The Role of Diffusion weighted Imaging versus dynamic multiphase contrast enhanced MRI in the evaluation of uterine malignancies

Abstract

Magnetic resonant imaging is a non-invasive, rapid and highly accurate diagnostic tool in the evaluation of crowded structures of pelvic region. Introduction of MRI to assess uterine malignancies was good addition to both radiologists and surgeons. MRI has the advantage of declaration of zonal anatomy, parametrial invasion and lymph node assessment of pelvic region. In addition, cyclical changes of endometrium can be also diagnosed by MRI. However, T1 WI are not the sole diagnostic tool, addition of other sequences like DWI and DCE-MRI was mandatory to extend accuracy of MRI both vertically and horizontally. The additional sequences have the advantage of diagnosing the tumor behaviour, size and differentiation of lymph node assessment. The purpose of this study was to evaluate the impact of Magnetic resonance imaging in preoperative staging of endometrial & cervical carcinomas, with special focus on : Evaluation of sensitivity and specificity of Magnetic resonance imaging staging, with cyto-histological diagnosis taken as the reference. Forty percent of the studied cases (14 cases with endometrial and 26 cases with cervical carcinoma), the mean age was 57.1±15.4, the overall accuracy of MRI DWI and DCE were 87.6 %, 86% respectively in comparison with the histopathology results for both tumors, regarding myometrial invasion, cervical involvement and cervical stromal invasion there was no statistically significant difference between both modalities, however, there was great difference between both sequences and T2WI. Regarding ADC values; the minimum ADC value for endometrial and cervical cancer showed a trend for lower values in grade 3 tumors than grade 1; however, this did not reach a statistical significance.