Evaluation of endometrial carcinoma on magnetic resonance imaging

Our aims were to assess diagnostic performance of T2-weighted (T2W) and dynamic gadolinium-enhanced T1-weighted (T1W) magnetic resonance imaging (MRI) in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. Two radiologists retrospectively reviewed MR images of 96 patients with endometrial carcinoma. Tumor size, depth of myometrial and cervical invasion, and nodal enlargement were recorded and then correlated with histology. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the identification of any myometrial invasion (superficial or deep) were 0.94, 0.50, 0.93, 0.55 on T2W and 0.92, 0.50, 0.92, 0.50 on dynamic T1W, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91 on T2W and 0.72, 0.88, 0.72, 0.88 on dynamic T1W. The sensitivity, specificity, PPV and NPV for any cervical invasion (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90 on T2W and 0.50, 0.90, 0.46, 0.92 on dynamic T1W, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95 on T2W and 0.50, 0.96, 0.57, 0.95 on dynamic T1W. Leiomyoma or adenomyosis were seen in 73% of misdiagnosed cases. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. Fifty percent of patients with cervical invasion on MRI had nodal metastases. In conclusion, MRI has a high sensitivity for detecting myometrial invasion and a high NPV for deep invasion. MRI has a high specificity and NPV for detecting cervical invasion. Dynamic enhancement did not improve diagnostic performance. MRI may allow accurate categorization of cases into low- or high-risk groups ensuring suitable extent of surgery and adjuvant therapy

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Diagnostic Accuracy of Pre-operative Magnetic Resonance Imaging in Assessing Prognostic Pathological Parameters in Endometrial Carcinoma

10.37184/lntbj.2708-7808.2.9 ◽

2020 ◽

Keyword(s):

Magnetic Resonance Imaging ◽

Lymph Node ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Endometrial Carcinoma ◽

Preoperative Staging ◽

Myometrial Invasion ◽

Resonance Imaging ◽

Extent Of Surgery ◽

Sensitivity Specificity

Introduction: The 2nd most common gynecological malignancy and sixth among commonly diagnosed cancer is Endometrial carcinoma (EC). The risk and prognosis of the disease are assessed by appropriate staging according to the FIGO classification. Size and grade of the tumor, depth of myometrial invasion, endocervical stromal invasion, and pelvic and paraaortic lymph node involvement play an important role in the prognosis of the disease. For preoperative staging of endometrial cancer, magnetic resonance imaging (MRI), transvaginal ultrasonography (TVUS), and computed tomography (CT) are widely used as diagnostic tools. Accurate pre-operative staging provides a better platform to decide the therapeutic plan and extent of surgery. Accurate preoperative staging provides a better platform to decide the therapeutic plan and extent of surgery. Objective: To determine the efficiency of magnetic resonance imaging in the preoperative determination of the prognostic parameters in endometrial carcinoma taking histopathology as the gold standard is the objective of the study. Material and Methods: This is a retrospective study conducted at Liaquat National Hospital (LNH), Stadium Road Karachi, Pakistan. Four years record (2015-2018) was retrieved and fifty-one patients who had undergone preoperative MRI followed by surgery and biopsy-proven endometrial carcinoma were included in the study. Results: A total of 51 records were reviewed. The mean age of the patient was 61.45 ± 7.83 years. The frequent histological type was endometroid (n=37, 72.55%). For deep myometrial invasion, MRI sensitivity, specificity, PPV, and NPV were 95.83%, 77.87%, 79.31%, 94.45% respectively. In assessing endocervical invasion, MRI sensitivity, specificity, PPV, and NPV were 83.33%, 80%, 35.71%, and 97.30% respectively. For lymph node invasion, these diagnostic accuracy parameters were 71.43%, 97.73%, 83.33%, 95.56% respectively. For tumor size, sensitivity, specificity, PPV, and NPV of MRI were 100%, 36.36%, 67%, 100% respectively.

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Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2007.02.029 ◽

2008 ◽

Vol 137 (2) ◽

pp. 232-235 ◽

Cited By ~ 40

Author(s):

Osman Ortashi ◽

Seema Jain ◽

Oedyop Emannuel ◽

Richard Henry ◽

Angus Wood ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Endometrial Cancer ◽

Magnetic Resonance ◽

Preoperative Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Predictive Values ◽

Preoperative Magnetic Resonance ◽

Sensitivity Specificity

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Diagnostic Performance of Nanoparticle-Enhanced Magnetic Resonance Imaging in the Diagnosis of Lymph Node Metastases in Patients With Endometrial and Cervical Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.07.166 ◽

2005 ◽

Vol 23 (12) ◽

pp. 2813-2821 ◽

Cited By ~ 259

Author(s):

Andrea G. Rockall ◽

Syed A. Sohaib ◽

Mukesh G. Harisinghani ◽

Syed A. Babar ◽

Naveena Singh ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Lymph Node ◽

Magnetic Resonance ◽

Lymph Node Metastases ◽

Predictive Value ◽

Diagnostic Performance ◽

Resonance Imaging ◽

Lymph Node Sampling ◽

Node Metastases ◽

Sensitivity Specificity

Purpose Lymph node metastases affect management and prognosis of patients with gynecologic malignancies. Preoperative nodal assessment with computed tomography or magnetic resonance imaging (MRI) is inaccurate. A new lymph node–specific contrast agent, ferumoxtran-10, composed of ultrasmall particles of iron oxide (USPIO), may enhance the detection of lymph node metastases independent of node size. Our aim was to compare the diagnostic performance of MRI with USPIO against standard size criteria. Methods Forty-four patients with endometrial (n = 15) or cervical (n = 29) cancer were included. MRI was performed before and after administration of USPIO. Two independent observers viewed the MR images before lymph node sampling. Lymph node metastases were predicted using size criteria and USPIO criteria. Lymph node sampling was performed in all patients. Results Lymph node sampling provided 768 pelvic or para-aortic nodes for pathology, of which 335 were correlated on MRI; 17 malignant nodes were found in 11 of 44 patients (25%). On a node-by-node basis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) by size criteria were 29%*, 99%, 56%, and 96%, and by USPIO criteria (reader 1/reader 2) were 93%/82%* (*P = .008/.004), 97%/97%, 61%/59%, and 100%/99%, respectively (where [*] indicates the statistical difference of P = x/x between the two results marked by the asterisk). On a patient-by-patient basis, sensitivity, specificity, PPV, and NPV by size criteria were 27%*, 94%, 60%, and 79%, and by USPIO criteria (reader 1/reader 2) were 100%/91%* (*P = .031/.06), 94%/87%, 82%/71%, and 100%/96%, respectively. The κ statistic was 0.93. Conclusion Lymph node characterization with USPIO increases the sensitivity of MRI in the prediction of lymph node metastases, with no loss of specificity. This may greatly improve preoperative treatment planning.

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Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging

OncoTargets and Therapy ◽

10.2147/ott.s145763 ◽

2017 ◽

Vol Volume 10 ◽

pp. 5937-5943 ◽

Cited By ~ 4

Author(s):

Yu Guo ◽

Ping Wang ◽

Penghui Wang ◽

Wei Gao ◽

Fenge Li ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging ◽

And Diffusion

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Diffusion-Weighted Magnetic Resonance Imaging of Cholesteatoma Using PROPELLER at 1.5T: A Single-Centre Retrospective Study

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2016.05.002 ◽

2017 ◽

Vol 68 (2) ◽

pp. 116-121 ◽

Cited By ~ 3

Author(s):

Sharon E. Clarke ◽

Dipan Mistry ◽

Talal AlThubaiti ◽

M. Naeem Khan ◽

David Morris ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Retrospective Study ◽

Magnetic Resonance ◽

Predictive Value ◽

Resonance Imaging ◽

Predictive Values ◽

Second Look ◽

Diffusion Weighted ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Purpose The purpose of this study was to evaluate the sensitivity, specificity, and positive and negative predictive values of the diffusion-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique in the detection of cholesteatoma at our institution with surgical confirmation in all cases. Methods A retrospective review of 21 consecutive patients who underwent diffusion-weighted PROPELLER magnetic resonance imaging (MRI) on a 1.5T MRI scanner prior to primary or revision/second-look surgery for suspected cholesteatoma from 2009-2012 was performed. Results Diffusion-weighted PROPELLER had a sensitivity of 75%, specificity of 60%, positive predictive value of 86%, and negative predictive value of 43%. In the 15 patients for whom the presence or absence of cholesteatoma was correctly predicted, there were 2 cases where the reported locations of diffusion restriction did not correspond to the location of the cholesteatoma observed at surgery. Conclusion On the basis of our retrospective study, we conclude that diffusion-weighted PROPELLER MRI is not sufficiently accurate to replace second look surgery at our institution.

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Added Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Advanced Stage Disease in Patients With Endometrial Carcinoma

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e3181995fd9 ◽

2009 ◽

Vol 19 (1) ◽

pp. 141-146 ◽

Cited By ~ 65

Author(s):

Evis Sala ◽

Robin Crawford ◽

Emma Senior ◽

Ashley Shaw ◽

Bryony Simcock ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Added Value ◽

Resonance Imaging ◽

Dce Mri ◽

3 Dimensional ◽

Stage Disease ◽

Contrast Enhanced

Aim:To assess the added value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting advanced stage disease in patients with endometrial carcinoma.Materials and Methods:Fifty patients with endometrial carcinoma underwent preoperative MRI assessment in a single gynecological cancer center during a 2-year period. Magnetic resonance imaging examinations included high-resolution sagittal, axial, and axial-oblique T2-weighted images (T2WI) of the pelvis, and axial T1-weighted images (T1WI) of the pelvis and upper abdomen followed by DCE-MRI using a multiphase 3-dimensional gradient refocused echo T1WI sequence. The T2W images were evaluated initially, and local and overall staging was assigned according to the FIGO classification. An identical scoring system was used to evaluate the combination of DCE-MRI and T2WI. The presence of potential pitfalls in the accurate assessment of depth of myometrial invasion (leiomyoma, adenomyosis, loss of junctional zone definition, polypoid tumor, poor tumor-to-myometrium contrast, and tumor extension to uterine cornu) was also recorded. Surgical histology constituted the standard of reference.Results:The depth of myometrial invasion was correctly determined in 78% (39/50) of the cases on T2WI alone, increasing to 92% (46/50) with the addition of DCE-MRI (95% confidence interval for improvement, 4.4%-23.6%, P = 0.016). The addition of DCE-MRI led to the correct detection of deep myometrial invasion in all cases. Tumor extension to uterine cornu was the only variable significantly associated (P = 0.014) with incorrect estimation of depth of myometrial invasion.Conclusions:The addition of multiphase 3-dimensional DCE-MRI to T2WI can effectively assess the depth of myometrial invasion in endometrial carcinoma and may be a useful tool to guide the surgical approach.

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A Multivariate Analysis of Assessment of Myometrial Invasion of Endometrial Carcinoma by Magnetic Resonance Imaging

Gynecologic Oncology ◽

10.1006/gyno.1994.1214 ◽

1994 ◽

Vol 54 (3) ◽

pp. 298-306 ◽

Cited By ~ 7

Author(s):

Hiroshi Atsukawa ◽

Hiroshi Sasaki ◽

Shimpei Tada

Keyword(s):

Magnetic Resonance Imaging ◽

Multivariate Analysis ◽

Magnetic Resonance ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Resonance Imaging

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Diagnosis of mesial temporal sclerosis: sensitivity, specificity and predictive values of the quantitative analysis of magnetic resonance imaging

The Neuroradiology Journal ◽

10.1177/1971400917731301 ◽

2017 ◽

Vol 31 (1) ◽

pp. 50-59 ◽

Cited By ~ 3

Author(s):

Ana María Granados Sánchez ◽

Juan Felipe Orejuela Zapata

Keyword(s):

Magnetic Resonance Imaging ◽

Quantitative Analysis ◽

Magnetic Resonance ◽

Threshold Value ◽

Qualitative Assessment ◽

Mesial Temporal Sclerosis ◽

Conventional Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Predictive Values ◽

Sensitivity Specificity

In the diagnosis of mesial temporal sclerosis (MTS), sensitivity, specificity and predictive values of qualitative assessment using conventional magnetic resonance imaging are low, mainly in mild or bilateral atrophy. Quantitative analysis may improve this performance. We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of quantitative analysis using the hippocampal volumetric index (HVI) and hippocampal asymmetry index (HAI) compared with qualitative assessment in the MTS diagnosis. Twenty-five patients diagnosed with MTS, and 25 healthy subjects underwent conventional magnetic resonance imaging. Hippocampal volumes were obtained using an automated software (FreeSurfer); HVI and HAI were calculated. Receiver operating characteristic curve analysis was performed to obtain the optimal threshold values. Sensitivity, specificity and predictive values were calculated. Sensitivity, specificity, PPV and NPV for qualitative analysis were 44.00%, 96.00%, 91.67% and 63.16%, respectively. In the quantitative analysis, a threshold value of K = 0.22 for HVI provided a sensitivity value of 76.00%, specificity value of 96.00%, PPV of 95.00% and NPV of 80.00%. A threshold value of K = 0.06 for HAI provided the minimum C1 and C2 errors, with a sensitivity value of 88.00%, specificity value of 100%, PPV of 100% and NPV of 89.30%. A statistically significant difference was observed for HAI ( P < 0.0001), and ipsilateral HVI (left MTS, P = 0.0152; right MTS, P < 0.0001), between MTS and healthy groups. The HVI and HAI, both individually and in conjunction, improved the sensitivity, specificity and predictive values of magnetic resonance imaging in the diagnosis of MTS compared to the qualitative analysis and other quantitative techniques. The HAI is highly accurate in the diagnosis of unilateral MTS, whereas the HVI may be better for bilateral MTS cases.

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