The Utility of Diffusion Weighted Imaging and Dynamic Contrast Enhanced MRI Techniques in Differentiation Between Benign and Malignant Uterine Masses

Al-Shimaa Magdy Ammar,Manal Ezzat Badawy,Essmat Hamdy Abozaid,Mohamed Mohamed Hefeda,Mohammed Mahmoud Dawoud

doi:10.11648/j.ijmi.20190703.12

Al-Shimaa Magdy Ammar, Manal Ezzat Badawy + Show 3 more

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https://doi.org/10.11648/j.ijmi.20190703.12

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Abstract

The aim of the present study was to evaluate the role of diffusion weighted imaging (DWI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in the differentiation between benign and malignant endometrial, uterine and cervical masses. The study included 78 patients. All patients had uterine or cervical masses on ultrasound examination. All patients had conventional MRI, DWI, and DCE-MRI. The patients were classified into three groups: patients with endometrial masses, myometrial lesions and cervical masses. The mean ADC value of benign endometrial and myometrial lesions was higher significantly from malignant lesions (P value <0.001 and <0.001). The cut off value of ≤1.1×10<sup>-3</sup>mm<sup>2</sup>/sec as a predictor of malignant lesions yielded a sensitivity, specificity, PPV, NPV and accuracy of 89.65%, 91.54%, 88.67%, 92.41% and 95.21% respectively. The semi-quanitative parameters of DCE-MRI including the enhancement amplitude (EA), maximum slope (MS) and time of half rising (THR), all showed significant difference between the benign and malignant lesion in endometrial, myometrial and cervical lesions. In clinically and sonographically indeterminate endometrial, myometrial or cervical masses, DWI and DCE-MRI proved to be more accurate than conventional MRI in differentiation between benign and malignant masses, with the DWI and ADC value had more sensitivity and specificity especially in endometrial masses and should be included in the routine pelvic MRI. DCE-MRI should be reserved for still questionable cases after DWI and to study the vascularity of the lesions.

Highlights

Cancer uterine body and cervix ranked as the 5th and 3rd most common malignancies in females respectively [1, 2]
Diagnosis of endometrial carcinoma or myometrial sarcoma on Magnetic resonance imaging (MRI) depends on the presence of moderate to high T2 signal intensity, which can be seen in the benign lesions like degenerating leiomyoma and benign polyps [9]
The aim of this study is to evaluate the diagnostic accuracy of diffusion weighted imaging and dynamic contrast enhanced MRI in differentiation between benign and malignant uterine and cervical masses

Summary

Introduction

Cancer uterine body and cervix ranked as the 5th and 3rd most common malignancies in females respectively [1, 2]. In Egypt, uterine cancer is ranked as the 10th most common cancer with increasing incidence in recent years [3, 4]. Ultrasound, which used to be the initial screening investigation for imaging of uterine lesions, has considerable limitations including restricted field of view and overlap in sonographic picture between benign and malignant masses [5,6,7]. Magnetic resonance imaging (MRI) is the second line technique for diagnosis of uterine masses and differentiation between the benign and malignant masses especially in large masses [8]. The differentiation between benign and malignant uterine masses may be difficult on conventional MRI

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