Contrast-enhanced MRI in women with endometrial cancer: dynamic versus single-phase acquisitions
Contrast-enhanced MRI in women with endometrial cancer: dynamic versus single-phase acquisitions
Chang Kyu Sung, M.D (Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.), Min Hoan Moon, M.D (Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.)
The 2019 ESUR guidelines for endometrial cancer recommend performing either dynamic contrast-enhanced MRI (CE MRI) or single-phase CE MRI. However, no study has directly compared these options. Therefore, this study compared dynamic versus single-phase CE MRI for the evaluation of myometrial invasion in women with endometrial cancer.
This retrospective, single-institution comparative study was conducted among women with surgically proven endometrial cancer, including 30 consecutive women with single-phase CE MRI and 30 age- and pathologic stage-matched women with dynamic CE MRI. Three readers independently compared dynamic and single-phase CE MRI in terms of the tumor-myometrium signal intensity (SI) difference ratio, depth of myometrial invasion, image quality, and image number. Pathologic findings served as a reference standard for the depth of myometrial invasion.
The estimated mean SI difference ratios of dynamic CE MRI and single-phase CE MRI fell within an equivalence margin of 0.05 (90% confidence intervals; -0.0497 to 0.0165, -0.0226 to 0.0403, -0.0429 to 0.0433, respectively, for readers A, B, and C). The area under the receiver operating characteristic curve for the detection of deep myometrial invasion was not significantly different between the acquisitions (P=0.3315, P=0.3345, and P=0.8593, respectively). Single-phase CE MRI showed significantly better image quality than dynamic CE MRI (P=0.0143, P=0.0042, and P=0.0066, respectively), while the median number of images for dynamic CE MRI was 2.4 times higher than that for single-phase CE MRI.
Plots of the two one-sided test results showing the absolute differences in the tumor-myometrium signal intensity difference ratios between single-phase CE MRI and dynamic CE MRI. The mean differences (squares) and their 90% CIs (horizontal lines) are within the equivalence margin of 0.05 (vertical dashed lines) for all readers.
Single-phase acquisition may be a better option for CE MRI in women with endometrial cancer than dynamic acquisition.
