Endometrial carcinoma: Evaluation using diffusion-tensor imaging and its correlation with histopathologic findings

Abstract

Background: Although the prognosis of endometrial carcinoma (EMC) patients strictly depends on tumor invasion depth and its histologic grade, accurate preoperative assessment of these prognostic factors is often difficult.

Purpose: To determine the usefulness of diffusion-tensor imaging (DTI) as a noninvasive method for evaluating tumor invasion depth and its histologic grade in patients with EMC.

Study type: Prospective.

Population: Twenty-five consecutive patients with histologically confirmed EMC who were surgically treated at our institution.

Field strength/sequence: DTI was performed with a 1.5T MRI system using a single-shot echo-planar imaging sequence with b values of 0 and 1000 s/mm² and motion-probing gradients in nine noncollinear directions.

Assessment: Fractional anisotropy (FA), mean diffusivity (MD), and axial diffusivity (AD) maps were analyzed by three observers and compared with histopathologic findings.

Statistical tests: Dunnett's test, Spearman's rank correlation coefficient, and receiver operating characteristic (ROC) curve analyses.

Results: FA maps from all patients distinctly identified the junctional zone as a high-FA zone (0.864 ± 0.037) that was significantly different from the endometrium and outer myometrium (0.251 ± 0.030 and 0.471 ± 0.091, respectively; P < 0.001). All EMCs were clearly depicted as hypointense areas on all DTI maps. AD maps provided the best tumor-to-uterus contrast, and EMCs (0.977 ± 0.120 × 10^-3 mm² /s) had significantly lower AD values than all other layers of the normal uterine wall (2.166 ± 0.408, 2.010 ± 0.289, and 2.655 ± 0.203 × 10^-3 mm² /s, respectively; P < 0.001). EMCs were clearly demarcated from the normal uterine wall, and DTI maps and histopathologic data yielded identical findings regarding tumor invasion depth. FA values showed a significant inverse correlation (r = -0.818; P < 0.001) with histologic grades 1, 2, and 3 of endometrioid adenocarcinomas.

Data conclusion: In patients with EMC, DTI may be useful for evaluating tumor invasion depth and its histologic grade.

Level of evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:250-260.

Keywords: MR imaging; diffusion-tensor imaging; diffusion-weighted imaging; endometrial carcinoma; uterus.