title: Diagnostic efficacy of diffusion-weighted MRI for pre-operative assessment of myometrial and cervical invasion and pelvic lymph node metastasis in endometrial carcinoma.
abstract: BACKGROUND
  To determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) for the pre-operative assessment of patients with endometrial carcinoma and to assess myometrial and cervical invasion as well as pelvic lymph node metastasis.
  
  
  METHODS
  Fifty-eight women who underwent surgery for histopathologically confirmed endometrial carcinoma were included in the current study. Prior to surgery, patients were evaluated using pelvic DW-MRI and gadolinium-enhanced T1-weighted imaging (Gd-T1WI). Gd-T1WI was evaluated together with T2-weighted images. DW-MR images were obtained in the axial plane using echo-planar spin-echo pulse sequences with different b factors. Endometrial carcinomas were observed as areas of increased intensity on DW-MRI images, and their intensity was compared with the surrounding hypo-intense myometrium. Pre-operative DW-MRI and Gd-T1WI results were compared with post-operative histopathological findings that served as reference standards.
  
  
  RESULTS
  The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and diagnostic accuracy of DW-MRI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 89%, 81%, 92% and 88%, respectively. The sensitivity, specificity and diagnostic accuracy rates were 82%, 91% and 89.6% for cervical invasion and 100%, 96% and 96.5% for pelvic lymph node metastasis, respectively. The sensitivity, specificity, PPV and NPV, and diagnostic accuracy of Gd-T1WI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 81.5%, 71%, 91% and 83%, respectively. The sensitivity, specificity and diagnostic accuracy were 73%, 89% and 86% for cervical invasion, respectively.
  
  
  CONCLUSIONS
  These findings suggest that DW-MRI may be a good diagnostic tool with high sensitivity and specificity for assessing myometrial invasion and detecting tumour extension. We suggest that DW-MRI should be considered as a routine part of the pre-operative pelvic MRI in all patients with endometrial carcinoma.
authors.affiliation: Department of Radiology, Medical Faculty of Selcuk University, Konya, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Koplay
authors.forename: Nasuh Utku
authors.initials: NU
authors.lastname: Dogan
authors.forename: Hasan
authors.initials: H
authors.lastname: Erdogan
authors.forename: Mesut
authors.initials: M
authors.lastname: Sivri
authors.forename: Cengiz
authors.initials: C
authors.lastname: Erol
authors.forename: Alaaddin
authors.initials: A
authors.lastname: Nayman
authors.forename: Pinar
authors.initials: P
authors.lastname: Karabagli
authors.forename: Yahya
authors.initials: Y
authors.lastname: Paksoy
authors.forename: Cetin
authors.initials: C
authors.lastname: Celik
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010386:Pelvic Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000473:pathology* / Q000556:secondary* / Q000601:surgery
keywords: MRI; diffusion-weighted imaging; endometrial carcinoma; staging