The Accuracy of Arterial Phase of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Cervical Stromal Invasion in Patients with Endometrial Carcinoma

Abstract

Background: Endometrial cancer is the most common gynecological cancer. Cervical stromal invasion in patients with endometrial carcinoma is associated with local recurrence and overall survival, making accurate preoperative evaluation essential. Currently, the delayed phase of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is recommended for diagnosing cervical stromal invasion. However, this approach is time-consuming, and diagnostic interpretations can vary across observers and institutions. Objectives: To compare the diagnostic accuracy of arterial-phase and delayed-phase DCE-MRI for detecting cervical stromal invasion in endometrial carcinoma. Patients and Methods: This cross-sectional study retrospectively collected data from 445 patients with endometrial cancer. Two radiologists jointly evaluated cervical stromal invasion using histopathology as the gold standard reference. The McNemar test was used to compare the sensitivity and specificity of cervical stromal invasion detection between the arterial and delayed phases of DCE-MRI. Logistic regression analysis was conducted to assess the impact of tumor location and cervical lesions on diagnostic accuracy for cervical stromal invasion using DCE-MRI. Results: The mean age of the study population was 53.5 years [standard deviation (SD) = 3.1]. Dynamic contrast-enhanced magnetic resonance imaging images of the cervix demonstrated distinct enhancement characteristics. For detecting cervical stromal invasion, arterial-phase DCE-MRI showed a sensitivity of 66.4% [95% confidence interval (CI): 60.0 - 74.6%] and a specificity of 87.9% (95% CI: 83.9 - 91.0%). In the delayed phase, sensitivity was 69.1% (95% CI: 60.0 - 77.1%) and specificity was 88.2% (95% CI: 84.3 - 91.2%). There was no statistically significant difference between the arterial and delayed phases (P = 1.00). Factors influencing the assessment of cervical stromal invasion included the cluster distribution of Nabothian cysts and lesions located in the lower uterine segment or the internal os (P = 0.01, P < 0.01). Conclusion: The arterial phase of DCE-MRI is a feasible, time-saving, and effective approach for detecting cervical stromal invasion in endometrial carcinoma.