title: Combined subjective and quantitative analysis of magnetic resonance images could improve the diagnostic performance of deep myometrial invasion in endometrial cancer.
abstract: OBJECTIVE
  To evaluate whether the combination of subjective magnetic resonance imaging (MRI) and quantitative analysis by using the exponential ADC (EADC) value of the peri-endometrial zone can improve the diagnostic performance of deep myometrial invasion in endometrial cancer patients.
  
  
  METHODS
  We prospectively evaluated 111 patients with either cervical cancer (normal endometria group) or endometrial cancer (endometrial cancer group). Two radiologists assessed all preoperative MR images with T1, T2, and diffusion-weighted imaging. The EADC value of the peri-endometrial zone was measured. Sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve (Az) were calculated for Subjective MRI, an EADC cutoff value of the peri-endometrial zone and the combination of the two methods in assessing the prediction of deep myometrial invasion.
  
  
  RESULTS
  Specificity for EADC cutoff of the peri-endometrial zone was higher (0.93) than for Subjective MRI (0.80), as were the positive predictive values (EADC, 0.79; visual, 0.60). Sensitivity for the combined test was higher (0.88) than for Subjective MRI (0.71) and the EADC cutoff value (0.65), as were the negative predictive values (the combined test, 0.94; vs. EADC, 0.79; vs. Subjective MRI, 0.60). There were no differences in Az between the three methods (P>0.05), but the combined test had the highest Az.
  
  
  CONCLUSIONS
  Combined with conventional Subjective MRI, calculating EADC value of the peri-endometrial zone could improve the accuracy of preoperative assessment of deep myometrial invasion in endometrial cancer patients, and maybe helpful in tailoring a surgical approach for intervention.
authors.affiliation: Radiology Department, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shannxi 710061, PR China. Electronic address: lylydu@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Deng
authors.affiliation: Radiology Department, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shannxi 710061, PR China. Electronic address: 43901404@qq.com.
authors.forename: Qiu-Ping
authors.initials: QP
authors.lastname: Wang
authors.affiliation: Radiology Department, The Northwest Women and Children Hospital, No. 1616, Yanxiang Road, Xi'an, Shaanxi 710061, PR China. Electronic address: ruiyan01@sina.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Yan
authors.affiliation: Radiology Department, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shannxi 710061, PR China. Electronic address: 349863320@qq.com.
authors.forename: Nan
authors.initials: N
authors.lastname: Yu
authors.affiliation: Radiology Department, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shannxi 710061, PR China. Electronic address: lulu050622@163.com.
authors.forename: Lu
authors.initials: L
authors.lastname: Bai
authors.affiliation: Radiology Department, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shannxi 710061, PR China. Electronic address: duanxy@mail.xjtu.edu.cn.
authors.forename: Xiao-Yi
authors.initials: XY
authors.lastname: Duan
authors.affiliation: Radiology Department, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shannxi 710061, PR China. Electronic address: guoyoumin163@sina.com.
authors.forename: You-Min
authors.initials: YM
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D004058:Diffusion; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
keywords: Diagnostic imaging; Diffusion; Endometrial carcinoma; Endometrial neoplasm; Magnetic resonance imaging