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      Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade

      research-article
      , MD, MSc , , MD, MSc, FRCR, , MD, , MD, , MD, , PhD, , MD, PhD, , MD, PhD
      Radiology
      Radiological Society of North America

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          Abstract

          In this study, the authors evaluated MR volumetry as a tool for the initial staging of endometrial cancer; when it was used as a quantitative biomarker, tumor volume allowed accurate prediction of deep myometrial invasion, tumor grade, and lymphovascular invasion.

          Abstract

          Purpose

          To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion.

          Materials and Methods

          The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24–91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material–enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion.

          Results

          No significant difference in tumor volume and TVR was found among the six MR imaging sequences ( P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors ( P = .0007) and with lymphovascular invasion ( P < .0001). There was no significant difference in the ADCs between grades 1 and 2 tumors ( P > .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors ( P < .02).

          Conclusion

          The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.

          © RSNA, 2015

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          Author and article information

          Contributors
          Journal
          Radiology
          Radiology
          Radiology
          Radiology
          Radiological Society of North America
          0033-8419
          1527-1315
          September 2015
          30 April 2015
          : 276
          : 3
          : 797-808
          Affiliations
          [1]From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.).
          Author notes
          Address correspondence to S.N. (e-mail: stephanienougaret@ 123456free.fr ).

          Author contributions: Guarantors of integrity of entire study, S.N., S.S.A.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, S.N., C.R., S.S.A., H.A., E.S.; clinical studies, S.N., C.R., S.S.A., H.A., J.A., B.G.; experimental studies, S.N.; statistical analysis, S.N., N.M., B.G.; and manuscript editing, S.N., C.R., B.G., E.S.

          Article
          PMC5410943 PMC5410943 5410943 141212
          10.1148/radiol.15141212
          5410943
          25928157
          4873128c-6895-4dc5-af9d-401d85ff323b
          2015 by the Radiological Society of North America, Inc.
          History
          Categories
          Original Research
          Genitourinary Imaging
          GU, Genitourinary Radiology
          MR, Magnetic Resonance Imaging

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