A Comparative Study of Mono-exponential and Advanced Diffusion-weighted Imaging in Differentiating Stage IA Endometrial Carcinoma from Benign Endometrial Lesions

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2024 Mar 20

PMID 38504026

Authors

Hai-Jiao Li

Kun Cao

Xiao-Ting Li

Hai-Tao Zhu

Bo Zhao

Min Gao

Xiang Song

Ying-Shi Sun

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of the current investigation is to compare the efficacy of different diffusion models and diffusion kurtosis imaging (DKI) in differentiating stage IA endometrial carcinoma (IAEC) from benign endometrial lesions (BELs).

Methods: Patients with IAEC, endometrial hyperplasia (EH), or a thickened endometrium confirmed between May 2016 and August 2022 were retrospectively enrolled. All of the patients underwent a preoperative pelvic magnetic resonance imaging (MRI) examination. The apparent diffusion coefficient (ADC) from the mono-exponential model, pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) from the bi-exponential model, distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index from the stretched-exponential model, diffusion coefficient (Dk) and diffusion kurtosis (K) from the DKI model were calculated. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficiency.

Results: A total of 90 patients with IAEC and 91 patients with BELs were enrolled. The values of ADC, D, DDC and Dk were significantly lower and D* and K were significantly higher in cases of IAEC (p < 0.05). Multivariate analysis showed that K was the only predictor. The area under the ROC curve of K was 0.864, significantly higher compared with the ADC (0.601), D (0.811), D* (0.638), DDC (0.743) and Dk (0.675). The sensitivity, specificity and accuracy of K were 78.89%, 85.71% and 80.66%, respectively.

Conclusion: Advanced diffusion-weighted imaging models have good performance for differentiating IAEC from EH and endometrial thickening. Among all of the diffusion parameters, K showed the best performance and was the only independent predictor. Diffusion kurtosis imaging was defined as the most valuable model in the current context.

Citing Articles

ZOOMit diffusion kurtosis imaging combined with diffusion weighted imaging for the assessment of microsatellite instability in endometrial cancer.

Wang F, Wang Y, Ran C, Liang J, Qi L, Zhang C Abdom Radiol (NY). 2024; .

PMID: 39641783 DOI: 10.1007/s00261-024-04720-y.

Analysis of ultrasonic imaging changes and factors related to malignant transformation in postmenopausal patients with endometrial polyps.

Meng Q, Ge N, Fan Y, Li L Am J Transl Res. 2024; 16(7):3055-3063.

PMID: 39114675 PMC: 11301457. DOI: 10.62347/GFIU8015.

References

Liu X, Zhou L, Peng W, Wang H, Zhang Y . Comparison of stretched-Exponential and monoexponential model diffusion-Weighted imaging in prostate cancer and normal tissues. J Magn Reson Imaging. 2015; 42(4):1078-85. DOI: 10.1002/jmri.24872. View

Chen T, Li Y, Lu S, Zhang Y, Wang X, Luo C . Quantitative evaluation of diffusion-kurtosis imaging for grading endometrial carcinoma: a comparative study with diffusion-weighted imaging. Clin Radiol. 2017; 72(11):995.e11-995.e20. DOI: 10.1016/j.crad.2017.07.004. View

Liu J, Wan Y, Wang Z, Qi Y, Qu P, Liu Y . Perfusion and diffusion characteristics of endometrial malignancy based on intravoxel incoherent motion MRI at 3.0 T: comparison with normal endometrium. Acta Radiol. 2015; 57(9):1140-8. DOI: 10.1177/0284185115618550. View

Van Hanegem N, Prins M, Bongers M, Opmeer B, Sahota D, Mol B . The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016; 197:147-55. DOI: 10.1016/j.ejogrb.2015.12.008. View

Zhang Q, Ouyang H, Ye F, Chen S, Xie L, Zhao X . Multiple mathematical models of diffusion-weighted imaging for endometrial cancer characterization: Correlation with prognosis-related risk factors. Eur J Radiol. 2020; 130:109102. DOI: 10.1016/j.ejrad.2020.109102. View

Yamada I, Sakamoto J, Kobayashi D, Miyasaka N, Wakana K, Oshima N . Diffusion kurtosis imaging of endometrial carcinoma: Correlation with histopathological findings. Magn Reson Imaging. 2019; 57:337-346. DOI: 10.1016/j.mri.2018.12.009. View

Zhang S, Gong T, Liu F, Jiang Y, Sun H, Ma X . Global, Regional, and National Burden of Endometrial Cancer, 1990-2017: Results From the Global Burden of Disease Study, 2017. Front Oncol. 2020; 9:1440. PMC: 6930915. DOI: 10.3389/fonc.2019.01440. View

Xie B, Qian C, Yang B, Ning C, Yao X, Du Y . Risk Factors for Unsuccessful Office-Based Endometrial Biopsy: A Comparative Study of Office-Based Endometrial Biopsy (Pipelle) and Diagnostic Dilation and Curettage. J Minim Invasive Gynecol. 2017; 25(4):724-729. DOI: 10.1016/j.jmig.2017.11.018. View

Jin X, Yan R, Li Z, Zhang G, Liu W, Wang H . Evaluation of Amide Proton Transfer-Weighted Imaging for Risk Factors in Stage I Endometrial Cancer: A Comparison With Diffusion-Weighted Imaging and Diffusion Kurtosis Imaging. Front Oncol. 2022; 12:876120. PMC: 9047827. DOI: 10.3389/fonc.2022.876120. View

10.

Chryssou E, Manikis G, Ioannidis G, Chaniotis V, Vrekoussis T, Maris T . Diffusion Weighted Imaging in the Assessment of Tumor Grade in Endometrial Cancer Based on Intravoxel Incoherent Motion MRI. Diagnostics (Basel). 2022; 12(3). PMC: 8947183. DOI: 10.3390/diagnostics12030692. View

11.

Jensen J, Helpern J . MRI quantification of non-Gaussian water diffusion by kurtosis analysis. NMR Biomed. 2010; 23(7):698-710. PMC: 2997680. DOI: 10.1002/nbm.1518. View

12.

Manfredi R, Gui B, Maresca G, Fanfani F, BONOMO L . Endometrial cancer: magnetic resonance imaging. Abdom Imaging. 2005; 30(5):626-36. DOI: 10.1007/s00261-004-0298-9. View

13.

Meng N, Fang T, Feng P, Huang Z, Sun J, Wang X . Amide Proton Transfer-Weighted Imaging and Multiple Models Diffusion-Weighted Imaging Facilitates Preoperative Risk Stratification of Early-Stage Endometrial Carcinoma. J Magn Reson Imaging. 2021; 54(4):1200-1211. DOI: 10.1002/jmri.27684. View

14.

Zhang G, Yan R, Liu W, Jin X, Wang X, Wang H . Use of biexponential and stretched exponential models of intravoxel incoherent motion and dynamic contrast-enhanced magnetic resonance imaging to assess the proliferation of endometrial carcinoma. Quant Imaging Med Surg. 2023; 13(4):2568-2581. PMC: 10102783. DOI: 10.21037/qims-22-688. View

15.

Takeuchi M, Matsuzaki K, Uehara H, Yoshida S, Nishitani H, Shimazu H . Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging. Eur Radiol. 2005; 15(11):2244-55. DOI: 10.1007/s00330-005-2814-x. View

16.

Meng N, Wang X, Sun J, Huang Z, Yang Z, Shang J . Evaluation of amide proton transfer-weighted imaging for endometrial carcinoma histological features: a comparative study with diffusion kurtosis imaging. Eur Radiol. 2021; 31(11):8388-8398. DOI: 10.1007/s00330-021-07966-y. View

17.

Granata V, Fusco R, Risi C, Ottaiano A, Avallone A, De Stefano A . Diffusion-Weighted MRI and Diffusion Kurtosis Imaging to Detect RAS Mutation in Colorectal Liver Metastasis. Cancers (Basel). 2020; 12(9). PMC: 7565693. DOI: 10.3390/cancers12092420. View

18.

Tian S, Chen A, Li Y, Wang N, Ma C, Lin L . The combined application of amide proton transfer imaging and diffusion kurtosis imaging for differentiating stage Ia endometrial carcinoma and endometrial polyps. Magn Reson Imaging. 2023; 99:67-72. DOI: 10.1016/j.mri.2022.12.026. View

19.

Iima M, Le Bihan D . Clinical Intravoxel Incoherent Motion and Diffusion MR Imaging: Past, Present, and Future. Radiology. 2015; 278(1):13-32. DOI: 10.1148/radiol.2015150244. View

20.

Bhosale P, Ramalingam P, Ma J, Iyer R, Soliman P, Frumovitz M . Can reduced field-of-view diffusion sequence help assess microsatellite instability in FIGO stage 1 endometrial cancer?. J Magn Reson Imaging. 2016; 45(4):1216-1224. DOI: 10.1002/jmri.25427. View