Evaluation Of Cervical Stroma Invasion In Endometrial Cancers: Comparative Study Of Diffusion-weighted And Dynamic Contrast-enhanced MR Imaging

Objectives:To compare the diagnostic value of dynamic contrast enhanced?DCE?MR imaging and that of diffusion weighted?DW?magnetic resonance?MR?imaging when judging the existence of cervical stroma invasion?CSI?in the context of endometrial cancer?EC?and analysis the factors that influence the assesments of cervical stroma invasion in differential sequences.Method:Retrospective analysis of the pelvic MRI images 1 to 2 weeks before operation of patients diagnosed with endometrial cancer from February 2009 to February 2017 in the General Hospital of Tianjin Medical University.Two radiologists who are unknowed with the pathologic results made the staging and assessed the presence or absence of cervical stroma infiltration of endometrial cancer on DWI and DCE sequences combined with conventional T₂WI sequences,and factors or lesions affecting the determination of cervical stroma infiltration were analyzed and recorded.The determination and analysis results were recorded and compared with postoperative FIGO pathological staging and cervical stroma infiltration.Statistical analysis was used to calculate the sensitivity,specificity,and negative predictive value of the evaluation of cervical stroma infiltration.Consensus analysis of two physicians'judgments of cervical stroma infiltration using the Kappa test for statistical analysis?when 0.00?K<0.4,the agreement was considered poor,0.40?K?0.70 indicates good agreement,K>0.70 indicates very good agreement?,after which it is judged whether the difference between these two sequences has statistical significance.Lesions and factors affected the determination of cervical stroma infiltration for two radiologists,such as cervical mucocele,cervical dilatation,cervical fibroids with degeneration and involvement of the uterine isthmus were analysed by Fisher's exact probability method and when P<0.05 considered statistically significant.Result:Through calculations and analysis,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value for cervical stroma infiltration were 77.8%,94.2%,92.4%,61.8%,97.2%for DCE combined with T₂WI and 66.7%,93.3%,90.4%,54.5%,95.9%for DWI combined with T₂WI for radiologist 1;and were 85.2%?93.3%?92.4%?60.5%?98.1%for DCE combined with T₂WI and 81.5%?90.5%?89.6%?51.2%?97.6%for DWI combined with T₂WI for radiologist 2,respectively.The consistency analysis of the results of two radiologists'judgments of cervical stroma infiltration using the Kappa test for statistical analysis showed that the results of the two physicians in DCE combined with T₂WI and DWI combined with T₂WI to determine cervical stroma infiltration had a good observer consistence.Statistical analysis showed that the accuracy,sensitivity,and specificity of DCE combined with T₂WI sequence in determining cervical infiltrating of endometrial carcinoma were higher than that of DWI combined with T₂WI sequence.The difference between the two methods was statistically significant?p<0.05?.Cervical mucinous cysts,cervical dilatation,and cervical fibroids with degeneration had no statistically significant effect on determination of cervical infiltration for endometrial cancer in DCE combined with T₂WI and DWI combined with T₂WI?p?0.05?,while the uterine isthmus involvement is the main factor that affected DWI combined T₂WI to determine cervical stroma infiltration for endometrial cancer.Conclusion:MRI dynamic contrast enhanced imaging combined with conventional T₂WI sequences was superior to diffusion-weighted imaging in determining the cervical stroma invasion of endometrial carcinoma.The involvement of uterine isthmus is the main factor affecting the assessment of endometrial carcinoma cervical stroma infiltration by DWI combined with T₂WI.