Perfusion and diffusion characteristics of endometrial malignancy based on intravoxel incoherent motion MRI at 3.0 T: comparison with normal endometrium

Abstract

Background

There has been a growing need for a non-invasive imaging method for the accurate diagnosis and differentiation of endometrial malignancy (EM).

Purpose

To study tissue characteristics of EM using an intravoxel incoherent motion (IVIM) model and to assess their diagnostic potential.

Material and Methods

Sixty-eight EMs and 31 healthy participants were prospectively recruited for diffusion-weighted (13 b-values, b = 0–3,000 s/mm²) and standard magnetic resonance imaging (MRI). A bi-exponential analysis was performed to derive f (perfusion fraction), D* (pseudodiffusion coefficient), and D (true diffusion coefficient) in EM and normal endometrium (NE). Apparent diffusion coefficient (ADC) was calculated. Student’s t test, the Mann–Whitney U test and a receiver operating characteristics (ROC) curve analysis were performed.

Results

EM had lower f (37.809 ± 12.158%) and was significantly different from NE (P < 0.001). However, the EMs had higher D (0.503 ± 0.155 × 10⁻³ mm²/s) and D* (19.796 ± 20.029 × 10⁻³ mm²/s) and were all significantly different from NE (P < 0.001). D was significantly lower than ADC in NE (P < 0.001) but not in EM (P > 0.05). f ≤ 48.5%, D > 0.432 × 10⁻³ mm²/s, D* > 4.94 × 10⁻³ mm²/s, and ADC ≤ 0.542 × 10⁻³ mm²/s could diagnose EM (AUC 0.786–0.961).

Conclusion

EM has distinctive IVIM perfusion and diffusion characteristics with promising potential for earlier non-invasive diagnosis.