Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging

Figures & data

Table 1 Surgical histopathologic characters

	Data	Percentage (%)
Overall FIGO stage
IA	43	74.1 (43/58)
IB	8	13.8 (8/58)
II	3	5.17 (3/58)
III	4	6.90 (4/58)
Myometrial invasion
Superficial	45	77.6 (45/58)
Deep	13	22.4 (13/58)
Histologic subtype
Endometrioid	51	87.9 (51/58)
Clear cell	2	3.4 (2/58)
Serous papillary	1	1.7 (1/58)
Mixed	4	6.9 (4/58)

Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.

Table 2 Sensitivity, specificity, and positive and negative predictive values for diagnosis of the depth of myometrial invasion with T2WI and T2WI-DWI

Diagnosis	Sensitivity (%)	Specificity (%)	Positive predictive value (%)	Negative predictive value (%)
Superficial invasion
T2WI	80 (36/45)	69.2 (9/13)	90 (36/40)	50 (9/18)
T2WI-DWI	95.6 (43/45)	92.3 (12/13)	97.7 (43/44)	85.7 (12/14)
Deep invasion
T2WI	69.2 (9/13)	80 (36/45)	50 (9/18)	90 (36/40)
T2WI-DWI	92.3 (12/13)	95.6 (43/45)	85.7 (12/14)	97.7 (43/44)

Abbreviations: DWI, diffusion-weighted imaging; T2WI, T2-weighted imaging.

Figure 1 Magnetic resonance images of an endometrial cancer patient (stage IA).

Notes: (A) T2-weighted image shows irregular endometrial thickening and appears as heterogeneous signals. (B) DW image shows a lesion with a high signal. (C) Fused T2WI-DWI image shows clear anatomical structures and the lesion shows good contrast from the surrounding normal tissue.
Abbreviations: DWI, diffusion-weighted imaging; T2WI, T2-weighted imaging.

Figure 2 A 56-year-old woman with endometrial carcinoma (pathologic stage is IA).

Notes: (A) T2-weighted image shows that the myometrial signal was heterogeneous (arrow), and we judged the depth of myometrial invasion to be greater than one-half of the myometrial thickness, classifying this case stage as stage IB using T2WI. (B) DW image shows that the extent of the lesion was limited. (C) Fused T2WI-DWI image shows clear margins of the tumor and depth of invasion to be less than one-half of the myometrial thickness.
Abbreviations: DWI, diffusion-weighted imaging; T2WI, T2-weighted imaging.

Figure 3 A 60-year-old woman with endometrial carcinoma (pathologic stage, IB).

Notes: (A) It was difficult to judge the depth of myometrial invasion with the T2-weighted image. (B) DW image shows the great extent of the high signal lesion. (C) Fused T2WI-DWI image shows clear margins of the tumor, and the depth of myometrial invasion to be greater than one-half of the myometrial thickness; the diagnosis was clearly stage IB.
Abbreviations: DWI, diffusion-weighted imaging; T2WI, T2-weighted imaging.

Table 3 Endometrial carcinoma staging with T2WI and fused T2WI-DWI images compared with pathologic results

T2WI/T2WI-DWI	Pathologic diagnoses
	IA	IB	II	III
IA	35/41	3/1	0/0	0/0
IB	8/2	5/7	0/0	0/0
II	0/0	0/0	3/3	0/0
III	0/0	0/0	0/0	4/4

Abbreviations: DWI, diffusion-weighted imaging; T2WI, T2-weighted imaging.

Table 4 Diagnostic accuracy rate of endometrial carcinoma staging with T2WI and T2WI-DWI

Diagnosis	Concordance	Discordance	Accuracy (%)	κ-value	P-value
T2WI	47	11	81.0 (47/58)	0.601	0.023
T2WI-DWI	55	3	94.8 (55/58)	0.881

Abbreviations: DWI, diffusion-weighted magnetic resonance imaging; T2WI, T2-weighted magnetic resonance imaging.