The Diagnostic Value Of Magnetic Resonance Diffusion Weighted Imaging Combining T2-Weighted Imaging In Detecting Cervical Invasion Of Early Endometrial Carcinoma

Objective To investigate the value of magnetic resonance diffusion weighted imaging combing T2-Weighted Imaging in cervical invasion of early endometrial carcinoma.Methods A retrospective review was conducted in our hospital from January2011 to December 2015. The patients with endometrial carcinoma were confirmed by operation and pathology. There were cervical infiltration in the patients in experiment group(stage ?), and no cervical infiltration in control group(stage?).All the cases received preoperative conventional magnetic resonance imaging(MRI) scans and magnetic resonance diffusion weighted imaging(MR-DWI, with b=0 s/mm2 and 800 s/mm2). Compared T2 WI and DWI(high b value sequence)features; refered to sagittal T2 WI images to observe and analyze the axial DWI images and measured ADC values in the regions of interest within the intrauterine and cervical lesions in patients in experiment group, while measured ADC values in the regions of interest within the intrauterine and cervical endometrium in patients in control group.Results In our study, there were 36 cases in the experiment group and control group respectively. The 36 patients in experiment group were all in stage ?, the tumor appeared as irregular thickening of the endometrium on T2 WI, the signal was higher than junctional zone and outer muscular layer but lower than that in normal mucosa; and enhanced slightly in comparison to the adjacent myometrium after enhancement, showed hyperintense on DWI(high b value sequence).22 cases with cervical invasion performed as lesions continuous with endometrial tumor on T2WI; the cervical normal form disappeared, and the signal of cervical stromal boundary increased and normal low signal blurred, becoming discontinuous. It appeared as high signal area of the uterine cavity spreading to the cervix on DWI(high b value sequence). There were no obvious abnormal signal in the other 14 patients on T2 WI, only showed normal low signal of cervical stromal boundary blurring; high signal of cervical stromal edge blurred after enhancement; the signal of stromal on DWI(high b value sequence) was abnormal increasing. 36 patients in control group were all in stage ?a. The tumor also showed irregular thickening of endometrium on T2 WI, the junctional zone were complete and continuous; the lesions showed slight enhancement after injection of contrast media and appearedn as local hyperintense on DWI(high b value sequence), but it is difficult to distinguish from the junctional zone. In the control group, there were no obvious abnormal signals in cervical endometrium in all sequences.There was no significant difference of the mean ADC value of the intrauterine cancer between experiment group((0.846±0.025)×10-3 mm2 /s) and control group((0.867±0.021)×10-3 mm2 /s),t=0.692,P=0.531>0.05). The mean ADC value of cervical lesions in experiment group(0.907±0.044)×10-3 mm2 /s)was significantly lower than that of cervical endometrium in patients in control group((1.517±0.040)×10-3 mm2 /s,t=10.255,P=0.000<0.05). ROC of the ADC value used for differentiating the normal cervical endometrium from endometrial carcinoma, the AUC is 0.966.When an ADC values of 1.195×10-3 mm2 /s was used for threshold, the sensitiity as a diagnostic test was 94.4% and specificity was100%.Conclusions DWI combined with routine T2 WI is helpful to determine the extent of invasion of endometrial cancer. ADC value mesurement is important to detect cervical invasion of stage ?-?endometrial carcinoma.