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Role of diffusion weighted imaging and contrast-enhanced MRI in the evaluation of intrapelvic recurrence of gynecological malignant tumor.

Kitajima K, Tanaka U, Ueno Y, Maeda T, Suenaga Y, Takahashi S, Deguchi M, Miyahara Y, Ebina Y, Yamada H, Tsurusaki M, Tamaki Y, Sugimura K - PLoS ONE (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.

ABSTRACT

Background and purpose: To 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 methods: Sixty-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.

Results: Locally 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.

Conclusion: MRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies.

No MeSH data available.


Related in: MedlinePlus

A 65-year-old woman with intrapelvic lymph node recurrence 12 months after surgery for endometrial cancer.(a) Axial T2-weighted MRI shows a 9-mm left external iliac LN (arrow). This equivocal finding for lymph node recurrence was assigned a score of 3 for protocol A. (b) Axial DWI shows a focal hyperintense spot in the left external iliac area (arrow), corresponding to the node seen in (a), being suspicious for lymph node recurrence. The score assigned for protocol B was 4. (c) Axial contrast-enhanced MRI shows slight ring-like enhancement of the same node (arrow), suggesting lymph node recurrence. The score assigned for protocol C was 4. Follow-up MRI showed an increase in the size of this node, confirming lymph node recurrence.
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pone.0117411.g003: A 65-year-old woman with intrapelvic lymph node recurrence 12 months after surgery for endometrial cancer.(a) Axial T2-weighted MRI shows a 9-mm left external iliac LN (arrow). This equivocal finding for lymph node recurrence was assigned a score of 3 for protocol A. (b) Axial DWI shows a focal hyperintense spot in the left external iliac area (arrow), corresponding to the node seen in (a), being suspicious for lymph node recurrence. The score assigned for protocol B was 4. (c) Axial contrast-enhanced MRI shows slight ring-like enhancement of the same node (arrow), suggesting lymph node recurrence. The score assigned for protocol C was 4. Follow-up MRI showed an increase in the size of this node, confirming lymph node recurrence.

Mentions: Three representative cases are shown in Figs. 2–3.


Role of diffusion weighted imaging and contrast-enhanced MRI in the evaluation of intrapelvic recurrence of gynecological malignant tumor.

Kitajima K, Tanaka U, Ueno Y, Maeda T, Suenaga Y, Takahashi S, Deguchi M, Miyahara Y, Ebina Y, Yamada H, Tsurusaki M, Tamaki Y, Sugimura K - PLoS ONE (2015)

A 65-year-old woman with intrapelvic lymph node recurrence 12 months after surgery for endometrial cancer.(a) Axial T2-weighted MRI shows a 9-mm left external iliac LN (arrow). This equivocal finding for lymph node recurrence was assigned a score of 3 for protocol A. (b) Axial DWI shows a focal hyperintense spot in the left external iliac area (arrow), corresponding to the node seen in (a), being suspicious for lymph node recurrence. The score assigned for protocol B was 4. (c) Axial contrast-enhanced MRI shows slight ring-like enhancement of the same node (arrow), suggesting lymph node recurrence. The score assigned for protocol C was 4. Follow-up MRI showed an increase in the size of this node, confirming lymph node recurrence.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4309401&req=5

pone.0117411.g003: A 65-year-old woman with intrapelvic lymph node recurrence 12 months after surgery for endometrial cancer.(a) Axial T2-weighted MRI shows a 9-mm left external iliac LN (arrow). This equivocal finding for lymph node recurrence was assigned a score of 3 for protocol A. (b) Axial DWI shows a focal hyperintense spot in the left external iliac area (arrow), corresponding to the node seen in (a), being suspicious for lymph node recurrence. The score assigned for protocol B was 4. (c) Axial contrast-enhanced MRI shows slight ring-like enhancement of the same node (arrow), suggesting lymph node recurrence. The score assigned for protocol C was 4. Follow-up MRI showed an increase in the size of this node, confirming lymph node recurrence.
Mentions: Three representative cases are shown in Figs. 2–3.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology of Kobe University Graduate School of Medicine, Kobe, Japan.

ABSTRACT

Background and purpose: To 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 methods: Sixty-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.

Results: Locally 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.

Conclusion: MRI using a combination of DWI and T2WI gives comparatively acceptable results for assessment of intrapelvic recurrence of gynecological malignancies.

No MeSH data available.


Related in: MedlinePlus