Advertisement

Evaluation of the Depth of Myometrial Invasion of Endometrial Carcinoma: Comparison of Orthogonal Pelvis-axial Contrast-enhanced and Uterus-axial Dynamic Contrast-enhanced MRI Protocols

Published:October 11, 2021DOI:https://doi.org/10.1016/j.acra.2021.09.011

      Rationale and Objectives

      To compare the diagnostic performance of orthogonal pelvis-axial (OPA) contrast-enhanced (CE) and orthogonal uterus-axial (OUA) dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) protocols in assessing the depth of myometrial invasion (MI) of endometrial carcinoma (EC).

      Materials and Methods

      Preoperative MRI of 398 consecutive EC patients (197 patients with OPA CE-MRI protocol and 201 patients with OUA DCE-MRI protocol) was analyzed. Two radiologists independently interpreted the depth of MI, with postoperative histopathology as the reference standard. The chi-square test, Fisher's exact test, and receiver operating characteristic curve analysis were used for diagnostic performance comparison.

      Results

      OUA DCE-MRI showed a significantly larger area under the curve than OPA CE-MRI in detecting the presence of MI for radiologist 1 (0.71 versus 0.49, p < 0.05) but not for radiologist 2 or deep MI (all p > 0.05). Compared to OPA CE-MRI, OUA DCE-MRI significantly improved the diagnostic accuracy of non-MI and superficial MI (radiologist 1: 45.5% versus 0 and 88.7% versus 86.4%, p = 0.045 and 0.567, respectively; radiologist 2: 45.5% versus 12.5% and 88.7% versus 78.8%, p = 0.177 and 0.027, respectively) and of EC with adenomyosis/submucous myomas, cornual tumor, and antero-posterior diameter ≤ 10 mm (radiologist 1: 86.4% versus 71.4%, 91.2% versus 67.7%, and 90.1% versus 81.1%, p = 0.048, 0.018, and 0.081, respectively; radiologist 2: 86.4% versus 64.3%, 88.2% versus 64.5%, and 87.0% versus 71.6%, p = 0.006, 0.023, and 0.019, respectively).

      Conclusion

      The OUA DCE-MRI protocol was superior to the OPA CE-MRI protocol in assessing the depth of MI of EC.

      Key Words

      Abbreviation:

      EC (Endometrial carcinoma), MI (Myometrial invasion), EAC (Endometrioid adenocarcinoma), MRI (Magnetic resonance imaging), CE (Contrast enhanced), DCE (Dynamic contrast enhanced), OUA (Orthogonal uterus-axial), OPA (Orthogonal pelvis-axial), PPV (Positive predictive value), NPV (Negative predictive value), ROC (Receiver operating characteristic), AUC (Area under the curve), APD (Antero-posterior diameter)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel RL
        • Miller KD
        • Jemal A.
        Cancer statistics, 2020.
        CA Cancer J Clin. 2020; 70: 7-30https://doi.org/10.3322/caac.21590
        • Nougaret S
        • Lakhman Y
        • Vargas HA
        • et al.
        From staging to prognostication: achievements and challenges of MR imaging in the assessment of endometrial cancer.
        Magn Reson Imaging Clin N Am. 2017; 25: 611-633https://doi.org/10.1016/j.mric.2017.03.010
        • Colombo N
        • Creutzberg C
        • Amant F
        • et al.
        ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up.
        Ann Oncol. 2016; 27: 16-41https://doi.org/10.1093/annonc/mdv484
        • Kitchener H
        • Swart AM
        • Qian Q
        • et al.
        Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study.
        Lancet. 2009; 373: 125-136https://doi.org/10.1016/S0140-6736(08)61766-3
        • Frost JA
        • Webster KE
        • Bryant A
        • et al.
        Lymphadenectomy for the management of endometrial cancer.
        Cochrane Database Syst Rev. 2017; 10CD007585https://doi.org/10.1002/14651858.CD007585.pub4
        • Obermair A
        • Baxter E
        • Brennan DJ
        • et al.
        Fertility-sparing treatment in early endometrial cancer: current state and future strategies.
        Obstet Gynecol Sci. 2020; 63: 417-431https://doi.org/10.5468/ogs.19169
        • Lin G
        • Ng KK
        • Chang CJ
        • et al.
        Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging–initial experience.
        Radiology. 2009; 250: 784-792https://doi.org/10.1148/radiol.2503080874
        • Goel G
        • Rajanbabu A
        • Sandhya CJ
        • et al.
        A prospective observational study evaluating the accuracy of MRI in predicting the extent of disease in endometrial cancer.
        Indian J Surg Oncol. 2019; 10: 220-224https://doi.org/10.1007/s13193-018-0832-9
        • Torricelli P
        • Ferraresi S
        • Fiocchi F
        • et al.
        3-T MRI in the preoperative evaluation of depth of myometrial infiltration in endometrial cancer.
        AJR Am J Roentgenol. 2008; 190: 489-495https://doi.org/10.2214/AJR.07.2380
        • Bonatti M
        • Stuefer J
        • Oberhofer N
        • et al.
        MRI for local staging of endometrial carcinoma: Is endovenous contrast medium administration still needed?.
        Eur J Radiol. 2015; 84: 208-214https://doi.org/10.1016/j.ejrad.2014.11.010
        • Gil RT
        • Cunha TM
        • Horta M
        • et al.
        The added value of diffusion-weighted imaging in the preoperative assessment of endometrial cancer.
        Radiol Bras. 2019; 52: 229-236https://doi.org/10.1590/0100-3984.2018.0054
        • Beddy P
        • Moyle P
        • Kataoka M
        • et al.
        Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging.
        Radiology. 2012; 262: 530-537https://doi.org/10.1148/radiol.11110984
        • Rauch GM
        • Kaur H
        • Choi H
        • et al.
        Optimization of MR imaging for pretreatment evaluation of patients with endometrial and cervical cancer.
        Radiographics. 2014; 34: 1082-1098https://doi.org/10.1148/rg.344140001
        • Das SK
        • Niu XK
        • Wang JL
        • et al.
        Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis.
        Cancer Imaging. 2014; 14: 32https://doi.org/10.1186/s40644-014-0032-y
        • Sala E
        • Crawford R
        • Senior E
        • et al.
        Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting advanced stage disease in patients with endometrial carcinoma.
        Int J Gynecol Cancer. 2009; 19: 141-146https://doi.org/10.1111/IGC.0b013e3181995fd9
        • Wu LM
        • Xu JR
        • Gu HY
        • et al.
        Predictive value of T2-weighted imaging and contrast-enhanced MR imaging in assessing myometrial invasion in endometrial cancer: a pooled analysis of prospective studies.
        Eur Radio. 2013; 23: 435-449https://doi.org/10.1007/s00330-012-2609-9
        • Sala E
        • Rockall A
        • Rangarajan D
        • et al.
        The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis.
        Eur J Radiol. 2010; 76: 367-385https://doi.org/10.1016/j.ejrad.2010.01.026
        • Reinhold C
        • Ueno Y
        • Akin EA
        • et al.
        ACR appropriateness criteria pretreatment evaluation and follow-up of endometrial cancer.
        J Am Coll Radiol. 2020; 17: S472-S486https://doi.org/10.1016/j.jacr.2020.09.001
        • Nougaret S
        • Horta M
        • Sala E
        • et al.
        Endometrial cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology.
        Eur Radiol. 2019; 29: 792-805https://doi.org/10.1007/s00330-018-5515-y
        • Sala E
        • Rockall AG
        • Freeman SJ
        • et al.
        The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know.
        Radiology. 2013; 266: 717-740https://doi.org/10.1148/radiol.12120315
        • Lin MY
        • Dobrotwir A
        • McNally O
        • et al.
        Role of imaging in the routine management of endometrial cancer.
        Int J Gynaecol Obstet. 2018; 143: 109-117https://doi.org/10.1002/ijgo.12618
        • Sakane M
        • Hori M
        • Onishi H
        • et al.
        Assessment of myometrial invasion in premenopausal grade 1 endometrial carcinoma: Is magnetic resonance imaging a reliable tool in selecting patients for fertility-preserving therapy?.
        J Comput Assist Tomogr. 2018; 42: 412-417https://doi.org/10.1097/RCT.0000000000000689
        • Suh DS
        • Kim JK
        • Kim KR
        • et al.
        Reliability of magnetic resonance imaging in assessing myometrial invasion absence in endometrial carcinoma.
        Acta Obstet Gynecol Scand. 2009; 88: 990-993https://doi.org/10.1080/00016340903141135
        • Saba L
        • Guerriero S
        • Sulis R
        • et al.
        Learning curve in the detection of ovarian and deep endometriosis by using Magnetic Resonance: comparison with surgical results.
        Eur J Radiol. 2011; 79: 237-244https://doi.org/10.1016/j.ejrad.2010.01.019
        • Woo S
        • Kim SY
        • Cho JY
        • et al.
        Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology.
        Eur Radiol. 2017; 27: 1877-1882https://doi.org/10.1007/s00330-016-4582-1
        • Guo Y
        • Wang P
        • Wang P
        • et al.
        Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging.
        Onco Targets Ther. 2017; 10: 5937-5943https://doi.org/10.2147/OTT.S145763
        • Luomaranta A
        • Leminen A
        • Loukovaara M.
        Magnetic resonance imaging in the assessment of high-risk features of endometrial carcinoma: a meta-analysis.
        Int J Gynecol Cancer. 2015; 25: 837-842https://doi.org/10.1097/IGC.0000000000000194
        • Teng F
        • Zhang YF
        • Wang YM
        • et al.
        Contrast-enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis: diagnostic value and error analysis in endometrial carcinoma.
        Acta Obstet Gynecol Scand. 2015; 94: 266-273https://doi.org/10.1111/aogs.12570
        • Haldorsen IS
        • Husby JA
        • Werner HM
        • et al.
        Standard 1.5-T MRI of endometrial carcinomas: modest agreement between radiologists.
        Eur Radiol. 2012; 22: 1601-1611https://doi.org/10.1007/s00330-012-2400-y
        • Chung HH
        • Kang SB
        • Cho JY
        • et al.
        Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma.
        Gynecol Oncol. 2007; 104: 654-659https://doi.org/10.1016/j.ygyno.2006.10.007
        • Lee YJ
        • Moon MH
        • Sung CK
        • et al.
        MR assessment of myometrial invasion in women with endometrial cancer: discrepancy between T2-weighted imaging and contrast-enhanced T1-weighted imaging.
        Abdom Radiol (NY). 2016; 41: 127-135https://doi.org/10.1007/s00261-015-0607-5
        • Zheng L
        • Zheng S
        • Yuan X
        • et al.
        Comparison of dynamic contrast-enhanced magnetic resonance imaging with T2-weighted imaging for preoperative staging of early endometrial carcinoma.
        Onco Targets Ther. 2015; 8: 1743-1751https://doi.org/10.2147/OTT.S86519
        • Bhosale P
        • Ma J
        • Iyer R
        • et al.
        Feasibility of a reduced field-of-view diffusion-weighted (rFOV) sequence in assessment of myometrial invasion in patients with clinical FIGO stage I endometrial cancer[J].
        J Magn Reson Imaging. 2016; 43: 316-324https://doi.org/10.1002/jmri.25001