuracy [sensitivity 71 %, specificity 62 %, PPV 38 %, NPV 87 %, and accuary 57 %] than T2-W and postcontrast images. The MRE of carcinomas were significantly lower than those of the myometrium. This analysis showed a significant improvement in tumor versus myometrium contrast during the late phase. On DWI, the mean ADC value of tumor was 1.02 ± 0.48 × 10(-3). There was no statistically significant correlation between tumor grades and ADCs.


CONCLUSIONS
As the 3T MRI scanner allows high-resolution images, accurate assessment of myometrial infiltration can be done especially with postcontrast late phase images.
Department of Radiology, School of Medicine, University of Kocaeli, Kocaeli Uni. Tip Fak, Radyoloji AD, 41380, Umuttepe, Kocaeli, Turkey.
Demet
D
Dogan
Nagihan
N
Inan
Hasan Tahsin
HT
Sarisoy
Sevtap
S
Gumustas
Gur
G
Akansel
Bahar
B
Muezzinoğlu
Izzet
I
Yücesoy
Ali
A
Demirci
D000230:Adenocarcinoma / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness; D057234:Preoperative Period; D012680:Sensitivity and Specificity