Share：
Share this content in WeChat
X
[Chinese][PDF]80474
• 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.

[1]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
[2]
Wei LH. Screening for endometrial cancer. Chin J Obstet Gynecol, 2013, 48(12): 881-883.魏丽惠．重视子宫内膜癌的筛查．中华妇产科杂志, 2013, 48(12): 881-883.
[3]
Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer, 2016, 26(1): 2-30.
[4]
Nougaret S, Reinhold C, Alsharif SS, et al. Endometrial cancer: combined MR Volumetry and diffusion-weighted imaging for assessment of myometrial and lymphovascular invasion and tumor grade. Radiology, 2015, 276(3): 797-808.
[5]
Thanachaiviwat A, Thirapakawong C, Leelaphatanadit C, et al. Accuracy of preoperative curettage in determining tumor type and grade in endometrial cancer. J Med Assoc Thai, 2011, 94(7): 766-771.
[6]
Karateke A, Tug N, Cam C, et al. Discrepancy of pre- and postoperative grades of patients with endometrial carcinoma. Eur J Gynaecol Oncol, 2011, 32(3): 283-285.
[7]
Wang X, Zhang H, Di W, et al. Clinical factors affecting the diagnostic accuracy of assessing dilation and curettage vs frozen section specimens for histologic grade and depth of myometrial invasion in endometrial carcinoma. Am J Obstet Gynecol, 2009, 201(2): 191-194.
[8]
Emlik D, Kiresi D, Ozdemir S, et al. Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma: comparison of multi-section dynamic MR imaging using a three dimensional FLASH technique and T2-weighted MR imaging. J Med Imaging Radiat Oncol, 2010, 54(3): 202-210.
[9]
Brunberg JA, Chenevert TL, Mckeever PE, et al. In vivo MR determination of water diffusion coefficients and diffusion anisotropy: correlation with structural alteration in gliomas of the cerebral hemispheres. AJNR Am J Neuroradiol, 1995, 16(2): 361-371.
[10]
Le Bihan D, Breton E, Lallemand D, et al. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology, 1988, 168(2): 497-505.
[11]
Ma C, Li Y, Wang L, et al. Intravoxel incoherent motion DWI of the pancreatic adenocarcinomas: monoexponential and biexponential apparent diffusion parameters and histopathological correlations. Cancer Imaging, 2017, 17(1): 12.
[12]
Surov A, Meyer HJ, Hohn AK, et al. Correlations between intravoxel incoherent motion (IVIM) parameters and histological findings in rectal cancer: preliminary results. Oncotarget, 2017, 8(13): 21974-21983.
[13]
Marzi S, Piludu F, Sanguineti G, et al. The prediction of the treatment response of cervical nodes using intravoxel incoherent motion diffusion-weighted imaging. Eur J Radiol, 2017, 92: 93-102.
[14]
Pesapane F, Patella F, Fumarola EM, et al. Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the periferic prostate cancer detection and stratification. Med Oncol, 2017, 34(3): 35.
[15]
Granata V, Fusco R, Catalano O, et al. Intravoxel incoherent motion (IVIM) in diffusion-weighted imaging (DWI) for Hepatocellular carcinoma: correlation with histologic grade. Oncotarget, 2016, 7(48): 79357-79364.
[16]
Woo S, Lee JM, Yoon JH, et al. Intravoxel incoherent motion diffusion-weighted MR imaging of hepatocellular carcinoma: correlation with enhancement degree and histologic grade. Radiology, 2014, 270(3): 758-767.
[17]
Shen N, Zhao L, Jiang J, et al. Intravoxel incoherent motion diffusion-weighted imaging analysis of diffusion and microperfusion in grading gliomas and comparison with arterial spin labeling for evaluation of tumor perfusion. J Magn Reson Imaging, 2016, 44(3): 620-632.
[18]
Zhu Q, Ye J, Zhu W, et al. Value of intravoxel incoherent motion in assessment of pathological grade of clear cell renal cell carcinoma. Acta Radiol, 2018, 59(1): 121-127.
[19]
Husby JA, Salvesen OO, Magnussen IJ, et al. Tumour apparent diffusion coefficient is associated with depth of myometrial invasion and is negatively correlated to tumour volume in endometrial carcinomas. Clin Radiol, 2015, 70(5): 487-494.
[20]
Wang F, Zhou Y, Wang YX, et al. Premilinary study of histogram analysis of mono-exponential and intravoxel incoherent motion models in epithelial ovarian cancer. Chin J Radio, 2016, 50(10): 768-773.王丰，周延，王玉湘，等. MR扩散加权成像单指数模型及体素内不相干运动模型参数直方图对上皮性卵巢癌分型的价值．中华放射学杂志, 2016, 50(10): 768-773.
[21]
Iima M, Reynaud O, Tsurugizawa T, et al. Characterization of glioma microcirculation and tissue features using intravoxel incoherent motion magnetic resonance imaging in a rat brain model. Invest Radiol, 2014, 49(7): 485-490.
[22]
Kuiper C, Molenaar IG, Dachs GU, et al. Low ascorbate levels are associated with increased hypoxia-inducible factor-1 activity and an aggressive tumor phenotype in endometrial cancer. Cancer Res, 2010, 70(14): 5749-5758.
[23]
Kamat AA, Merritt WM, Coffey D, et al. Clinical and biological significance of vascular endothelial growth factor in endometrial cancer. Clin Cancer Res, 2007, 13(24): 7487-7495.
[24]
Williams E, Martin S, Moss R, et al. Co-expression of VEGF and CA9 in ovarian high-grade serous carcinoma and relationship to survival. Virchows Arch, 2012, 461(1): 33-39.

PREV Feasibility of non-contrast-enhanced magnetic resonance angiography for evaluating portal venous hemodynamics
NEXT Value of intravoxel incoherent motion diffusion weighted imaging in endometrial cancer for estimating histological grade and myometrial invasion
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn