Abstract
Endometrial pathologies represent a diagnostic challenge for radiologist and gynecologist due to dynamic changes of the endometrium, wide variability in imaging appearance and overlap between benign and malignant causes of endometrial abnormalities. Although tissue analysis via dilatation and curettage, endometrial biopsy or hysteroscopy is the backbone in the diagnosis, these tests are invasive, not without complications and may be difficult to perform in certain circumstances, hence the need for noninvasive imaging methods to aid in the diagnosis and triaging the patient for subsequent invasive procedures as well as contribution in treatment planning. This study aimed to evaluate the role of diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value measurement in differentiating benign from malignant uterine endometrial lesions. The study included 47 patients with endometrial lesions divided into two groups according to the result of histopathological analysis; the malignant group consisting from 18 cases and the benign group consisting from 29 cases, the latter was further subdivided into: polyp, hyperplasia and other benign entities. Pelvic magnetic resonance imaging with DWI performed for each patient with visual evaluation of signal intensity on diffusion and ADC value measurement. Subsequently mean ADC values for each group were calculated and compared, and validity measures for the optimal cut-off values for differentiating benign from malignant lesions were determined. The mean±standard deviation for ADC value (x10-3mm2/sec) for malignant group was 0.71±0.12, and for benign group was 1.52±0.42, with a significant difference between the two groups (P value <0.01), there was no significant difference in ADC value between the subdivision of benign group. At ADC cut-off value of 0.976x10-3mm2/sec, the sensitivity, specificity, positive predictive value and negative predictive value and accuracy of DWI in detecting endometrial carcinoma were 100%, 89.6%, 85.71%, 100% and 93.62% respectively. In conclusion, DWI with ADC value measurement is a valuable non-invasive diagnostic test, aiding in the differentiation of benign from malignant uterine endometrial cavity lesions. Key words: diffusion weighted imaging, apparent diffusion coefficient map, benign endometrial lesions, malignant endometrial lesions.
Highlights
EIntroduction ndometrial pathologies represent a diagnostic challenge for radiologist and gynecologist due to dynamic changes of the endometrium affected by patient age, state of menstrual cycle and use of hormonal replacement therapy in addition to wide variability in imaging appearance and overlap between benign and malignant causes of endometrial abnormalities
Since the early detection of endometrial carcinoma allows high opportunity for cure[17], the objective of this study was to evaluate the role of diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value measurement in differentiating benign from malignant endometrial lesions with reference to histopathological diagnosis as a gold standard, we found that ADC value is an excellent non-invasive discriminatory test that produce high sensitivity and specificity in detecting endometrial malignancy, this is especially helpful in those patients in whom dilatation and curettage (D&C) or transvaginal biopsy is difficult or risky and helpful in avoiding unnecessary surgical intervention for benign causes as well as avoiding delay in intervention for malignancy, i.e. it’s helpful in stratifying patients who need subsequent invasive test and its urgency[18]
ADC map reconstructed from DWI provide quantitative evaluation and we found a statistically significant difference between ADC value of malignant group and that of benign group with P value
Summary
EIntroduction ndometrial pathologies represent a diagnostic challenge for radiologist and gynecologist due to dynamic changes of the endometrium affected by patient age, state of menstrual cycle and use of hormonal replacement therapy in addition to wide variability in imaging appearance and overlap between benign and malignant causes of endometrial abnormalities. The technique often results in high lesion to background contrast leading to increase lesion conspicuity and improve its detection These advantages are emphasized when contrast cannot be given for example due to severe renal impairment or allergy, or the obtained post contrast images do not offer a diagnosis (for example due to motion artifact, improper bolus timing, baseline hyperintense lesion on T1, or in cases of too small lesion difficult to characterize), in these circumstances DWI and ADC value become valuable and even when post contrast images are available the DWI and ADC value can increase the radiologist’s confidence or reinforce information provided by other sequences in the protocol[14,15]. The aim of this study is to evaluate the role of diffusion weighted imaging with apparent diffusion coefficient value measurement in differentiating benign from malignant uterine endometrial pathologies
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