Can maximum, mean or minimum ADC values of the cervix-parametrium boundary estimate parametrial invasion for cervical carcinoma?

Abstract

Purpose: Diffusion weighted imaging (DWI), which is quantified by apparent diffusion coefficient (ADC), can predict tissue microstructure. It has become an essential part of the gynecological magnetic resonance imaging (MRI) protocol. In our study it was aimed to evaluate the value of the maximum, mean, and minimum ADC values of the cervix-parametrium boundary to estimate parametrial invasion for cervix carcinoma. Material and Method: Totally 50 patients with cervical carcinoma, 18 of which had no parametrial invasion (4811-year-old) and 32 had parametrial invasion (5812-year-old) according to conventional T2 weighted imaging were enrolled. Maximum, mean, and minimum ADC values of cervix-parametrium boundary of primary tumors were statistically compared between the groups without and with parametrial invasion. The diagnostic performances of the maximum, mean and minimum ADC values were evaluated by ROC analysis in terms of estimating parametrial invasion. Results: The mean maximum, mean and minimum ADC values were lower for the patients with parametrial invasion. However, only the minimum ADC values had statistically significant differences between the groups. ROC analysis showed an AUC value of 0.726 for minimum ADC in estimating parametrial invasion. A minimum ADC cut-off value of 0.553x10-3 mm2/s had a sensitivity of 63%, specificity of 73%, negative predictive value of 52% and positive predictive value of 80% and accuracy of 66%. Conclusions: ADC values can be applied for the determination of parametrial invasion of cervical carcinoma. Lower minimum ADC values obtained from cervix-parametrium boundary of primary cervical carcinoma may help parametrial invasion. Especially positive predictive value of the cervix-parametrium boundary ADC is remarkable.