Top

Published in:

01-02-2008 | Urogenital

Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results

Authors: Shinya Fujii, Eiji Matsusue, Junzo Kigawa, Shinya Sato, Yoshiko Kanasaki, Junko Nakanishi, Shuji Sugihara, Toshio Kaminou, Naoki Terakawa, Toshihide Ogawa

Published in: European Radiology | Issue 2/2008

Abstract

Our purpose is to evaluate the diagnostic accuracy of apparent diffusion coefficient (ADC) measurement in differentiating malignant from benign uterine endometrial cavity lesions. We retrospectively evaluated 25 uterine endometrial cavity lesions in 25 female patients: endometrial carcinoma (n = 11), carcinosarcoma (n = 2), submucosal leiomyoma (n = 8), and endometrial polyp (n = 4). Diffusion-weighted images were performed at 1.5 T with b factors of 0–1,000/mm². The region of interest was defined within the tumor on T2-weighted EPI image and then manually copied to an ADC map. Thereby, the ADC value was obtained. We compared ADC values between malignant and benign lesions using Student’s t-test. The mean and standard deviation of ADC values (×10⁻³ mm²/s) were as follows: endometrial carcinoma, 0.98±0.21; carcinosarcoma, 0.97±0.02; submucosal leiomyoma, 1.37±0.28; and endometrial polyp, 1.58±0.45. The ADC values differed significantly between malignant (0.98±0.19) and benign lesions (1.44±0.34) (P < 0.01). We defined malignant tumors as cases with an ADC value less than 1.15 × 10⁻³ mm²/s for obtaining the highest accuracy. Sensitivity, specificity, and accuracy were 84.6%, 100%, and 92%, respectively. ADC measurement can provide useful information in differentiating malignant from benign uterine endometrial cavity lesions.

Guo Y, Cai YQ, Cai ZL, Gao YG, An NY, Ma L, Mahankali S, Gao JH (2002) Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging. J Magn Reson Imaging 16:172–178PubMedCrossRef

Woodhams R, Matsunaga K, Kan S, Hata H, Ozaki M, Iwabuchi K, Kuranami M, Watanabe M, Hayakawa K (2005) ADC mapping of benign and malignant breast tumors. Magn Reson Med Sci 4:35–42PubMedCrossRef

Rubesova E, Grell AS, De Maertelaer V, Metens T, Chao SL, Lemort M (2006) Quantitative diffusion imaging in breast cancer: a clinical prospective study. J Magn Reson Imaging 24:319–324PubMedCrossRef

Nasu K, Kuroki Y, Nawano S, Kuroki S, Tsukamoto T, Yamamoto S, Motoori K, Ueda T (2006) Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology 239:122–130PubMedCrossRef

Cova M, Squillaci E, Stacul F, Manenti G, Gava S, Simonetti G, Pozzi-Mucelli R (2004) Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results. Br J Radiol 77:851–857PubMedCrossRef

Thoeny HC, Keyzer FD, Oyen RH, Peeters RR (2005) Diffusion-weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience. Radiology 235:911–917PubMedCrossRef

Ichikawa T, Erturk SM, Motosugi U, Sou H, Iino H, Araki T, Fujii H (2006) High-B-value diffusion-weighted MRI in colorectal cancer. AJR Am J Roentgenol 187:181–184PubMedCrossRef

Sato C, Naganawa S, Nakamura T, Kumada H, Miura S, Takizawa O, Ishigaki T (2005) Differentiation of non-cancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate. J Magn Reson Imaging 21:258–262PubMedCrossRef

Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, Katsuoka Y (2007) Diffusion-weighted MR imaging for urinary bladder carcinoma: initial results. Eur Radiol 17:201–204PubMedCrossRef

10.

Naganawa S, Sato C, Kumada H, Ishigaki T, Miura S, Takizawa O (2005) Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Eur Radiol 15:71–78PubMedCrossRef

11.

Thoeny HC, De Keyzer F (2007) Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol 17:1385–1393PubMedCrossRef

12.

Szafer A, Zhong J, Anderson AW, Gore JC (1995) Diffusion-weighted imaging in tissues: theoretical models. NMR Biomed 8:289–296PubMedCrossRef

13.

Sugahara T, Korogi Y, Kochi M, Ikushima I, Shigematu Y, Hirai T, Okuda T, Liang L, Ge Y, Komohara Y, Ushio Y, Takahashi M (1999) Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging 9:53–60PubMedCrossRef

14.

Gauvain KM, McKinstry RC, Mukherjee P, Perry A, Neil JJ, Kaufman BA, Hayashi RJ (2001) Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging. AJR Am J Roentgenol 177:449–454PubMed

15.

Guo AC, Cummings TJ, Dash RC, Provenzale JM (2002) Lymphomas and high-grade astrocytomas: comparison of water diffusibility and histologic characteristics. Radiology 224:177–183PubMedCrossRef

16.

Rumboldt Z, Camacho DL, Lake D, Welsh CT, Castillo M (2006) Apparent diffusion coefficients for differentiation of cerebellar tumors in children. AJNR Am J Neuroradiol 27:1362–1369PubMed

17.

Hayashida Y, Hirai T, Morishita S, Kitajima M, Murakami R, Korogi Y, Makino K, Nakamura H, Ikushima I, Yamura M, Kochi M, Kuratsu JI, Yamashita Y (2006) Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. AJNR Am J Neuroradiol 27:1419–1425PubMed

18.

Takeuchi M, Matsuzaki K, Uehara H, Yoshida S, Nishitani H, Shimazu H (2005) Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging. Eur Radiol 15:2244–2255PubMedCrossRef

19.

Imaoka I, Sugimura K, Masui T, Takehara Y, Ichijo K, Naito M (1999) Abnormal uterine cavity: differential diagnosis with MR imaging. Magn Reson Imaging 17:1445–1455PubMedCrossRef

20.

Ohguri T, Aoki T, Watanabe H, Nakamura K, Nakata H, Matsuura Y, Kashimura M (2002) MRI findings including gadolinium-enhanced dynamic studies of malignant, mixed mesodermal tumors of the uterus: differentiation from endometrial carcinomas. Eur Radiol 12:2737–2742PubMed

21.

Grasel RP, Outwater EK, Siegelman ES, Capuzzi D, Parker L, Hussain SM (2000) Endometrial polyps: MR imaging features and distinction from endometrial carcinoma. Radiology 214:47–52PubMed

22.

Park BK, Kim B, Park JM, Ryu JA, Kim MS, Bae DS, Ahn GH (2006) Differentiation of the various lesions causing an abnormality of the endometrial cavity using MR imaging: emphasis on enhancement patterns on dynamic studies and late contrast-enhanced T1-weighted images. Eur Radiol 16:1591–1598PubMedCrossRef

23.

Moteki T, Horikoshi H, Endo K (2002) Relationship between apparent diffusion coefficient and signal intensity in endometrial and other pelvic cysts. Magn Reson Imaging 20:463–470PubMedCrossRef

24.

Moteki T, Ishizaka H (2000) Diffusion-weighted EPI of cystic ovarian lesions: evaluation of cystic contents using apparent diffusion coefficients. J Magn Reson Imaging 1:1014–1019CrossRef

25.

Nakayama T, Yoshimitsu K, Irie H, Aibe H, Tajima T, Nishie A, Asayama Y, Matake K, Kakihara D, Matsuura S, Nakano H, Honda H (2005) Diffusion-weighted echo-planar MR imaging and ADC mapping in the differential diagnosis of ovarian cystic masses: usefulness of detecting keratinoid substances in mature cystic teratomas. J Magn Reson Imaging 22:271–278PubMedCrossRef

26.

Katayama M, Masui T, Kobayashi S, Ito T, Sakahara H, Nozaki A, Kabasawa H (2002) Diffusion-weighted echo planar imaging of ovarian tumors: is it useful to measure apparent diffusion coefficients? J Comput Assist Tomogr 26:250–256PubMedCrossRef

27.

Shimada K, Ohashi I, Kasahara I, Watanabe H, Ohta S, Miyasaka N, Itoh E, Shibuya H (2004) Differentiation between completely hyalinized uterine leiomyomas and ordinary leiomyomas: three-phase dynamic magnetic resonance imaging (MRI) vs. diffusion-weighted MRI with very small b-factors. J Magn Reson Imaging 20:97–104PubMedCrossRef

28.

Liapi E, Kamel IR, Bluemke DA, Jacobs MA, Kim HS (2005) Assessment of response of uterine fibroids and myometrium to embolization using diffusion-weighted echoplanar MR imaging. J Comput Assist Tomogr 29:83–86PubMedCrossRef

29.

Jacobs MA, Herskovits EH, Kim HS (2005) Uterine fibroids: diffusion-weighted MR imaging for monitoring therapy with focused ultrasound surgery-preliminary study. Radiology 236:196–203PubMedCrossRef

30.

Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282PubMed

31.

Young RH, Scully RE (2002) Sex cord-stromal, steroid cell, and other ovarian tumor. In: Kurman RJ (ed) Blaustein’s pathology of the female genital tract, 5th edn. Springer, Berlin Heidelberg New York, pp 907–925

32.

Tamai K, Koyama T, Saga T, Umeoka S, Nhkami Y, Fujii S, Togashi K (2007) Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 26:682–687PubMedCrossRef

33.

Silverberg SG, Kurman RJ (2002) Tumors of the uterine corpus and gestational trophoblastic disease. In: Rosai J, Aovin L (eds) Atlas of tumor pathology. Vol 3. Armed Forces Institute of Pathology, Washington, DC, pp 113–151

34.

Ueda H, Togashi K, Konishi I, Kataoka ML, Koyama T, Fujiwara T, Kobayashi H, Fujii S, Konishi J (1999) Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics 19:S131–S145PubMed

Title: Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results
Authors: Shinya Fujii
Eiji Matsusue
Junzo Kigawa
Shinya Sato
Yoshiko Kanasaki
Junko Nakanishi
Shuji Sugihara
Toshio Kaminou
Naoki Terakawa
Toshihide Ogawa
Publication date: 01-02-2008
Publisher: Springer-Verlag
Published in: European Radiology / Issue 2/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-007-0769-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2008

Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease

Value of contrast-enhanced ultrasonography for detecting renal infarcts proven by contrast enhanced CT. A feasibility study

Variability of repeated coronary artery calcium measurements by 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT

MR classification of renal masses with pathologic correlation

Percutaneous treatment of symptomatic non-parasitic benign liver cysts: Single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure

A possible cause of multiple intramuscular masses: Mazabraud’s syndrome (2007: 11b)