Staging of Endometrial Cancer Using Fusion T2-Weighted Images with Diffusion-Weighted Images: A Way to Avoid Gadolinium?

Teresa Resende Neves,Mariana Horta,António Proença Caetano,Mariana Tomé Correia,Maria Ana Serrado,Teresa Margarida Cunha

doi:10.3390/cancers14020384

Teresa Resende Neves, Mariana Horta + Show 4 more

Open Access

https://doi.org/10.3390/cancers14020384

Copy DOI

Abstract

Simple SummaryThis work aims to evaluate the utility of fusing T2-weighted images with diffusion-weighted images to determinate the depth of myometrial invasion and the stage of endometrial cancer. By showing its superior diagnostic performance, we aim to encourage its use in endometrial cancer staging, and, in the future, obviate the need for intravenous contrast medium administration.Endometrial cancer is the eighth most common cancer worldwide, and its prognosis depends on various factors, with myometrial invasion having a major impact on prognosis. Optimizing MRI protocols is essential, and it would be useful to improve the diagnostic accuracy without the need for other sequences. We conducted a retrospective, single-center study, which included a total of 87 patients with surgically confirmed primary endometrial cancer, and who had undergone a pre-operative pelvic MRI. All exams were read by an experienced radiologist dedicated to urogenital radiology, and the depth of myometrial invasion was evaluated using T2-Weighted Images (T2WI) and fused T2WI with Diffusion-Weighted Images (DWI). Both results were compared to histopathological evaluations. When comparing both sets of imaging (T2WI and fused T2WI-DWI images) in diagnosing myometrial invasion, the fused images had better accuracy, and this difference was statistically significant (p < 0.001). T2WI analysis correctly diagnosed 82.1% (70.6–88.7) of cases, compared to 92.1% correctly diagnosed cases with fused images (79.5–97.2). The addition of fused images to a standard MRI protocol improves the diagnostic accuracy of myometrial invasion depth, encouraging its use, since it does not require more acquisition time.

Highlights

According to the Global Cancer Observatory, endometrial cancer (EC) is the eighth most common cancer worldwide and the sixth most common cancer in female patients, with an incidence of 8.7 per 100,000 women per year [1,2]
The majority of patients were staged as FIGO IA (39.1%, n = 34), and, of the staged IVB patients, one had a proven spleen metastasis, which was previously detected by magnetic resonance imaging (MRI), one had malignant cells in the peritoneal fluid, and five had peritoneal metastases at the time of surgery
According to the results of this study, fused images (T2WI-Diffusion-Weighted Images (DWI)) have a statistically significantly higher capacity to predict the degree of myometrial invasion when compared to standard MRI evaluation with separate morphologic and functional sequences

Summary

Introduction

According to the Global Cancer Observatory, endometrial cancer (EC) is the eighth most common cancer worldwide and the sixth most common cancer in female patients, with an incidence of 8.7 per 100,000 women per year [1,2]. EC is classically divided into the following two histopathological types: type I ( known as endometrioid, estrogen-dependent), which comprises the majority of cases (80%) and is associated with a better outcome, and type II (nonendometrioid, nonestrogendependent; 20% of cases), which is associated with high-grade tumors and a dismal prognosis [4,6,7,8]. Myometrial invasion is correlated with tumor grade, presence of lymph node metastasis, and overall survival [6,13,14]. Myometrial invasion beyond fifty percent of myometrium thickness is associated with a six to seven times increase in the prevalence of lymph node metastases [13,15,16]

Objectives

Methods

Results

Discussion

Conclusion