title: Semiquantitative perfusion combined with diffusion-weighted MR imaging in pre-operative evaluation of endometrial carcinoma: results in a group of 57 patients.
abstract: OBJECTIVE
  To evaluate the semiquantitative DCE and quantitative DWI parameters in endometrial cancer, in order to assess the presence of neoplastic tissue and normal myometrium and to ascertain a potential relationship with tumor grade.
  
  
  METHODS
  A total of 57 patients with biopsy-proven endometrial adenocarcinoma who underwent MR imaging examination for staging purposes were retrospectively evaluated. Imaging protocol included multiplanar T1- and T2-weighted TSE, DCE T1-weighted (THRIVE; 0, 30, 90 and 120seconds after intravenous injection of gadolinium) and DWIBS sequences (b values=0 and 1000mm(2)/s). Color perfusion and ADC maps were automatically generated on dedicated software. Relative enhancement (RE, %), maximum enhancement (ME, %), maximum relative enhancement (MRE, %), time to peak (TTP, s) and mean apparent diffusion coefficient (ADC) were calculated by manually drawing a region of interest (ROI) both on the neoplastic tissue and the normal myometrium. Histopathology was used as reference standard.
  
  
  RESULTS
  Histopathological analysis confirmed the presence of endometrial carcinoma in all patients. Neoplastic tissue demonstrated significantly lower (P<0.001) values of RE (%) 63.92±35.68; ME (%) 864.91±429.54 and MRE (%) 75.97±38.26 as compared to normal myometrium (RE (%) 151.43±55.99; ME (%) 1800.73±721.32; MRE (%) 158.28±54.05). TTP was significantly higher (P<0.05) in tumor lesion (385.51±1630.27 vs 195.44±78.69). Mean ADC value of neoplastic tissue (775.09±?220.73×10(-3)mm(2)/s) was significantly lower (P<0.05) than in myometrium (1602.37±378.54×10(-3)mm(2)/s). The analysis of perfusion and diffusion parameters classified according to tumor grades, showed a statistically significant difference only for RE (P=0.043) and ME (P=0.007).
  
  
  CONCLUSIONS
  Perfusion parameters and mean ADC differ significantly between endometrial cancer and normal myometrium, potentially reflecting the different microscopical features of cellularity and vascularity; however a significant relationship with tumor grade was not found in our series.
authors.affiliation: School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy. Electronic address: davide.atena@tiscalinet.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Ippolito
authors.affiliation: School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Cadonici
authors.affiliation: School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy.
authors.forename: Pietro Andrea
authors.initials: PA
authors.lastname: Bonaffini
authors.affiliation: School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Minutolo
authors.affiliation: School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casiraghi
authors.affiliation: Department of Pathology, San Gerardo Hospital, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Perego
authors.affiliation: School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sironi
mesh_terms: D000465:Algorithms; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015588:Observer Variation; D018579:Patient Selection; D010363:Pattern Recognition, Automated / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Endometrial cancer; Magnetic resonance imaging; Perfusion imaging; Staging; T1 contrast sequences