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• Clinical Article •
Value of intravoxel incoherent motion diffusion weighted imaging in endometrial cancer for estimating histological grade and myometrial invasion
ZHANG Qi  YU Xiao-duo  LIN Meng  OUYANG Han 

DOI:10.12015/issn.1674-8034.2018.03.010.


[Abstract] Objective: To investigate the utility of intravoxel incoherent motion (IVIM) imaging in assessing pathological grade and myometrial invasion of endometrial cancer (EC) preoperatively.Materials and Methods: Forty-three consecutive patients with EC confirmed by surgery and pathology underwent IVIM DWI with 12 b values preoperatively. IVIM parameters including apparent diffusion coefficient (ADC), true diffusivity (D), perfusion-related diffusivity (D*) and perfusion fraction (f) were measured and compared among different pathological grades (Grade 1, 2, 3), and between the depth of myometrial invasion. Spearman correlation was performed to analyze the association of these parameters with the histological grades and the depth of myometrial invasion. ROC curve was used to determine diagnostic efficiency.Results: The ADC, D and f values were negatively associated with tumor grades of EC(r=-0.604,-0.448 and-0.428, P=0.000, 0.002 and 0.004). There were significant difference of ADC values between G1 and G3 of EC, between G2 and G3 of EC (P=0.000 and 0.009). The D and f values of ECwere significantly lower in the G3 than G1 (P=0.01). No statistical difference of the D* existed between those three groups (P=0.071). Area under the curve (AUC) was largest for ADC in distinguishing G3 from G1-2 (AUC=0.825, 95%CI: 0.679- 0.924; P=0.0001), and with the cut-off of 0.796×10-3 mm2/s, the sensitivity, specificity and accuracy were 71.43%, 89.66% and 83.72%, respectively. All these parameters were negatively correlated with the depth of myometrial invasion. The ADC, D, D* and f values were significantly lower in the deep myometrial invasion than the superficial myometrial invasion. The D value showed the highest diagnostic performance in recognizing deep myometrial invasion (AUC=0.879, 95%CI: 0.744- 0.959, P=0.0001), and using the cut-off of 0.631×10-3 mm2/s, the sensitivity, specificity and accuracy were 100%, 76.67% and 83.72%, respectively.Conclusions: IVIM DWI parameters may be a promising biomarker for endometrial cancer in predicting histological grade and the depth of myometrial invasion preoperatively which could be helpful in treatment planning and prognosis evaluation.
[Keywords] Endometrial neoplasms；Pathology；Neoplasm grading；Magnetic resonance imaging

ZHANG Qi Department of Diagnostic Radiology, National Cancer Center Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

YU Xiao-duo Department of Diagnostic Radiology, National Cancer Center Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

LIN Meng Department of Diagnostic Radiology, National Cancer Center Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

OUYANG Han* Department of Diagnostic Radiology, National Cancer Center Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

*Correspondence to: Ouyang H, E-mail: houybj@126.com

Conflicts of interest   None.

Received  2017-11-16
Accepted  2018-01-20
DOI: 10.12015/issn.1674-8034.2018.03.010
DOI:10.12015/issn.1674-8034.2018.03.010.

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