Diagnostic value of diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) in differentiation between normal and abnormally thickened endometrium: prospective study

Background: Diffusion tensor imaging (DTI) can be beneficial to differentiate between endometrium and other uterine layers. It is believed that it can be used to differentiate between normal and abnormally thickened endometrium. The purpose of this study was to find out the diagnostic value of DTI as an extension of DWI in characterization of abnormally thickened endometrium and differentiate it from normal. Results: This study included 68 females, results of 3 of them were excluded (unable to complete the study), so the final number was 65 females subdivided into 2 groups; (A) control: 24 (13 premenopausal and 11 asymptomatic postmenopausal), (B) pathological thickened endometrium: 41 (11 premenopausal and 30 postmenopausal): benign (21 patients) and malignant (20 patients). The collected data was correlated to the histopathological results (as the gold standard) in cases of endometrial pathologies. The mean DW-ADC values for normal, benign, and malignant patients were 1.43 +/- 0.13, 1.56 +/- 0.17, and 0.86 +/- 0.16 respectively and with significant statistical difference between normal and benign endometrial lesions (P value = 0.006), and between normal and malignant endometrial lesions, and between benign and malignant endometrial lesions (P value < 0.001). The DTI-FA mean values for normal, benign, and malignant patients were 0.349 +/- 0.08, 0.29 +/- 0.09, and 0.299 +/- 0.08 respectively and with significant statistical difference between normal and benign endometrial lesions (P value = 0.02), but there is no significant statistical difference regarding DTI-FA values between normal and malignant endometrial lesions or between benign and malignant endometrial lesions (P value > 0.05). Also, there is a significant statistical difference regarding DTI-MD mean values between normal (1.59 +/- 0.06) and benign (1.37 +/- 0.09), normal and malignant (0.71 +/- 0.25), and between benign and malignant endometrial lesions (P value < 0.001). The DT-MD had a higher sensitivity, specificity, and accuracy than both DW-ADC and DT-FA in differentiating normal, benign, and malignant endometrial pathologies. Conclusion: DTI (added to DWI) is a valuable non-invasive tool that can increase the accuracy in differentiating normal, benign, and malignant endometrial conditions, helping early management, and decrease the possibility of misdiagnosis.