title: Retrospective Assessment of Histogram-Based Diffusion Metrics for Differentiating Benign and Malignant Endometrial Lesions.
abstract: OBJECTIVE
  Our study aimed to retrospectively evaluate the utility of volumetric histogram-based diffusion metrics in differentiating benign from malignant endometrial abnormalities.
  
  
  METHODS
  A total of 54 patients underwent pelvic magnetic resonance imaging with diffusion-weighted imaging before endometrial tissue diagnosis. Two radiologists placed volumes of interest on the apparent diffusion coefficient (ADC) map encompassing the entire endometrium and focal endometrial lesions. The mean ADC, percentile ADC values, kurtosis, skewness, and entropy of ADC were compared between benign and malignant abnormalities.
  
  
  RESULTS
  In premenopausal patients, significant independent predictors of malignancy were whole-endometrium analysis for R1, 10th to 25th ADC percentile (P = 0.012); whole-endometrium analysis for R2, mean ADC (P = 0.001) and skewness (P = 0.004); focal lesion analysis for R1, skewness (P = 0.045); focal lesion analysis for R2, 10th to 25th ADC percentile (P ≤ 0.0001). The area under the curve for malignancy was 90.0% to 97.3% and 76.1% to 77.3% for the more and less experienced radiologists, respectively. In postmenopausal patients, the only significant difference was kurtosis using whole-endometrium analysis for R1 (P = 0.042).
  
  
  CONCLUSIONS
  Volumetric ADC histogram metrics may help radiologists assess the risk of malignancy in endometrial abnormalities on magnetic resonance imaging in premenopausal patients.
authors.affiliation: From the Department of Radiology, NYU Langone Medical Center, New York, NY.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Kierans
authors.forename: Ankur M
authors.initials: AM
authors.lastname: Doshi
authors.forename: Diane
authors.initials: D
authors.lastname: Dunst
authors.forename: Dorota
authors.initials: D
authors.lastname: Popiolek
authors.forename: Stephanie V
authors.initials: SV
authors.lastname: Blank
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity