Semiquantitative perfusion combined with diffusion-weighted MR imaging in pre-operative evaluation of endometrial carcinoma: Results in a group of 57 patients

Purpose: To evaluate the semiquantitative DCE and quantitative DWI parameters in endometrial cancer, in order to assess the presence of neoplastic tissue and normal myometrium and to ascertain a potential relationship with tumor grade. Methods and materials: A total of 57 patients with biopsy-proven endometrial adenocarcinoma who underwent MR imaging examination for staging purposes were retrospectively evaluated. Imaging protocol included multiplanar T-1- and T-2-weighted TSE, DCE T-1-weighted (THRIVE; 0, 30, 90 and 120 seconds after intravenous injection of gadolinium) and DWIBS sequences (b values = 0 and 1000 mm(2)/s). Color perfusion and ADC maps were automatically generated on dedicated software. Relative enhancement (RE, %), maximum enhancement (ME, %), maximum relative enhancement (MRE, %), time to peak (TTP, s) and mean apparent diffusion coefficient (ADC) were calculated by manually drawing a region of interest (ROI) both on the neoplastic tissue and the normal myometrium. Histopathology was used as reference standard. Results: Histopathological analysis confirmed the presence of endometrial carcinoma in all patients. Neoplastic tissue demonstrated significantly lower (P < 0.001) values of RE (%) 63.92 +/- 35.68; ME (%) 864.91 +/- 429.54 and MRE (%) 75.97 +/- 38.26 as compared to normal myometrium (RE (%) 151.43 +/- 55.99; ME (%) 1800.73 +/- 72132; MRE (%) 158.28 +/- 54.05).TTP was significantly higher (P < 0.05) in tumor lesion (385.51 +/- 1630.27 vs 195.44 +/- 78.69). Mean ADC value of neoplastic tissue (775.09 +/- ?220.73 x 10(-3) mm(2)/s) was significantly lower (P < 0.05) than in myometrium (1602.37 +/- 378.54 x 10(-3) mm(2)/s). The analysis of perfusion and diffusion parameters classified according to tumor grades, showed a statistically significant difference only for RE (P = 0.043) and ME (P = 0.007). Conclusions: Perfusion parameters and mean ADC differ significantly between endometrial cancer and normal myometrium, potentially reflecting the different microscopical features of cellularity and vascularity; however a significant relationship with tumor grade was not found in our series. (C) 2014 Elsevier Inc. All rights reserved.