title: MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center of Biostatistics for Clinical Epidemiology, Department of Health Sciences, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy.
authors.forename: Anita
authors.initials: A
authors.lastname: Andreano
authors.forename: Gilda
authors.initials: G
authors.lastname: Rechichi
authors.forename: Paola
authors.initials: P
authors.lastname: Rebora
authors.forename: Sandro
authors.initials: S
authors.lastname: Sironi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Valsecchi
authors.forename: Stefania
authors.initials: S
authors.lastname: Galimberti
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D012680:Sensitivity and Specificity