title: Role of diffusion weighted imaging and contrast-enhanced MRI in the evaluation of intrapelvic recurrence of gynecological malignant tumor.
abstract: OBJECTIVE
  To investigate the diagnostic performance of diffusion-weighted imaging (DWI) and contrast-enhanced imaging in combination with T2-weighted imaging (T2WI) for magnetic resonance imaging (MRI) evaluation of intrapelvic recurrence of gynecological malignancies.
  
  
  METHODS
  Sixty-two patients with suspected intrapelvic recurrence of gynecological malignancies underwent pelvic MRI including T2WI DWI, and contrast-enhanced imaging. Diagnostic performance for detection of local recurrence, pelvic lymph node and bone metastases, and peritoneal lesions was evaluated by consensus reading of two experienced radiologists using a 5-point scoring system, and compared among T2WI with unenhanced T1-weighted imaging (T1WI) (protocol A), a combination of protocol A and DWI (protocol B), and a combination of protocol B and contrast-enhanced imaging (protocol C). Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. Receiver operating characteristic (ROC) analysis and McNemar test were employed for statistical analysis.
  
  
  RESULTS
  Locally recurrent disease, lymph node recurrence, peritoneal dissemination and bone metastases were present in 48.4%, 29.0%, 16.1%, and 6.5% of the patients, respectively. The patient-based sensitivity, specificity, accuracy, and area under the ROC curve (AUC) for detection of intrapelvic recurrence were 55.0, 81.8, 64.5% and 0.753 for protocol A, 80.0, 77.3, 79.0% and 0.838 for protocol B, and 80.0, 90.9, 83.9% and 0.862 for protocol C, respectively. The sensitivity, accuracy, and AUC were significantly better for protocols B and C than for protocol A (p<0.001). There was no significant difference between protocols B and C.
  
  
  CONCLUSIONS
  MRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies.
authors: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Kazuhiro
authors: K
authors: Kitajima
authors: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Utaru
authors: U
authors: Tanaka
authors: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Yoshiko
authors: Y
authors: Ueno
authors: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Tetsuo
authors: T
authors: Maeda
authors: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Yuko
authors: Y
authors: Suenaga
authors: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Satoru
authors: S
authors: Takahashi
authors: Department of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Masashi
authors: M
authors: Deguchi
authors: Department of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Yoshiya
authors: Y
authors: Miyahara
authors: Department of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Yasuhiko
authors: Y
authors: Ebina
authors: Department of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Hideto
authors: H
authors: Yamada
authors: Department of Diagnostic Radiology, Kinki University School of Medicine, Osaka, Japan.
authors: Masakatsu
authors: M
authors: Tsurusaki
authors: Department of Radiation Oncology, Shimane University School of Medicine, Shimane, Japan.
authors: Yukihisa
authors: Y
authors: Tamaki
authors: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Kazuro
authors: K
authors: Sugimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010388:Pelvis / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
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