Skip to main content
SpringerLink
Log in

Endometrial cancer: preoperative staging using three-dimensional T2-weighted turbo spin-echo and diffusion-weighted MR imaging at 3.0 T: a prospective comparative study

  • Urogenital
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To prospectively assess the efficacy of 3-T magnetic resonance (MR) imaging using the three-dimensional turbo spin-echo T2-weighted and diffusion-weighted technique (3D-TSE/DW) compared with that of conventional imaging using the two-dimensional turbo spin-echo T2-weighted and dynamic contrast-enhanced technique (2D-TSE/DCE) for the preoperative staging of endometrial cancer, with pathological analysis as the reference standard.

Methods

Seventy-one women with endometrial cancer underwent MR imaging using 3D-TSE/DW (b = 1,000 s/mm2) and 2D-TSE/DCE. Two radiologists independently assessed the two imaging sets. Accuracy, sensitivity, and specificity for staging were analysed with the McNemar test; the areas under the receiver operating characteristic curve (Az) were compared with a univariate z-score test.

Results

The results for assessing deep myometrial invasion, accuracy, sensitivity, specificity and Az, respectively, were as follows: 3D-TSE/DW—observer 1, 87 %, 95 %, 85 % and 0.96; observer 2, 92 %, 84 %, 94 % and 0.95; 2D-TSE/DCE—observer 1, 80 %, 79 %, 81 % and 0.89; observer 2, 86 %, 84 %, 87 % and 0.86. Most of the values were higher with 3D-TSE/DW without significant differences (P > 0.12). For assessing cervical stromal invasion, there were no significant differences in those values for both observers (P > 0.6).

Conclusions

Accuracy of 3D-TSE/DW was at least equivalent to that of the conventional technique for the preoperative assessment of endometrial cancer.

Key Points

• New techniques in MR imaging help assess patients with endometrial cancer.

• A 3D T2-weighted TSE sequence seems equally as accurate as conventional techniques.

• Three-dimensional TSE/DW imaging does not require intravenous contrast material and is relatively quick.

• Tumour extent of endometrial cancer can be clearly shown on diffusion-weighted images.

• Junctional zone can be visualised well on 3D-TSE T2-weighted images.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

3D-TSE:

Three-dimensional turbo spin-echo

2D-TSE:

Two-dimensional turbo spin-echo

3D-TSE/DW:

Three-dimensional turbo spin-echo T2-weighted and diffusion-weighted technique

2D-TSE/DCE:

Two-dimensional turbo spin-echo and dynamic contrast-enhanced technique

SSH-TSE:

Single shot turbo spin-echo

SEE:

sub-endometrial enhancement

References

  1. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366:491–505

    Article  PubMed  Google Scholar 

  2. Rose PG (1996) Endometrial carcinoma. N Engl J Med 335:640–649

    Article  PubMed  CAS  Google Scholar 

  3. Lewin SN, Herzog TJ, Barrena Medel NI et al (2010) Comparative performance of the 2009 international Federation of gynecology and obstetrics’ staging system for uterine corpus cancer. Obstet Gynecol 116:1141–1149

    Article  PubMed  Google Scholar 

  4. Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging-a meta-analysis and Bayesian analysis. Radiology 216:444–449

    PubMed  CAS  Google Scholar 

  5. Hricak H, Rubinstein LV, Gherman GM, Karstaedt N (1991) MR imaging evaluation of endometrial carcinoma: results of an NCI cooperative study. Radiology 179:829–832

    PubMed  CAS  Google Scholar 

  6. Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718

    PubMed  CAS  Google Scholar 

  7. Manfredi R, Mirk P, Maresca G et al (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378

    Article  PubMed  Google Scholar 

  8. Chung HH, Kang SB, Cho JY et al (2007) Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol 104:654–659

    Article  PubMed  Google Scholar 

  9. Kinkel K, Forstner R, Danza FM et al (2009) Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol 19:1565–1574

    Article  PubMed  CAS  Google Scholar 

  10. Torricelli P, Ferraresi S, Fiocchi F et al (2008) 3-T MRI in the preoperative evaluation of depth of myometrial infiltration in endometrial cancer. AJR Am J Roentgenol 190:489–495

    Article  PubMed  Google Scholar 

  11. Hori M, Kim T, Murakami T et al (2009) MR imaging of endometrial carcinoma for preoperative staging at 3.0 T: comparison with imaging at 1.5 T. J Magn Reson Imaging 30:621–630

    Article  PubMed  Google Scholar 

  12. Tamai K, Koyama T, Saga T et al (2007) Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 26:682–687

    Article  PubMed  Google Scholar 

  13. Fujii S, Matsusue E, Kigawa J et al (2008) Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results. Eur Radiol 18:384–389

    Article  PubMed  Google Scholar 

  14. Takeuchi M, Matsuzaki K, Nishitani H (2009) Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion. Acta Radiol 50:947–953

    Article  PubMed  CAS  Google Scholar 

  15. Lin G, Ng KK, Chang CJ et al (2009) Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging - initial experience. Radiology 250:784–792

    Article  PubMed  Google Scholar 

  16. Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S (2010) Myometrial invasion in endometrial cancer: diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 20:754–762

    Article  PubMed  Google Scholar 

  17. Beddy P, Moyle P, Kataoka M et al (2012) Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 262:530–537

    Article  PubMed  Google Scholar 

  18. Hori M, Kim T, Onishi H et al (2011) Uterine tumors: comparison of 3D versus 2D T2-weighted turbo spin-echo MR imaging at 3.0 T—initial experience. Radiology 258:154–163

    Article  PubMed  Google Scholar 

  19. Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44:265–272

    PubMed  CAS  Google Scholar 

  20. Yamashita Y, Harada M, Sawada T, Takahashi M, Miyazaki K, Okamura H (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501

    PubMed  CAS  Google Scholar 

  21. Proscia N, Jaffe TA, Neville AM, Wang CL, Dale BM, Merkle EM (2010) MRI of the pelvis in women: 3D versus 2D T2-weighted technique. AJR Am J Roentgenol 195:254–259

    Article  PubMed  Google Scholar 

  22. Agrawal G, Riherd JM, Busse RF, Hinshaw JL, Sadowski EA (2009) Evaluation of uterine anomalies: 3D FRFSE cube versus standard 2D FRFSE. AJR Am J Roentgenol 193:W558–562

    Article  PubMed  Google Scholar 

  23. Hecht EM, Yitta S, Lim RP et al (2011) Preliminary clinical experience at 3 T with a 3D T2-weighted sequence compared with multiplanar 2D for evaluation of the female pelvis. AJR Am J Roentgenol 197:W346–352

    Article  PubMed  Google Scholar 

  24. Whittaker CS, Coady A, Culver L, Rustin G, Padwick M, Padhani AR (2009) Diffusion-weighted MR imaging of female pelvic tumors: a pictorial review. Radiographics 29:759–774

    Article  PubMed  Google Scholar 

  25. Ito K, Matsumoto T, Nakada T, Nakanishi T, Fujita N, Yamashita H (1994) Assessing myometrial invasion by endometrial carcinoma with dynamic MRI. J Comput Assist Tomogr 18:77–86

    Article  PubMed  CAS  Google Scholar 

  26. Seki H, Kimura M, Sakai K (1997) Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted images. Clin Radiol 52:18–23

    Article  PubMed  CAS  Google Scholar 

  27. Takahashi S, Murakami T, Narumi Y et al (1998) Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging. Radiology 206:539–547

    PubMed  CAS  Google Scholar 

  28. Nakao Y, Yokoyama M, Hara K et al (2006) MR imaging in endometrial carcinoma as a diagnostic tool for the absence of myometrial invasion. Gynecol Oncol 102:343–347

    Article  PubMed  Google Scholar 

  29. Sala E, Crawford R, Senior E et al (2009) Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting advanced stage disease in patients with endometrial carcinoma. Int J Gynecol Cancer 19:141–146

    Article  PubMed  Google Scholar 

  30. Lin G, Ho KC, Wang JJ et al (2008) Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3 T. J Magn Reson Imaging 28:128–135

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Takayuki Enomoto

    Present address: Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan

Authors and Affiliations

  1. Department of Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Masatoshi Hori, Tonsok Kim, Hiromitsu Onishi, Atsushi Nakamoto & Noriyuki Tomiyama

  2. Department of Radiology, Kinki University School of Medicine, Osaka, Japan

    Izumi Imaoka, Yuki Kagawa & Takamichi Murakami

  3. Department of Radiology, Osaka University Hospital, Osaka, Japan

    Takashi Ueguchi & Mitsuaki Tatsumi

  4. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan

    Takayuki Enomoto & Tadashi Kimura

Authors
  1. Masatoshi Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tonsok Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiromitsu Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Izumi Imaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuki Kagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takamichi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Atsushi Nakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takashi Ueguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mitsuaki Tatsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takayuki Enomoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tadashi Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Noriyuki Tomiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masatoshi Hori.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hori, M., Kim, T., Onishi, H. et al. Endometrial cancer: preoperative staging using three-dimensional T2-weighted turbo spin-echo and diffusion-weighted MR imaging at 3.0 T: a prospective comparative study. Eur Radiol 23, 2296–2305 (2013). https://doi.org/10.1007/s00330-013-2815-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-013-2815-0

Keywords

Search

Navigation