Abstract
Recently, few noninvasive methods have been reported to evaluate endometrial fibrosis. Our study was to investigate the feasibility of intravoxel incoherent motion (IVIM) MR imaging in the detection of endometrial fibrosis in patients with intrauterine injury. 30 patients with hysteroscopy-confirmed endometrial fibrosis and 28 healthy women were enrolled to undergo MR examination including the IVIM sequence. Endometrial thickness (ET); apparent diffusion coefficient (ADC); and IVIM parameters, including pure diffusion coefficient (D), pseudodiffusion coefficient (D*) and vascular fraction (f) were evaluated. A multivariable model combing ADC, D, and f values using binary logistic regression analysis was built to diagnose endometrial fibrosis. Endometrial fibrosis patients demonstrated lower endometrial ADC, D, f values and ET (all p < 0.05). The multivariable model, ADC, D, f values and ET performed well in diagnosing endometrial fibrosis with AUC of 0.979, 0.965, 0.920, 0.901 and 0.833, respectively. The multivariable model revealed a better diagnostic accuracy than D, f and ET (all p < 0.05). Although ADC achieved a better diagnostic value than ET (z = 2.082, p < 0.05), no difference in AUC was shown among ADC, D, and f (all p > 0.05); between ET and D (p > 0.05); and between ET and f (p > 0.05). The reproducibility of ADC, D, f and D* values in patients with endometrial fibrosis and healthy women were good to excellent (ICC: 0.614–0.951). IVIM parameters exhibit promising potential to serve as imaging biomarkers in the noninvasive assessment of endometrial fibrosis.
Highlights
Endometrial fibrosis is a repair process of the endometrium that is commonly associated with trauma to the endometrium from surgical procedures, primarily curettage1,2
Our pilot study demonstrated differences in intravoxel incoherent motion (IVIM) parameter values and Endometrial thickness (ET) between patients with endometrial fibrosis and healthy women
We observed that apparent diffusion coefficient (ADC) and diffusion-linked component D values decreased significantly in the fibrous endometrium
Summary
Endometrial fibrosis is a repair process of the endometrium that is commonly associated with trauma to the endometrium from surgical procedures, primarily curettage. Hysteroscopy is considered the gold standard for the diagnosis of endometrial fibrosis, but it is an invasive and painful procedure with a risk of secondary injury of the endometrium5,6 It is certainly not the ideal procedure for serially repeated assessment of fibrotic progression. Due to excellent soft tissue contrast and high spatial resolution, MR imaging may demonstrate a partial or complete absence of the normal high signal endometrial layer in patients with endometrial fibrosis on T2-weighted images. Due to excellent soft tissue contrast and high spatial resolution, MR imaging may demonstrate a partial or complete absence of the normal high signal endometrial layer in patients with endometrial fibrosis on T2-weighted images8 These conventional imaging techniques cannot quantitatively assess the degree of fibrosis, reflect the biological abnormality of endometrial fibrosis at the cellular level, and evaluate the function of the remaining endometrium. The purpose of this study was to investigate the difference in IVIM-derived parameters of the endometrium between patients with endometrial fibrosis and healthy women and to explore the diagnostic performance of IVIM parameters in endometrial fibrosis
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