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Dynamic contrast-enhanced MRI in endometrial carcinoma identifies patients at increased risk of recurrence

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Abstract

Objectives

To study the feasibility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for assessment of tumour microvasculature in endometrial carcinoma patients, and to explore correlations with histological subtype, clinical course and microstructural characteristics based on apparent diffusion coefficient (ADC) values.

Methods

Diffusion-weighted imaging (DWI) and three-dimensional DCE-MRI (1.5 T) with high temporal resolution (2.49 s) were acquired preoperatively in 55 patients. Quantitative modelling allowed the calculation of four independent parameters describing microvasculature: blood flow (Fb), extraction fraction (E), capillary transit time (Tc) and transfer constant from the extravascular extracellular space [EES] to blood (Kep); and four derived parameters: blood volume (Vb), volume of EES (Ve), capillary permeability surface area product (PS) and transfer from blood to EES (Ktrans).

Results

Endometrial carcinoma tissue exhibited reduced Fb, E, Vb, Ve, PS and Ktrans compared with normal myometrium. Non-endometrioid carcinomas (n = 12) had lower Fb, and E than endometrioid carcinomas (n = 43; P < 0.05). Tumour Ve positively correlated with tumour ADC value (r = 0.29, P = 0.03). Reduced survival was observed in patients with low tumour Fb and high tumour Tc (P < 0.05).

Conclusions

We demonstrate the feasibility of DCE-MRI in reflecting histological subtype and clinical course in primary endometrial carcinomas. DCE-MRI may potentially provide future biomarkers for preoperative risk stratification in endometrial carcinomas.

Key Points

• Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) offers new information about endometrial carcinoma.

• Pelvic DCE-MRI with subsequent quantitative modelling seems feasible in endometrial carcinoma patients.

• Low tumour perfusion is a feature of a more aggressive tumour subtype.

• DCE-MRI provides potential biomarkers for preoperative risk stratification in endometrial carcinoma patients.

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Abbreviations

E:

extraction fraction

EES:

extravascular extracellular space

Fb:

blood flow

Kep:

transfer constant from EES to blood

Ktrans:

transfer from blood to EES

PS:

capillary permeability surface area product

Tc:

intravascular/capillary transit time

Vb:

blood volume

Ve:

fractional volume of EES

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Acknowledgments

This work was supported by The Western Norway Regional Health Authority, Research Funds at the Department of Radiology, Haukeland University Hospital, MedViz, Norwegian Research Council, The University of Bergen, The Meltzer Foundation, and The Norwegian Cancer Society (The Harald Andersen’s legacy).

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Authors and Affiliations

  1. Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway

    Ingfrid S. Haldorsen, Renate Grüner, Jenny A. Husby, Inger J. Magnussen & Torfinn Taxt

  2. Section for Radiology, Centre for Cancer Biomarkers, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway

    Ingfrid S. Haldorsen & Jenny A. Husby

  3. Department of Physics and Technology, University of Bergen, 5020, Bergen, Norway

    Renate Grüner

  4. Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021, Bergen, Norway

    Henrica M. J. Werner, Line Bjørge, Jone Trovik & Helga B. Salvesen

  5. Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway

    Henrica M. J. Werner, Line Bjørge, Jone Trovik & Helga B. Salvesen

  6. Unit for applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway

    Øyvind O. Salvesen

  7. Centre for Cancer Biomarkers, The Gade Institute, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway

    Ingunn Stefansson & Lars A. Akslen

  8. Department of Pathology, Haukeland University Hospital, 5021, Bergen, Norway

    Ingunn Stefansson & Lars A. Akslen

  9. Department of Biomedicine, University of Bergen, 5020, Bergen, Norway

    Torfinn Taxt

Authors
  1. Ingfrid S. Haldorsen
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  2. Renate Grüner
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  3. Jenny A. Husby
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  4. Inger J. Magnussen
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  5. Henrica M. J. Werner
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  6. Øyvind O. Salvesen
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  7. Line Bjørge
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  8. Ingunn Stefansson
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  9. Lars A. Akslen
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  10. Jone Trovik
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  11. Torfinn Taxt
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  12. Helga B. Salvesen
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Corresponding author

Correspondence to Ingfrid S. Haldorsen.

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Haldorsen, I.S., Grüner, R., Husby, J.A. et al. Dynamic contrast-enhanced MRI in endometrial carcinoma identifies patients at increased risk of recurrence. Eur Radiol 23, 2916–2925 (2013). https://doi.org/10.1007/s00330-013-2901-3

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  • DOI: https://doi.org/10.1007/s00330-013-2901-3

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