The Valuation Of Assessment In Endometrial Carcinoma Using MR Diffusion Weighted Imaging With Background Suppression: Relationship With The Pathology

Objective: Magnetic resonance diffusion weighted imaging with backgroundsuppression (MR-DWIBS) combined with convention MRI was used to study thedifferent features of normal endometrium, benign endometrial hyperplasia andendometrial carcinoma, and the analysis of situation of the invasion and metastasis ofendometrial carcinoma was emphasized, and the value of mean signal intensity(SIm),mean apparent diffusion codffient(ADCm), mean exponential apparent diffusioncodffient (eADCm) were evaluated, which was used to predict the ability of invasionand metastasis of endometrial carcinoma. To study the relationship between ADCmvalue, eADCm value and MMP-9, CD44v6, in order to predict the biologicalbehavior of endometrial carcinoma and to provide more accurate information forclinical treatment and prognosis.Materials and Methods: The MRI data and clinical data of forty endometrialcarcinomas, six benign endometrial hyperplasias and twenty four peoples withoutgynecological disease were collected. All people were diagnosed for the first time inour hospital and accepted the MR examinations included axial T1WI and T2WI,sagittal and coronal T2WI with fat suppress and MR-DWIBS. The performancecharacteristics of the DWIBS images and the condition of invasion and metastasis ofendometrial carcinoma were observed. The SIm value, ADCm value and eADCm value of three different layers in the normal uterine, endometrium of hyperplasia andendometrial carcinoma were measured. All people were grouped by the differentclinical conditions and tumor conditions. All statistical analysis of data for eachgroup were processed using SPSS17.0.The tumor tissue of the endometrial carcinoma was conventional fixed,embedded and sectioned. The expression of MMP-9and CD44v6of tumor tissuewere detected by immunohistochemical staining，and the relationship betweenADCm, eADCm and MMP-9, CD44v6were analyzed.Results: The endometrial carcinoma was showed high signal intensity in the originalimages and very lower signal intensity in MR-DWIBS of black-white inversion. Theintensity of invasion and metastasis lesions were similar with the original lesions.The SIm value, ADCm value and eADCm value of three different layers of thenormal uterine were different（P<0.05）; the SIm and ADCm value of menostasiagroups were lower than that of nonmenostasia group. Different age has different SImand ADCm value（P<0.05）. The FIGO staging and the maximum diameter ofendometrial carcinoma have an significant effect on the ADCm value and he eADCmvalue. The ADCm value of endometrial adenocarcinoma with vesselsinvolvement/cervical involvement/lymph node invasion were lower than that with novessels involvement/no cervical involvement/no lymph node invasion, and theeADCm value was higher （P<0.05）. The SIm and eADCm of endometrialadenocarcinoma were all significantly lower than the normal endometrium,endometrium of hyperplasia and endometrium of hyperplasia with localcancerization, and the ADCm value was significantly higher（P<0.05）. The ADCmvalue of endometrial carcinoma was correlated negatively with the expression ofMMP-9and CD44v6(P=0.000; P=0.010), and the eADCm value of endometrialcarcinoma was correlated positively with the expression of MMP-9andCD44v6(P=0.002; P=0.000).Conclusion: Combining convention MRI with MR-DWIBS has important clinicalvalue to determine the localization and characterization, the condition of invasionand metastasis of endometrial carcinoma; quantitative measurement of ADCm value and eADCm value of tumor tissue of endometrial carcinoma can be noninvasive toassess the biological behavior of tumor.