Evaluation Of Pathological Stage And Grade Of Endometrial Carcinoma Using3.0T MR Three-dimensional Liver Acquisition Wiht Volume Acceleration Dynamic Contrast-enhanced And Diffusion Weighted Imaging

Objective Through analyzing the preoperative MRI materials of patients with endometrial carcinoma at stage Ⅰ、Ⅱproved by postoperative pathology, to observe the performance of endometrial carcinoma in3.0T magnetic resonance three-dimensional(3D) liver acquisition with volume acceleration(LAVA) dynamic contrast-enhanced imaging, to investigate the diagnostic accuracy of dynamic contrast-enhanced imaging in staging endometrial carcinoma; and to study whether the apparent diffusion coefficient (ADC) values of endometrial carcinoma with different pathological grades show statistical difference.Materials and Methods There were73patients with endometrial carcinoma at stage Ⅰ、Ⅱ proved by postoperative pathology. All patients had no MRI contraindication, got pelvic MRI examination before operation, and received no radiational and chemical theropy before examination. MRI scanning was performed using GE3.0T HDx superconducting MRI system and Torsopa pelvic phased array surface coil. Examination included the routine sagittal and fat-suppressed axial T2WI、3D liver acquisition with volume acceleration dynamic contrast-enhanced T1WI and diffusion weighted imaging(DWI).1. After the routine sagittal and fat-suppressed axial T2WI was performed,56cases underwent array spatial sensitivity encoding technique(ASSET) checking sequence scanning, then received3D LAVA dynamic contrast-enhanced imaging for repeated acquisitions at30s、60s、120s、180s delay with breath-hold after venous injection of Gd-DTPA by pressure injector. The performance of endometrial carcinoma was observed at T2WI and LAVA images, and tumor was staged by2009FIGO staging standard. Compared with the results of pathology, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of T2WI and3D LAVA dynamic contrast-enhanced imaging in staging endometrial carcinoma at stage Ⅰ a、Ⅰb and Ⅱ (2009FIGO staging standard) were analyzed and compared.2. After the routine sagittal and fat-suppressed axial T2WI was performed,41cases underwent ASSET CAT checking sequence scanning, then received axial diffusion weighted imaging (DWI) using single excitation spin echo-echo planar imaging (SE-EPI) sequence with b values of0and1000s/mm2respectively, the sensitive gradient pulse was applied to X, Y and Z directions at the same time. The scanning slice of DWI stayed the same with that of axial T2WI. After DWI examination was performed, ADC maps were obtained by postprocessing at workstations. The ADC values of endometrial carcinoma with different pathological grades and right gluteus minimum at the same slice were measured and mean ADC values were calculated, then whether mean ADC values of endometrial carcinoma with different pathological grades showed statistical difference were compared.Results1. Endometrial carcinoma was staged as Ⅰa in44cases、Ⅰb in9cases、Ⅱ in3cases proved by postoperative pathology. T2WI correctly judged carcinoma at stage Ⅰa in38cases、Ⅰb in6cases and Ⅱ in3cases;9cases were misjudged、6cases at stage Ⅰa were misjudged as stage Ⅰ b，3cases at stage Ⅰb were misjudged as stage Ⅰ a. Compared with postoperative pathological results, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of T2WI in staging endometrial carcinoma at stage Ⅰa、Ⅰb and Ⅱ(2009FIGO staging standard) were86.4%、66.7%、100.0%,75.0%、87.2%、100.0%,83.9%、83.9%、100.0%,92.7%、50.0%、100.0%,60.0%、93.2%、100.0%, respectively.3D LAVA dynamic contrast-enhanced imaging correctly judged carcinoma at stage Ⅰa in41cases、Ⅰb in7cases and Ⅱ in3cases;5cases were misjudged,3cases at stage Ⅰa were misjudged as stage Ⅰb,2cases at stage Ⅰb were misjudged as stage Ⅰa. Compared with postoperative pathological results, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of3D LAVA dynamic contrast-enhanced imaging in staging endometrial carcinoma at stage Ⅰa、Ⅰb and Ⅱ (2009FIGO staging standard) were93.2%、77.8%、100.0%,83.3%、93.6%、100.0%,91.1%、91.1%、100.0%,95.3%、70.0%、100.0%,76.9%、95.7%、100.0%, respectively.3D LAVA dynamic contrast-enhanced imaging correctly judged4cases of9cases misjudged by T2WI, and the sensitivity, specificity, accuracy of3D LAVA dynamic contrast-enhanced imaging were increased.2. Endometrial carcinoma in41cases undergoing DWI all were endometrioid adenocarcinoma of well-differentiated (G1)in20cases, moderately-differentiated (G2) in14cases, poorly-differentiated (G3) in7cases. The mean ADC values of G1、 G2、G3endometrial carcinoma were (0.78±0.14)X10-3mm2/s、(0.64±0.06)X10-3mm2/s、(0.40±0.09)×10-3mm2/s, respectively; the mean ADC values of endometrial carcinoma of different pathological grades differed,and the difference between any two grades showed statistically significant (p<0.01).Conclusions1.3.OT magnetic resonance3D LAVA dynamic contrast-enhanced imaging can be rather accurate in staging endometrial carcinoma at stage Ⅰ、Ⅱ, should be the routine preoperative MRI examination of endometrial carcinoma.2. The mean ADC values of endometrial carcinoma of different pathological grades differ, and the difference between any two grades shows statistically significant; the ADC value of tumor with higher grade tends to decrease compared to that with lower grade; the measurement of ADC value has a potential ability to differentiate endometrial carcinoma of different pathological grades.3. The combination of3D LAVA dynamic contrast-enhanced imaging and DWI can provide rather accurate information about the pathological stage and grade of endometrial carcinoma, helps the clinic choose suitable treatment plan.