Role of Diffusion Weighted Imaging and Contrast-Enhanced MRI in the Evaluation of Intrapelvic Recurrence of Gynecological Malignant Tumor |
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| Authors: | Kazuhiro Kitajima Utaru Tanaka Yoshiko Ueno Tetsuo Maeda Yuko Suenaga Satoru Takahashi Masashi Deguchi Yoshiya Miyahara Yasuhiko Ebina Hideto Yamada Masakatsu Tsurusaki Yukihisa Tamaki Kazuro Sugimura |
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| Affiliation: | 1. Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.; 2. Department of Obstetrics and Gynecology of Kobe University Graduate School of Medicine, Kobe, Japan.; 3. Department of Diagnostic Radiology, Kinki University School of Medicine, Osaka, Japan.; 4. Department of Radiation Oncology, Shimane University School of Medicine, Shimane, Japan.; University of Munich, GERMANY, |
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| Abstract: | ![]()
Background and PurposeTo investigate the diagnostic performance of diffusion-weighted imaging (DWI) and contrast-enhanced imaging in combination with T2-weighted imaging (T2WI) for magnetic resonance imaging (MRI) evaluation of intrapelvic recurrence of gynecological malignancies.Materials and MethodsSixty-two patients with suspected intrapelvic recurrence of gynecological malignancies underwent pelvic MRI including T2WI DWI, and contrast-enhanced imaging. Diagnostic performance for detection of local recurrence, pelvic lymph node and bone metastases, and peritoneal lesions was evaluated by consensus reading of two experienced radiologists using a 5-point scoring system, and compared among T2WI with unenhanced T1-weighted imaging (T1WI) (protocol A), a combination of protocol A and DWI (protocol B), and a combination of protocol B and contrast-enhanced imaging (protocol C). Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. Receiver operating characteristic (ROC) analysis and McNemar test were employed for statistical analysis.ResultsLocally recurrent disease, lymph node recurrence, peritoneal dissemination and bone metastases were present in 48.4%, 29.0%, 16.1%, and 6.5% of the patients, respectively. The patient-based sensitivity, specificity, accuracy, and area under the ROC curve (AUC) for detection of intrapelvic recurrence were 55.0, 81.8, 64.5% and 0.753 for protocol A, 80.0, 77.3, 79.0% and 0.838 for protocol B, and 80.0, 90.9, 83.9% and 0.862 for protocol C, respectively. The sensitivity, accuracy, and AUC were significantly better for protocols B and C than for protocol A (p<0.001). There was no significant difference between protocols B and C.ConclusionMRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies. |
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