title: Influence of menopausal status on diagnostic accuracy of myometrial invasion in endometrial cancer: diffusion-weighted and dynamic contrast-enhanced MRI at 3 T.
abstract: OBJECTIVE
  To assess the influence of menopausal status on the diagnostic accuracy of diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for evaluating myometrial invasion in patients diagnosed with endometrial cancer.
  
  
  METHODS
  In this prospective study, 91 consecutive female patients diagnosed with endometrial cancer were enrolled for preoperative evaluation using 3 T MRI. Two radiologists interpreted myometrial invasion depth on DW (b=1000 s/mm(2)) and DCE MRI images, with surgical histopathology as the reference standard. Statistical methods included kappa statistics for evaluating reader agreement and diagnostic performance analysis between pre- and postmenopausal groups.
  
  
  RESULTS
  Reader agreement of DW MRI was poor (κ=0.20) for premenopausal patients. The diagnostic accuracy of DW MRI in detecting myometrial involvement was significantly lower in premenopausal compared with postmenopausal patients (0.42 versus 0.73, p=0.006). There was no difference in the diagnostic accuracy of DW MRI in detecting deep myometrial invasion between premenopausal and postmenopausal groups (0.94 versus 0.95, p>0.99).
  
  
  CONCLUSIONS
  For premenopausal patients who plan to receive fertility-preserving treatment for endometrial cancer, DCE MRI is superior to DW MRI in excluding any possible myometrial invasion. For preoperative assessment of deep myometrial invasion, DW MRI can be a legitimate alternative to DCE MRI regardless of menopausal status and is particularly beneficial for patients at risk of nephrogenic systemic fibrosis.
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan.
authors.forename: G
authors.initials: G
authors.lastname: Lin
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan.
authors.forename: A
authors.initials: A
authors.lastname: Chao
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan.
authors.forename: K-K
authors.initials: KK
authors.lastname: Ng
authors.affiliation: Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan.
authors.forename: L-Y
authors.initials: LY
authors.lastname: Yang
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan. Electronic address: shuhangng@gmail.com.
authors.forename: S-H
authors.initials: SH
authors.lastname: Ng
authors.affiliation: Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000592:standards; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness; D015588:Observer Variation; D017698:Postmenopause / Q000502:physiology*; D017697:Premenopause / Q000502:physiology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA