MRI to assess deep myometrial invasion in patients with endometrial cancer:A multi-reader study to evaluate the diagnostic role of different sequences. Issue 138 (May 2021)

• Record Type: Journal Article
• Authors: Stanzione, Arnaldo; Maurea, Simone; Danzi, Roberta; Cuocolo, Renato; Galatola, Roberta; Romeo, Valeria; Raffone, Antonio; Travaglino, Antonio; Di Spiezio Sardo, Attilio; Insabato, Luigi; Pace, Leonardo; Scaglione, Mariano; Brunetti, Arturo; Mainenti, Pier Paolo
• Is Part Of: European journal of radiology. Issue 138(2021)
• Publication Date: 2021-05
• Subjects: DMI deep myometrial invasion -- DWI diffusion weighted imaging -- DCE dynamic contrast enhanced -- ICC Intraclass Correlation Coefficient -- EC endometrial cancer -- CI confidence intervals; Endometrial cancer -- MRI -- Deep myometrial invasion; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109629
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: DMI assessment using T2-w, DWI and DCE MRI sequences is crucial for EC staging. The performance of DWI, DCE and of the full protocol do not significantly differ. When T2-w and DWI are consistent, an unenhanced MRI protocol could be proposed. This strategy reduces costs, time and invasiveness but not diagnostic accuracy. Abstract: Objective: The identification of deep myometrial invasion (DMI) represents a fundamental aspect in patients with endometrial cancer (EC) for accurate disease staging. It can be detected on MRI using T2-weighted (T2-w), diffusion weighted (DWI) and dynamic contrast enhanced sequences (DCE). Aim of the study was to perform a multi-reader evaluation of such sequences to identify the most accurate and its reliability for the best protocol. Methods: In this multicenter retrospective study, MRI were independently evaluated by 4 radiologists (2 senior and 2 novice) with a sequence-based approach to identify DMI. The performance of the entire protocol was also evaluated. A comparison between the different sequences assessed by the same reader was performed using receiver operating curve and post-hoc analysis. Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-observer variability. Results: A total of 92 patients were included. The performance of the readers did not show significant differences among DWI, DCE and the entire protocol. For only one senior radiologist, who reached the highest diagnostic accuracy with the entire protocol (82, 6 %), both DWI ( p = 0, 0197) and entire protocol ( p = 0, 0039) were found significantly superior to T2-w. The highest inter-observer agreement was obtained with the entire protocol by expert readers (ICC = 0, 77). Conclusions: For the detection of DMI, the performances of DWI and DCE alone and that of a complete protocol do not significantly differ, even though the latter ensures the highest reliability particularly for expert readers. In cases in which T2-w and DWI are consistent, an unenhanced protocol could be proposed.