| Part 1 Value of low-field MR imaging in diagnosing and staging in endometrial carcinomapurposeTo evaluate the value of low-field MR imaging in diagnosing and staging in endometrial carcinoma, and to discuss the value of non-breath-hold T2-weighted(T2WI) fast spin echo sequence and contrast-enhanced T1-weighted with a 3D gradient echo sequence(T1WI/3D) in detecting depth of myometrial invasion and cervical invasion in patients with endometrial carcinoma.Materials and MethodsTwo hundred and thirty-nine cases which were suspected by clinics or proved by dilatation and curettage with endometrial carcinoma were prospectively studied.The patients were undergone conventional and contrast-enhanced MR scan before operation. The sequences of MR imaging included spin echo T1-weighted imaging(T1WI), transverse, cornonal and saggital fast spin echo T2-weighted imaging(T2WI) or spectra-presaturation inverted recovery T2-weighted imaging(T2WI/SPIR). T1WI 3-dimentional gradient echo sequence(T1WI/3D) was applied after administration of Gd-DTPA. Compared with the results of pathology, sensitivity,specificity and accuracy of different myometrial depth of invasion, cervical invasion and lymph nodal metastases in MRI were analysed with SPSS software. And the value in superficial-and deep myometrial invasion and cervical invasion on T2WI and enhanced T1WI/3D were analysed.ResultsMR imaging had a rate of 97.80%(222/227) in detected lesion and accuracy of 93.31 %(223/239) for diagnosing in endometrial carcinoma.MR imaging had coincidence rate of 73.2% for iocaiizing the depth of myometrial depth in endometrial carcinoma on T2WI with contrast-enhanced Tl WI/3D sequences. Compared with the results of pathology, sensitivity, specificity, accuracy of MRI was 66.7%/95.6%/91.9% for tumor confined in endometrium, 67.2%/84%/73.2% for super-myometrial invasion respectively, and 93.8%/77.6%/81.3% for deep-myometrial invasion on T2WI with T1WI/3D. Accuracy was 86.1 %/70.0%/80.9% for tumor confined in endometrium, super-myometrial invasion and deep-myometrial invasion on T2WI and 91.1%/72.6%/81.6% on T1WI/3D. No statistical significance was found for the accuracy of myometrial-depth invasion on T2WI with T1WI/3D and T2WI or T1WI/3D(P=0.448, 0.902). No statistical significance was found for the accuracy of myometrial invasion on two sequences(P=0.268). The value of Kappa was.751, P=0.000.MR imaging had sensitivity, specificity and accuracy of 60.6%/91.2%/83.3% for evaluating cervical invasion on T2WI with T1WI/3D, and 58.1%/91.2%/81.3% on T2WI, 71.2%/89.8%/84.5% respectively on T1WI/3D. No statistical significance was found for the accuracy of cervical invasion on two sequences(P=0.501). The value of Kappa was.922, P=0.000.MR imaging had sensitivity, specificity and accuracy of 80.0%/94.7%/93.3% for lymph nodal metastases, 50%/97.4%/93.8% for paraendometrial invasion, sensitivity of 54.5% for serous coat and 36.4% for ovary metastases.ConclusionLow-field MR imaging had the relatively accurate evaluation in diagnosing and localizing the depth of myometrial invasion, cervical invasion and lymph nodal metastases in endometrial carcinoma.It plays an important role for clinician establishing the right scheme of therapy. T2WI and T1WI/3D had good correlation for the evaluation of the superficial/deep myometrial and cervical invasion in endometrial carcinoma. Part 2 Evaluation of high-field MR diffusion-weighted and perfusion-weighted imaging in endometrial carcinomapurposeTo investigate the usefulness of high-field MR diffusion-weighted imaging(DWI) and perfusion-weighted imaging(PWI) in evaluating endometrial carcinoma.Materials and methods25 female patients with suspected or proved by dilatation and curettage with endometrial carcinoma were prospectively studied and all were underwent surgery after MRI examination. MR images were obtained at a 3.0 T MR scanner(GE, SIGNA EXCITE HD 3.0T) and an 8-element phased-array torsopa coil was used to receive MR signal. The conventional pulse sequences included axial SE T1WI, FSE T2WI and fat saturated FSE T2WI, sagital FSE T2WI, and coronal fat saturated FSE T2WI. Axial DWI was performed in all patients using a SE-EPI sequence with a b value of 200,400,600,800,1000s/mm2. Apparent diffusion coefficients(ADC) were measured for every patients and different b value. PWI was performed with LAVA sequence, the type of uterus dynamic enhancement and perfusional curves of the endometrial lesion were investigated and the perfusional value of lesion, myometrium and uterine cervix were measured.resultsAll endometrial lesions were markedly high signal intensity on DWI compared with myometrium. The ADC of endometrial lesions and myometrium was decrease with the increasing of the b value. The ratio of ADC values of the endometrial carcinoma/myometrim(RT/M)also decreased with the increasing of the b value. Statistical significant difference in RT/M was found for b value of 1000 and 600 s/mm2(P=0.039), b value of 1000 and 400 s/mm2(P=0.034), b value of 1000 and 200 s/mm2(P=0.036). Significant difference was found for the ADC of different b value compared endometrial lesion and myometrium. The ADC of endometrial carcinoma was 2.22×10-3,1.58×10-3,1.32×10-3,1.21×10-3, 1.05×10-3mm2/s respectively on b value of 200,400,600,800,1000s/mm2.The types of uterus dynamic e,nhancement of 16 patients who were performed perfusion-weighted imaging successfully were categorized as followed: typeâ… subendometrial enhancement was found in 5 cases; typeâ…¡thin layer enhancement corresponding to the superficial myometrium or junctional zone was found in 10 cases; typeâ…¢outer(deep) myometrium enhancement was found in 1 cases. The perfusional curves in endometrial lesions appeared as: gradual late peak enhancement found in 1 patients with endometrial hyperplasia; early peak enhancement and no gradual washout was found in 11 patients with endometrial carcinoma and 1 patiens with endometrial hyperplasia and 1 patient with cervical carcinoma invased endometrum; early peak enhancement followed with gradual washout and late weak enhancement found in 2 cases with endometrial carcinoma.Statistical significant difference was found in positive enhancement integral(PEI), time to peak(TP) and maximal slope of increase(MSI) compared endometrial carcinoma with myometrium(P<0.05).ConclusionDWI had high sensitivity in detecting endometrial lesion, but had some difficulty in differentiating endometrial carcinoma with hyperplasia. For the characteration of lesion and the ADC value measured accurately, the b value of 800 or 1000 s/mm2 on DWI was proposed. The different appearance of perfusional curves and earlier TP in endometrial carcinoma with hyperplasia can provide a useful clue in the differentiation of carcinoma and hyperplasia. However, due to our small study population, further evaluation is needed to comfirm the difference in the ADC and perfusion value of endometrial carcinoma and endometrial hyperplasia.
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