@2024 Afarand., IRAN
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(3):253-260
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(3):253-260
Diagnostic Accuracy of Diffusion Weighted Imaging and Dynamic Imaging Techniques in Endometrial and Lymph Nodes Cancer Staging
ARTICLE INFO
Article Type
Original ResearchAuthors
Seyed Abkenari S.K. (1)Faeghi F. (*)
Arian A. (2)
(*) Radiology Technology Department, Allied Medical Sciences School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(1) Radiology Technology Department, Allied Medical Sciences School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(2) Imaging Center of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Correspondence
Address: Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Darband Street, Tehran, IranPhone: +982122718531
Fax: +982122521170
f_faeghi@sbmu.ac.ir
Article History
Received: July 20, 2015Accepted: May 10, 2016
ePublished: June 30, 2016
ABSTRACT
Aims
Endometrial cancer is the most common malignancy of the female reproductive tract. As the prognosis factors, the determination of exact cancer stage and the differentiation of the lymph nodes plays a role in the selection of treatment plan and the rate of patient’s survival. The aim of this study was to investigate the diagnosis accuracy of dynamic and diffusion imaging techniques in the endometrial cancer staging as well as the differentiation of metastatic and non-metastatic lymph nodes.
Materials & Methods In this prospective study, 30 patients with endometrial cancer were studied in MRI ward of the imaging center of Imam Khomeini Hospital in Tehran in 2013-14. The subjects, selected by purposeful sampling method, underwent the pelvis imaging before the surgery. T1W and T2W scenes, the dynamic technique in phases including 25, 60, 120, and 240 seconds after the injection, and the diffusion technique (b= zero and 1000 s/mm2) were used in the imaging. Data was analyzed by SPSS 22 software using kappa statistic, two-independent T test, and one-way ANOVA.
Findings The agreement rate between the results of radiology and pathology in the determination of the different cancer stages was approximately 0.8, showing a good and considerable result (p<0.001). The diagnostic authenticity rate of the dynamic and diffusion techniques was 0.83. The results of radiology and pathology were completely consistent regarding the differentiation between the metastatic and non-metastatic lymph nodes. In different cancer stages, as well as in the metastatic and non-metastatic lymph nodes, the mean age and number of fertility were not significantly different (p>0.05).
Conclusion In the differentiation between the metastatic and non-metastatic lymph nodes in patients with endometrial cancer, the diagnostic accuracy is increased by the diffusion techniques utilizing the routine scenes and the injection.
Materials & Methods In this prospective study, 30 patients with endometrial cancer were studied in MRI ward of the imaging center of Imam Khomeini Hospital in Tehran in 2013-14. The subjects, selected by purposeful sampling method, underwent the pelvis imaging before the surgery. T1W and T2W scenes, the dynamic technique in phases including 25, 60, 120, and 240 seconds after the injection, and the diffusion technique (b= zero and 1000 s/mm2) were used in the imaging. Data was analyzed by SPSS 22 software using kappa statistic, two-independent T test, and one-way ANOVA.
Findings The agreement rate between the results of radiology and pathology in the determination of the different cancer stages was approximately 0.8, showing a good and considerable result (p<0.001). The diagnostic authenticity rate of the dynamic and diffusion techniques was 0.83. The results of radiology and pathology were completely consistent regarding the differentiation between the metastatic and non-metastatic lymph nodes. In different cancer stages, as well as in the metastatic and non-metastatic lymph nodes, the mean age and number of fertility were not significantly different (p>0.05).
Conclusion In the differentiation between the metastatic and non-metastatic lymph nodes in patients with endometrial cancer, the diagnostic accuracy is increased by the diffusion techniques utilizing the routine scenes and the injection.
Keywords:
Diffusion Magnetic Resonance Imaging,
Technetium Tc 99m Exametazime ,
Endometrial Neoplasms ,
Lymph Nodes ,
CITATION LINKS
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[2]Beddy P, Moyle P, Kataoka M, Yamamoto AK, Joubert I, Lomas D, Crawford R, et al. Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: Comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiol. 2012;262(2):530-7.
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[10]Park SB, Moon MH, Sung CK, Oh S, Lee YH. Dynamic contrast-enhanced mr imaging of endometrial cancer: optimizing the imaging delay for tumour-myometrium contrast. Eur Radiol. 2014;24(11):2795-9.
[11]Dogan D, Inan N, Sarisoy H, Gumustas S, Akansel G, Muezzınoğlu B, et al. Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI. Abdom Imaging. 2013;38(2):388-96.
[12]Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Yen TC, et al. Myometrial invasion in endometrial cancer: Diagnostic accuracy of diffusion-weighted 3.0-T MR imaging—initial experience. Radiol. 2009;250(3):784-92.
[13]Bonatti M, Stuefer J, Oberhofer N, Negri G, Tagliaferri T, Schifferle G, et al. MRI for local staging of endometrial carcinoma: Is endovenous contrast medium administration still needed?. Eur J Radiol. 2015;84(2):208-14.
[14]Das SK, Niu XK, Wang JL, Zeng LC, Wang WX, Bhetuwal A, et al. Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: A systematic review and meta-analysis. Cancer Imaging. 2014;14(1):32.
[15]Mak S, Hulse PA, Carrington BM. MRI mnual of pelvic cancer. 2nd edition. Boca Raton, Florida: CRC Press; 2011. pp. 115-20.
[16]Liu Y, Liu H, Bai X, Ye Z, Sun H, Bai R, et al. Differentiation of metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer using diffusion-weighted imaging. Gynecol Oncol. 2011;122(1):19-24.
[17]Fujii S, Matsusue E, Kigawa J, Sato S, Kanasaki Y, Nakanishi J, et al. Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: Initial results. Eur Radiol.2008;18(2):384-9.
[18]Levy A, Medjhoul A, Caramella C, Zareski E, Berges O, Chargari C, et al. Interest of diffusion-weighted echo-planar MR imaging and apparent diffusion coefficient mapping in gynecological malignancies: A review. J Magn Reson Imaging. 2011;33(5):1020-7.
[19]Motoshima S, Irie H, Nakazono T, Kamura T, Kudo S. Diffusion-weighted MR imaging in gynecologic cancers. J Gynecol Oncol. 2011;22(4):275-87.
[20]Tamai K, Koyama T, Saga T, Umeoka S, Mikami Y, Fujii S, et al. Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging. 2007;26(3):682-7.
[21]Lin G, Ho KC, Wang JJ, Ng KK, Wai YY, Chen YT, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging. 2008;28(1):128-35.
[22]Zhang F, Zhu L, Huang X, Niu G, Chen X. Differentiation of Reactive and Tumor Metastatic Lymph Nodes with Diffusion-weighted and SPIO-Enhanced MRI. Mol Imaging Biol. 2013;15(1):40-7.
[23]Kitajima K, Yamasaki E, Kaji Y, Murakami K, Sugimura K. Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer. World J Radiol. 2012;4(5)207-14.
[24]Harriet C, Posemarie F, Frederik D. genitourinary applications of diffusion-weighted mr imaging in the pelvis. Radiol. 2012;263(2):326-42.
[25]Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. New Engl J Med. 2003;348(25):2491-9.
[26]Thoeny HC, Froehlich JM, Triantafyllou M, Huesler J, Bains LJ, Vermathen P, et al. Metastases in normal-sized pelvic lymph nodes: Detection with diffusion-weighted MR imaging. Radiol. 2014;273(1):125-35.
[2]Beddy P, Moyle P, Kataoka M, Yamamoto AK, Joubert I, Lomas D, Crawford R, et al. Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: Comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiol. 2012;262(2):530-7.
[3]Rha SE, Byun JY, Jung SE, Lee SL, Cho SM, Hwang SS, et al. CT and MRI of Uterine Sarcomas and Their Mimickers. Am J Roentgenol. 2003;181(5):1369-74.
[4]Van den Bosch T, Coosemans A, Morina M, Timmerman D, Amant F. Screening for uterine tumours. Clin Obstet Gynaecol. 2012;26(2):257-66.
[5]Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK. Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol. 1996;88(3):394-8.
[6]Kaur H, Choi H, You YN, Rauch GM, Jensen CT, Hou P, et al. MR Imaging for Preoperative Evaluation of Primary Rectal Cancer: Practical Considerations. Radiogr. 2012;32(2):389-409.
[7]Rauch GM, Kaur H, Choi H, Ernst RD, Klopp AH, Boonsirikamchai P, et al. Optimization of MR Imaging for Pretreatment Evaluation of Patients with Endometrial and Cervical Cancer. Radiogra. 2014;34(4):1082-98.
[8]Sanjuan A, Escaramis G, Ayuso JR, Roman SM, Torne A, Ordi J, et al. Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer. Arch Gynecol Obstet. 2008;278(6):535-9.
[9]Inada Y, Matsuki M, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, et al. Body diffusion-weighted MR imaging of uterine endometrial cancer: Is it helpful in the detection of cancer in nonenhanced MR imaging?. Eur J Radiol. 2009;70(1):122-7.
[10]Park SB, Moon MH, Sung CK, Oh S, Lee YH. Dynamic contrast-enhanced mr imaging of endometrial cancer: optimizing the imaging delay for tumour-myometrium contrast. Eur Radiol. 2014;24(11):2795-9.
[11]Dogan D, Inan N, Sarisoy H, Gumustas S, Akansel G, Muezzınoğlu B, et al. Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI. Abdom Imaging. 2013;38(2):388-96.
[12]Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Yen TC, et al. Myometrial invasion in endometrial cancer: Diagnostic accuracy of diffusion-weighted 3.0-T MR imaging—initial experience. Radiol. 2009;250(3):784-92.
[13]Bonatti M, Stuefer J, Oberhofer N, Negri G, Tagliaferri T, Schifferle G, et al. MRI for local staging of endometrial carcinoma: Is endovenous contrast medium administration still needed?. Eur J Radiol. 2015;84(2):208-14.
[14]Das SK, Niu XK, Wang JL, Zeng LC, Wang WX, Bhetuwal A, et al. Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: A systematic review and meta-analysis. Cancer Imaging. 2014;14(1):32.
[15]Mak S, Hulse PA, Carrington BM. MRI mnual of pelvic cancer. 2nd edition. Boca Raton, Florida: CRC Press; 2011. pp. 115-20.
[16]Liu Y, Liu H, Bai X, Ye Z, Sun H, Bai R, et al. Differentiation of metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer using diffusion-weighted imaging. Gynecol Oncol. 2011;122(1):19-24.
[17]Fujii S, Matsusue E, Kigawa J, Sato S, Kanasaki Y, Nakanishi J, et al. Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: Initial results. Eur Radiol.2008;18(2):384-9.
[18]Levy A, Medjhoul A, Caramella C, Zareski E, Berges O, Chargari C, et al. Interest of diffusion-weighted echo-planar MR imaging and apparent diffusion coefficient mapping in gynecological malignancies: A review. J Magn Reson Imaging. 2011;33(5):1020-7.
[19]Motoshima S, Irie H, Nakazono T, Kamura T, Kudo S. Diffusion-weighted MR imaging in gynecologic cancers. J Gynecol Oncol. 2011;22(4):275-87.
[20]Tamai K, Koyama T, Saga T, Umeoka S, Mikami Y, Fujii S, et al. Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging. 2007;26(3):682-7.
[21]Lin G, Ho KC, Wang JJ, Ng KK, Wai YY, Chen YT, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging. 2008;28(1):128-35.
[22]Zhang F, Zhu L, Huang X, Niu G, Chen X. Differentiation of Reactive and Tumor Metastatic Lymph Nodes with Diffusion-weighted and SPIO-Enhanced MRI. Mol Imaging Biol. 2013;15(1):40-7.
[23]Kitajima K, Yamasaki E, Kaji Y, Murakami K, Sugimura K. Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer. World J Radiol. 2012;4(5)207-14.
[24]Harriet C, Posemarie F, Frederik D. genitourinary applications of diffusion-weighted mr imaging in the pelvis. Radiol. 2012;263(2):326-42.
[25]Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. New Engl J Med. 2003;348(25):2491-9.
[26]Thoeny HC, Froehlich JM, Triantafyllou M, Huesler J, Bains LJ, Vermathen P, et al. Metastases in normal-sized pelvic lymph nodes: Detection with diffusion-weighted MR imaging. Radiol. 2014;273(1):125-35.