Comparison of the diagnostic efficacy of DWI and DCE-MRI in depth of myometrial invasion, cervical invasion and FIGO staging in patients with endometrial cancer

This study aims to compare the diagnostic efficacy of DWI (Diffusion Weighted Imag-ing) and DCE-MRI (Dynamic Contrast Enhancement-Magnetic Resonance Imaging) in the depth of myometrial invasion, cervical invasion and FIGO (Federation International of Gynecology and Obstetrics) staging in patients with endometrial cancer. 128 patients were selected for preoperative diagnosis with DWI and DCE-MRI techniques. The diagnostic efficacy of the two diagnostic methods on the depth of myometrial invasion, cervical invasion and FIGO staging was compared. Receiver operating characteristic curves were plotted for the two diagnostic methods to further compare the differences between the two diagnostic methods. The accuracy, sensitivity, positive predictive value and negative predictive value of DWI were conspicuously higher than that of DCE-MRI in the diagnosis of depth of myometrial invasion and cervical invasion (p < 0.05). ROC (Receiver Operating Characteristic Curve) analysis demonstrated that the diagnostic effect of DWI was better than that of DCE-MRI in the diagnosis of depth of myometrial invasion and cervical invasion, and the difference in the area under the curve between the two diagnostic methods was statistically significant (p < 0.05). In terms of FIGO staging diagnosis, the accuracy of DWI was 86.72%, which was higher than 65.63% of DCE-MRI (χ2 = 15.689, p < 0.001). For patients with endometrial cancer, preoperative depth of myometrial invasion, cervical invasion and FIGO staging have critical guiding significance for clinical diagnosis and treatment. Compared with DCE-MRI, DWI has better diagnostic efficacy for depth of myometrial invasion, cervical invasion and FIGO staging, which is worthy of clinical application.

DWI; DCE-MRI; Endometrial cancer; Depth of myometrial invasion; Cervical invasion; FIGO staging

[1] Moreira ASL, Ribeiro V, Aringhieri G, Fanni SC, Tumminello L, Faggioni L, et al. Endometrial cancer staging: is there value in ADC? Journal of Personalized Medicine. 2023; 13: 728.

[2] Satta S, Dolciami M, Celli V, Di Stadio F, Perniola G, Palaia I, et al. Quantitative diffusion and perfusion MRI in the evaluation of endometrial cancer: validation with histopathological parameters. The British Journal of Radiology. 2021; 94: 20210054.

[3] Chen J, Fan W, Gu H, Zhang W, Liu Y, Wang Y, et al. Preoperative MRI and immunohistochemical examination for the prediction of high-risk endometrial cancer. Gland Surgery. 2021; 10: 2180–2191.

[4] Lee MS, Moon MH, Kim SY, Jang S, Oh S, Cho JY. Preoperative risk stratification in women with endometrial cancer: a comparison of contrast-enhanced MR imaging and diffusion-weighted MR imaging. European Journal of Radiology. 2022; 150: 110276.

[5] Neves TR, Correia MT, Serrado MA, Horta M, Caetano AP, Cunha TM. Staging of endometrial cancer using fusion T2-weighted images with diffusion-weighted images: a way to avoid gadolinium? Cancers. 2022; 14: 384.

[6] Ota T, Tsuboyama T, Onishi H, Nakamoto A, Fukui H, Yano K, et al. Diagnostic accuracy of MRI for evaluating myometrial invasion in endometrial cancer: a comparison of MUSE-DWI, rFOV-DWI, and DCE-MRI. La Radiologia Medica. 2023; 128: 629–643.

[7] Yan B, Liang X, Zhao T, Ding C, Zhang M. Is the standard deviation of the apparent diffusion coefficient a potential tool for the preoperative prediction of tumor grade in endometrial cancer? Acta Radiologica. 2020; 61: 1724–1732.

[8] Bi Q, Wang Y, Deng Y, Liu Y, Pan Y, Song Y, et al. Different multiparametric MRI-based radiomics models for differentiating stage IA endometrial cancer from benign endometrial lesions: a multicenter study. Frontiers in Oncology. 2022; 12: 939930.

[9] Espedal H, Berg HF, Fonnes T, Fasmer KE, Krakstad C, Haldorsen IS. Feasibility and utility of MRI and dynamic 18F-FDG-PET in an orthotopic organoid-based patient-derived mouse model of endometrial cancer. Journal of Translational Medicine. 2021; 19: 406.

[10] Bo J, Jia H, Zhang Y, Fu B, Jiang X, Chen Y, et al. Preoperative prediction value of pelvic lymph node metastasis of endometrial cancer: combining of ADC value and radiomics features of the primary lesion and clinical parameters. Journal of Oncology. 2022; 2022: 3335048.

[11] Jin X, Yan R, Li Z, Zhang G, Liu W, Wang H, et al. 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. Frontiers in Oncology. 2022; 12: 876120.

[12] Mao W, Chen C, Gao H, Xiong L, Lin Y. A deep learning-based automatic staging method for early endometrial cancer on MRI images. Frontiers in Physiology. 2022; 13: 974245.

[13] Ozturk M, Kalkan C, Danaci M, Kefeli M. Diffusion-weighted MRI at 3T in endometrial cancer: correlation of apparent diffusion coefficient with histopathological prognostic parameters. Journal of the College of Physicians and Surgeons. 2021; 31: 1399–1405.

[14] Arian A, Easa AM, Arab-Ahmadi M. Diagnostic value of diffusion-weighted magnetic resonance imaging in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer. Acta Radiologica. 2020; 61: 1580–1586.

[15] Zhang Q, Ouyang H, Ye F, Chen S, Xie L, Zhao X, et al. Multiple mathematical models of diffusion-weighted imaging for endometrial cancer characterization: correlation with prognosis-related risk factors. European Journal of Radiology. 2020; 130: 109102.

[16] Liu XF, Yan BC, Li Y, Ma FH, Qiang JW. Radiomics feature as a preoperative predictive of lymphovascular invasion in early-stage endometrial cancer: a multicenter study. Frontiers in Oncology. 2022; 12: 966529.

[17] Wang L, Tseng Y, Wee NK, Low JJH, Tan CH. Diffusion-weighted imaging versus dynamic contrast-enhanced imaging for pre-operative diagnosis of deep myometrial invasion in endometrial cancer: a meta-analysis. Clinical Imaging. 2021; 80: 36–42.

[18] Stanzione A, Maurea S, Danzi R, Cuocolo R, Galatola R, Romeo V, et al. MRI to assess deep myometrial invasion in patients with endometrial cancer:a multi-reader study to evaluate the diagnostic role of different sequences. European Journal of Radiology. 2021; 138: 109629.