MRI for local staging of endometrial carcinoma: Is endovenous contrast medium administration still needed?

Purpose: To compare the diagnostic performance of T2-weighted images (T2-WI) + contrast-enhanced T1-weighted images (CE TI -WI) with the one of T2-WI + diffusion-weighted images (DWI) in the assessment of myometrial and cervical stromal infiltration by endometrial carcinoma (EC). Materials and methods: Institutional review board approved our retrospective study; requirement for informed consent was waived. 56 patients with histologically proven EC who underwent preoperative MRI and surgery at our Institution over a 34 months period were included. Two radiologists independently evaluated T2-WI + CE T1-WI and T2-WI + DWI of each patient. Confidence in imaging evaluation (0-3), depth of myometrial invasion (</>= 50%) and presence of cervical stromal infiltration (Yes/No) were assessed. MRI findings were compared with pathological ones. Results: Confidence in imaging evaluation was higher for T2-WI + CE TI-WI (2.8313) than for T2-WI + DWI (2.6213). T2-WI + DWI showed a better diagnostic performance than T2-WI + CE TI-WI in recognizing deep myometrial infiltration by EC (accuracy, sensitivity and specificity of 0.89, 0.89 and 0.89 vs. 0.86, 0.84, 0.86; p > 0.05) whereas both imaging sequences combinations showed the same diagnostic performance in recognizing cervical stromal infiltration (accuracy, sensitivity and specificity of 0.95, 0.98 and 0.80, p > 0.05). Conclusion: T2-WI + DWI can reliably replace the "classical" combination T2-WI + CE T1 -WI for local staging of endometrial carcinoma. (C) 2014 Elsevier Ireland Ltd. All rights reserved.